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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 2026, 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 4.5 out of 5 stars in 2026.
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 a $275.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
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) Medicare plan has an annual drug deductible of $275. For prescription drug coverage, beneficiaries pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs at standard pharmacies and through standard 3-month mail orders. Tier 2 generic drugs are available at standard pharmacies with a $12 copay for a 1-month supply and a $24 copay for a 2-month or 3-month supply. Higher-tier medications under this plan require copayments or coinsurance. Tier 3 preferred brand drugs cost a $45 copay for a 1-month supply, while Tier 4 non-preferred drugs cost a $100 copay for a 1-month supply at standard pharmacies. Tier 5 specialty drugs require a 29% coinsurance for a 1-month supply at standard pharmacies.
Additional Benefits
The Prominence Plus (HMO) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, telehealth services, annual physicals, and home health care. For more urgent medical needs, emergency room visits carry a $150 copay, while inpatient hospital stays require a $100 daily copay for the first six days with no copay for additional days. Outpatient hospital services and specialist consultations are also highly accessible, requiring only set copays and no coinsurance. In addition to core medical care, this plan provides robust supplemental benefits including preventive dental care and eyewear with no copay, alongside a $200 annual allowance for glasses or contacts. Members also benefit from twenty-four free one-way transportation trips per year and an $82 quarterly over-the-counter item allowance with no copays. Routine hearing exams are available for a low $10 copay, and the plan helps cover prescription hearing aids up to a $600 annual limit per ear.
Inpatient Hospital See details
Prominence Plus (HMO) covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute care, you pay a $100 daily copay for days 1-6 and no copay for days 7-90, while psychiatric care requires a $330 daily copay for days 1-5 and no copay for days 6-90. Non-Medicare-covered stays and hospital upgrades are not covered.
Outpatient Services See details
Outpatient services under Prominence Plus (HMO) are covered with no coinsurance, featuring outpatient hospital copays ranging from $25 to $350 and observation services at a $100 copay per stay. Ambulatory surgical center services require a $25 copay, outpatient substance abuse sessions have a $10 copay, and outpatient blood services are covered with no copay or deductible.
Partial Hospitalization See details
Prominence Plus (HMO) covers partial hospitalization services with a $55 copay and no coinsurance. Prior authorization may be required for some of these covered services.
Ambulance and Transportation Services See details
Prominence Plus (HMO) covers ground and air ambulance services with a $300 copay and no coinsurance, which is waived if you are admitted to the hospital. The plan also covers up to 24 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Prominence Plus (HMO) covers emergency services with a $150 copay and urgently needed services with a $30 copay, with no coinsurance for either service and copays waived if admitted to the hospital within three days. Worldwide emergency and urgent services are also covered up to a $25,000 maximum with no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Prominence Plus (HMO) offers primary care and telehealth services with no copay and no coinsurance, while specialist, mental health, and therapy services require copays ranging from $0 to $50 with no coinsurance. Chiropractic services are partially covered, with routine care covered at a $20 copay and other chiropractic services not covered.
Preventive Services See details
Preventive services are covered by Prominence Plus (HMO) with no copay and no coinsurance for annual physical exams, kidney education, and other preventive screenings. Additional preventive services are partially covered with no copay and no coinsurance (prior authorization required), but do not cover health education, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, home and bathroom safety devices, and counseling.
Hearing Services See details
Prominence Plus (HMO) provides partially covered hearing services, including one routine hearing exam and fitting evaluation per year for a $10 copay and no coinsurance. Prescription hearing aids are covered with no coinsurance and copays ranging from no copay up to $1,725 (up to a $600 maximum coverage limit per ear annually), but OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Prominence Plus (HMO) partially covers vision services, offering one routine eye exam per year with a $30 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing a $200 annual maximum allowance for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Prominence Plus (HMO) partially covers dental services up to a $2,000 annual maximum, offering preventive care with no copay and no coinsurance. Covered comprehensive services require no copay and 10% to 50% coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Prominence Plus (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs, including insulin, are covered with a 0% to 20% coinsurance, with insulin also carrying a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the Prominence Plus (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Prominence Plus (HMO) partially covers medical equipment with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, though diabetic supplies themselves are not covered. Prior authorization is required for these covered medical equipment benefits.
Diagnostic and Radiological Services See details
Prominence Plus (HMO) partially covers diagnostic and radiological services, requiring prior authorization for covered benefits. Diagnostic services feature no copay and no coinsurance, although diagnostic procedures, tests, and lab services are not covered. Covered radiological services require a minimum $20.00 copay and no coinsurance for diagnostic radiology, and a copay and 20% coinsurance for therapeutic radiology, while outpatient X-ray services are not covered.
Home Health Services See details
Home health services are covered by Prominence Plus (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Prominence Plus (HMO) provides Cardiac Rehabilitation Services where some services are covered with no coinsurance and a $5 copay, though prior authorization is required. However, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Prominence Plus (HMO) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. For Medicare-covered days, there is a $20 daily copayment for days 1 through 20 and a $218 daily copayment for days 21 through 100, though additional days beyond the standard 100-day benefit are not covered.
Other Services See details
Prominence Plus (HMO) partially covers other services, offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance, while acupuncture is not covered. The OTC benefit provides up to $82 every three months via reimbursement, and the meal benefit requires prior authorization.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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