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Prominence Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Prominence Plus (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Prominence Plus (HMO) in 2025, please refer to our full plan details page.
Prominence Plus (HMO) is a HMO plan offered by Universal Health Services, Inc. available for enrollment in 2025 to people living in Northern Nevada. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Prominence Plus (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Prominence Plus (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Prominence Plus (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3400.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Prominence Plus (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions depending on the drug tier and pharmacy you use. For example, you may pay a $12 copay for a preferred generic drug at a standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Prominence Plus (HMO) plan offers a range of benefits, including inpatient and outpatient hospital services with varying copays. It also covers primary care, preventive, hearing, vision, and dental services. For hearing, this includes exams and hearing aids up to $600 per year, while vision includes eye exams and eyewear up to $200 annually. Dental services have a $2,000 annual maximum. Additional benefits include ambulance and transportation services, emergency services, and home health services with no copay. The plan also covers medical equipment with 20% coinsurance, and skilled nursing facility services with copays. However, it's important to note that some services such as cardiac rehabilitation and certain other services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $50 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you will pay a $330 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital Psychiatric are not covered, nor are Non-Medicare-covered Stays or Upgrades for Inpatient Hospital-Acute.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered by the Prominence Plus (HMO) plan. Outpatient Hospital Services have a copay between $25 and $350, Observation Services have a $100 copay, and Ambulatory Surgical Center Services have a $25 copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $10.
Partial Hospitalization See details
Partial Hospitalization is covered by the Prominence Plus (HMO) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground and Air Ambulance Services each have a $300 copay, which is waived if admitted to the hospital. Transportation Services to a plan-approved health-related location are covered for 24 one-way trips per year, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Prominence Plus (HMO) plan. Emergency Services have a $140 copay, Urgently Needed Services have a $30 copay, and Worldwide Emergency Coverage has a $125 copay. Worldwide Urgent Coverage has a $30 copay, and Worldwide Emergency Transportation is not covered.
Primary Care See details
The Prominence Plus (HMO) plan covers primary care physician services, chiropractic services with a $10 copay, occupational therapy, physician specialist services with a $25-$35 copay, mental health specialty services with a $10 copay for individual and group sessions, podiatry services with a $20 copay, other health care professional services with a $0-$35 copay, psychiatric services with a $10 copay for individual and group sessions, physical therapy and speech-language pathology services with a $10 copay, additional telehealth benefits, and opioid treatment program services with a $10 copay. Chiropractic and podiatry services require prior authorization.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, annual physical exams, and additional services. Additional preventive services are covered, but require prior authorization, while health education, personal emergency response systems, medical nutrition therapy, post discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home and bathroom safety devices and modifications, counseling services, and support for caregivers of enrollees are not covered. Fitness benefit, telemonitoring services, remote access technologies and additional sessions of smoking and tobacco cessation counseling are covered, while enhanced disease management is not. Kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visit are also covered.
Hearing Services See details
The Prominence Plus (HMO) plan covers hearing exams with a $10 copay. The plan also covers fitting/evaluation for hearing aids and prescription hearing aids, with a maximum benefit of $600 per year. Prescription hearing aids (all types) have a copay between $0 and $1725, but prescription hearing aids for inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a $30 copay, and coverage for eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum benefit of $200 every year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are limited to one pair per year.
Dental Services See details
The Prominence Plus (HMO) plan provides dental services with a $2,000 annual maximum. Covered services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services with a $50-$100 copay, adjunctive general services with a $0-$50 copay, endodontics with a $100 copay, periodontics with a $0-$100 copay, prosthodontics (removable) with a $50-$100 copay, implant services, prosthodontics (fixed) with a $50-$100 copay, and oral and maxillofacial surgery with a $50-$100 copay. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Prominence Plus (HMO) plan. You will pay 20% coinsurance for these services, and prior authorization is required.
Medical Equipment See details
Medical Equipment is covered under the Prominence Plus (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, with no copay, and requires authorization. Prosthetic Devices have a 20% coinsurance and no copay. Medical supplies have a 20% coinsurance, and no copay. Diabetic Supplies are not covered, but Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Prominence Plus (HMO), but Diagnostic Procedures/Tests, Lab Services, and Outpatient X-Ray Services are not covered. Diagnostic Radiological Services have a copay of at most $60, while Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Prominence Plus (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Prominence Plus (HMO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Prominence Plus (HMO) plan. For days 1-20, the copay is $20, and for days 21-100, the copay is $214; additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Prominence Plus (HMO) plan does not cover acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services. Over-the-counter (OTC) items are covered with a maximum benefit of $75 every three months, and the plan offers nicotine replacement therapy. Meal benefits are covered, but require prior authorization.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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