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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 Washoe County. 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 $2400.00 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. In the initial coverage phase, you'll pay a copay ranging from $12 to $100 for generic and brand-name drugs at standard pharmacies, with some drugs having a 33% coinsurance. The specialty tier drugs have no copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. If you qualify for the low-income subsidy, your Part D costs will be $0.
Additional Benefits
The Prominence Plus (HMO) plan provides coverage for a wide range of healthcare services. Inpatient hospital stays have copays depending on the type of stay and the length of stay. Outpatient services, including primary care, specialist visits, and mental health, have varying copays, while emergency services and urgent care have copays as well. The plan also includes coverage for preventive services, hearing, vision, and dental care, offering benefits like hearing exams, eyewear, and dental services with annual maximums. Additional benefits include ambulance and transportation services, home health, and medical equipment, with specific copays or coinsurance amounts. The plan also offers an OTC benefit, and covers skilled nursing facility services with copays for a limited number of days.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Prominence Plus (HMO) plan. For Inpatient Hospital-Acute, you will pay a $50 copay for days 1-5, and no copay for days 6-90; Inpatient Hospital Psychiatric has a $330 copay for days 1-5, and no copay for days 6-60. Additional Days for Inpatient Hospital-Acute are covered for 5 additional days, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $25 and $160, Observation Services with a $100 copay, Ambulatory Surgical Center (ASC) Services with a $25 copay, Outpatient Substance Abuse Services with a $10 copay for both Individual and Group Sessions, and Outpatient Blood Services with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered under 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 have a $300 copay, and transportation services to a plan-approved health-related location are covered for 24 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Prominence Plus (HMO) plan. Emergency Services have a $140 copay, and Urgently Needed Services have a $10 copay, while Worldwide Emergency Coverage has a $125 copay; all have no coinsurance. 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 services with a $5 copay, and physician specialist services with a $25-$35 copay. Mental health specialty services, podiatry services with a $10-$25 copay, other health care professional services with a $0-$35 copay, psychiatric services, physical therapy, speech-language pathology services with a $10 copay, additional telehealth benefits, and opioid treatment program services with a $10 copay are also covered.
Preventive Services See details
The Prominence Plus (HMO) plan covers preventive services including Medicare-covered preventive services, annual physical exams, and additional preventive services, though some services like health education and home and bathroom safety devices are not covered. The plan also includes coverage for in-home safety assessments, fitness benefits, telemonitoring services, remote access technologies, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit.
Hearing Services See details
The Prominence Plus (HMO) plan covers hearing exams with a $10 copay, 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. OTC hearing aids are not covered, and the plan does not cover Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear.
Vision Services See details
The Prominence Plus (HMO) plan covers vision services including eye exams with a $30 copay, and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum plan benefit coverage of $200 every year.
Dental Services See details
The Prominence Plus (HMO) plan offers dental services with a maximum benefit of $2,000 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatments are covered with limitations on the number of visits per year, while restorative services, endodontics, and prosthodontics have varying copays, and oral and maxillofacial surgery has a copay of $50-$100. Maxillofacial prosthetics and orthodontics are not covered, and implant services are offered as an optional supplemental benefit.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Prominence Plus (HMO) plan. For Medicare Part B insulin drugs, there is a $35 copay and 0-20% coinsurance; other Medicare Part B drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Prominence Plus (HMO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Equipment is covered, but Diabetic Supplies are not covered, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Prominence Plus (HMO) plan. Diagnostic services do not have a copay, but Diagnostic Procedures/Tests and Lab Services are not covered. Diagnostic Radiological Services have a copay of $20 to $60, and Therapeutic Radiological Services have a coinsurance of 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. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the sub-services of 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. Prior authorization is required, and copay information is available, but not specified in the provided information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Prominence Plus (HMO) plan, but require prior authorization. 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 covers Over-the-Counter (OTC) items with a maximum benefit of $110.00 every three months, and also offers a meal benefit for a chronic illness that requires prior authorization. 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 are not covered.
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