What Ultimate Health Plans does

Ultimate Health Plans is a Florida-based Medicare Advantage Health Maintenance Organization (HMO) headquartered in Spring Hill, Florida, founded in 2011 and operating as a private, for-profit entity. The company holds a Medicare contract as an HMO and a separate Florida State Medicaid program contract to offer Dual Special Needs Plans (D-SNP), and is accredited by the National Committee for Quality Assurance (NCQA). It serves Medicare-eligible beneficiaries across 16 Florida counties organized into 5 regions, spanning major markets including the Tampa Bay area (Hillsborough, Pinellas, Pasco, Hernando, Polk), Orlando metro (Orange, Osceola, Seminole), Sarasota/Bradenton (Manatee, Sarasota), the Space Coast (Brevard-adjacent Indian River, St. Lucie), and the Ocala/the Villages corridor (Lake, Marion, Sumter), with Citrus County rounding out the western reach.

The product portfolio is segmented into three plan families. The core Premier by Ultimate (HMO) and Premier Plus (HMO) plans offer standard Medicare Advantage coverage with integrated Part D prescription drug benefits and supplemental benefits including a Part B premium refund, vision coverage up to $500 per year for eyewear, up to $730 combined dental/vision/hearing allowance, monthly OTC allowances, dental coverage (crowns, dentures, fillings, extractions, root canals), and healthy food and utility allowances. The Advantage Care (HMO C-SNP) and Advantage Care COPD (HMO C-SNP) Chronic Special Needs Plans target members with diabetes, cardiovascular disease, chronic lung disorders, and heart failure, offering condition-specific care management and Special Supplemental Benefits for the Chronically Ill. The Advantage Plus Full and Partial D-SNPs serve dual-eligible members coordinating Medicare and Florida Medicaid benefits. Underlying service modules include Complex Case Management, Disease Management Programs, Utilization Management (using InterQual evidence-based clinical criteria), and a Medication Therapy Management Program administered through OptumRx.

Ultimate Health Plans operates a sales-led go-to-market motion reaching members through licensed insurance agents, direct phone enrollment, in-person community seminars, dedicated C-SNP and D-SNP phone lines, and online enrollment via the CMS Medicare website. Distribution is supported by physical community outreach offices in Hernando, Marion, and St. Lucie counties plus dedicated phone lines for the Hillsborough/Pinellas/Polk, Manatee/Sarasota, and Orange/Osceola/Seminole service clusters. The company relies on a deep vendor ecosystem for non-core functions: OptumRx for pharmacy benefit management, Premier Eye Care for vision, Nations Benefits for hearing, Optum Behavioral Care for behavioral health, FCL Dental for dental, LabCorp for laboratory services, Calypso and QAPrima for provider portals, and Availity for EDI claims submission. Revenue is generated primarily through capitation payments from CMS for Medicare-covered benefits, with member-paid monthly premiums (including $0 premium options for Extra Help recipients) and Florida Medicaid capitation for D-SNP members as secondary revenue streams.

Name

Ultimate Health Plans

Legal name

Ultimate Health Plans, Inc.

Website

https://chooseultimate.com

Company type

Private

Founded year

2011

Operating status

Operating

Headcount range

1–10 employees

Short description

Ultimate Health Plans is a Florida-based Medicare Advantage HMO serving beneficiaries across 16 counties. It offers standard HMO plans, Chronic Special Needs Plans (C-SNP), and Dual Special Needs Plans (D-SNP) with integrated Part D, supplemental benefits, and condition-specific care management.

Ownership category

akta.pro rank

Headquarters

HQ city

Spring Hill

HQ country

United States

HQ region

North America

Offices10 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

Personnel, Operations, Marketing or Sales, Technology or R&D, Infrastructure

Revenue model

1. Medicare Advantage Plan Premiums: Ultimate Health Plans operates as an HMO with a Medicare contract. The company generates revenue through Medicare Advantage plan premiums, with members paying monthly premiums (some plans with $0 premium for Extra Help recipients) and the company receiving capitated payments from CMS for providing Medicare-covered benefits
2. State Medicaid Program Contract: Contracted with the Florida State Medicaid program for Dual Special Needs Plans (D-SNP), providing coverage for dual-eligible beneficiaries who qualify for both Medicare and Medicaid

Pricing tiers

Go-to-market motion1 record

Distribution channels5 records

Marketing channels6 records

Core offering

Ultimate Health Plans is a local Florida-based Medicare Advantage HMO that offers health plan products combining medical coverage, prescription drug benefits, and supplemental benefits (dental, vision, hearing, OTC, transportation) for Medicare-eligible beneficiaries across 16 Florida counties. The company also offers Chronic Special Needs Plans (C-SNPs) for members with diabetes, cardiovascular disease, COPD, and heart failure, as well as Dual Special Needs Plans (D-SNPs) coordinating Medicare and Florida Medicaid benefits.

Product overview

Ultimate Health Plans operates as a Medicare Advantage HMO with a portfolio of plan products and integrated service modules. The core offerings include Premier by Ultimate (HMO) and Premier Plus (HMO) for standard Medicare beneficiaries, alongside two specialized Chronic Special Needs Plans (Advantage Care C-SNPs for diabetes, cardiovascular disease, COPD, and heart failure) and two Dual Special Needs Plans (Advantage Plus D-SNPs for members with Medicare and Medicaid). These plans are supported by integrated service modules including Complex Case Management, Disease Management Programs, Utilization Management, and a Medication Therapy Management Program administered through OptumRx. Supplemental benefits include OTC allowances, grocery benefits, dental, vision, and hearing coverage. All plans are offered exclusively in Florida across 16 counties in the state.

Differentiator

Problem solved

Functional benefit

Products and services

• Premier by Ultimate (HMO) Standard Medicare Advantage HMO plan offering comprehensive medical coverage, prescription drug benefits, and supplemental benefits including dental, vision, hearing, and OTC allowances for Medicare beneficiaries in 16 Florida counties.
• Premier Plus (HMO) Enhanced Medicare Advantage HMO plan with additional supplemental benefits beyond the standard Premier plan, offered to Medicare-eligible individuals in 16 Florida counties.
• Advantage Care by Ultimate (HMO C-SNP) Chronic Special Needs Plan for Medicare beneficiaries diagnosed with diabetes, cardiovascular disease, chronic lung disorder, or heart failure, providing specialized care management and condition-specific supplemental benefits.
• Advantage Care COPD by Ultimate (HMO C-SNP) Specialized chronic special needs plan specifically designed for Medicare beneficiaries with Chronic Obstructive Pulmonary Disease (COPD), offering tailored care management and supplemental benefits.
• Advantage Plus by Ultimate (Full) (HMO D-SNP) Dual Special Needs Plan for members who qualify for both Medicare and full Florida Medicaid benefits, providing coordinated coverage and care management across both programs.
• Advantage Plus by Ultimate (Partial) (HMO D-SNP) Dual Special Needs Plan for members receiving Medicare and partial Florida Medicaid benefits, providing coordinated care management and supplemental benefits.

Quantifiable outcome

• Prior authorization approval rate of 97.10% for standard requests
• +3 more outcomes

Named customers3 records

Segments3 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration11 records

Feature4 records

Partnerships

Twelve partnerships are on record, tiered core and supporting.

• OptumRxcoreTechnology or IntegrationPharmacy Benefit Manager (PBM) responsible for pharmacy benefit operations, formulary management, mail order pharmacy, prescription claims processing, and Medicare Prescription Payment Plan administration. Members receive bills from OptumRx on behalf of Ultimate Health Plans.
• Premier Eye CarecoreTechnology or IntegrationVision provider network partner for routine and medical eye care services; provides provider directory for vision providers within the Ultimate Health Plans network
• Nations BenefitscoreTechnology or IntegrationHearing provider network partner for hearing aid services and hearing care; members access Nations Benefits network for hearing provider search
• Optum Behavioral CarecoreTechnology or IntegrationBehavioral health services partner for mental health and substance abuse treatment; provides access to behavioral health provider network
• FCL DentalcoreTechnology or IntegrationDental services partner for dental coverage including crowns, dentures, fillings, extractions, and root canals; processes dental claims at 101 Parklane Blvd, Suite 301, Sugar Land, TX 77478
• LabCorpcoreTechnology or IntegrationLaboratory services provider for diagnostic lab testing; integrated into provider network for lab location searches
• InterQual (Access Management Co., LLC)coreTechnology or IntegrationClinical criteria provider for utilization management decisions; provides evidence-based review criteria including Acute Adult/Pediatric Criteria, Procedures Criteria, and specialty subsets
• American Specialty Health Group, Inc.supportingTechnology or IntegrationAcupuncture and chiropractic services claims processor; handles claims submissions for alternative therapy services
• Change Healthcare (Optum subsidiary)supportingTechnology or IntegrationHealthcare technology company that experienced cybersecurity incident in February 2024; Ultimate Health Plans expanded relationship with Availity for EDI claims submission following the incident
• AvailitycoreTechnology or IntegrationHealth information network for EDI claims submission; expanded partnership following Change Healthcare cybersecurity incident to ensure continued claims processing
• CalypsocoreTechnology or IntegrationProvider portal for authorization and eligibility management; enables providers to submit and track authorization requests online
• QAPrimacoreTechnology or IntegrationHEDIS quality measure portal for healthcare quality measurement and reporting; supports providers in tracking and reporting quality metrics

Scale indicators4 records

Recent moves6 records

Expansion highlights5 records

Broad incumbents

• CVS Health / Aetna: National MA carrier with growing Florida presence, including D-SNP and C-SNP plans. Comparable product mix and use of vertical pharmacy (CVS Caremark) for PBM services.
• UnitedHealthcare (AARP): Largest US health insurer and the dominant MA carrier nationally, with major Florida membership. Competes head-to-head with Ultimate in HMO, D-SNP, and C-SNP product categories.
• Humana: Largest Medicare Advantage-focused national carrier with deep Florida penetration. Directly comparable as a Medicare Advantage HMO/PPO operator with extensive C-SNP/D-SNP offerings and an established Florida provider network.
• Cigna Healthcare: National MA carrier with Florida HMO and D-SNP plans. Comparable in offering supplemental benefits and special needs plans for chronic and dual-eligible populations.
• Centene / WellCare: National government-program-focused insurer with deep D-SNP and Medicaid presence in Florida. Comparable in D-SNP product design and dependence on Florida Medicaid contract relationships.

Emerging players

• Devoted Health: Tech-enabled Medicare Advantage plan with HMO and D-SNP products. Comparable as a smaller, growth-oriented MA carrier competing on member experience and supplemental benefits, with a Florida expansion trajectory.
• Clover Health: Medicare Advantage carrier using technology and provider engagement to manage chronic populations. Comparable as a smaller MA-focused carrier navigating CMS payment pressure and competing on supplemental benefits.
• Alignment Healthcare: Technology-forward Medicare Advantage HMO with strong C-SNP orientation. Comparable in emphasizing chronic condition management, supplemental benefits, and senior-focused member experience in select geographies.

Direct peers

• Prominence Health Plan: Regional Medicare Advantage HMO operating in select Florida and Nevada counties. Directly comparable as a sub-scale regional MA plan competing against national carriers with HMO and SNP products.
• Florida Blue (Blue Cross and Blue Shield of Florida): Florida-headquartered nonprofit Blue plan offering Medicare Advantage HMO and PPO products across the same counties Ultimate serves. The most direct regional peer given shared Florida-only footprint.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat4 records

Key risks5 records

Key highlights5 records

Customer concentration

• Facebookfacebook.com/UltHP
• LinkedInlinkedin.com/company/ultimate-health-plans-inc

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Funding overview

Funding rounds2 records

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Ultimate Health Plans