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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 Washoe County. 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 $100.00 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 $2200.00 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 features a low annual drug deductible of $100. Enrollees enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs at standard pharmacies and through standard three-month mail orders. For Tier 2 generic medications, standard pharmacy copays are $12 for a one-month supply and $24 for a three-month supply. Tier 3 preferred brand drugs have a $45 copay for a one-month standard pharmacy supply, while Tier 4 non-preferred drugs require a $100 copay. Specialty medications in Tier 5 incur a 31% coinsurance for a one-month supply at standard pharmacies. Standard three-month mail order options are also available, costing $90 for Tier 3 and $300 for Tier 4 drugs.
Additional Benefits
The Prominence Plus (HMO) Medicare plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care, telehealth, and preventive services, while specialist visits require copays up to $40. For hospital care, inpatient stays carry a $100 daily copay for days one through five with no copay for additional days, while emergency room care has a $150 copay. Outpatient hospital services, diagnostics, and home health care are also covered, typically with no coinsurance and low-to-no copays. Beyond standard medical care, this plan provides valuable supplemental benefits including dental coverage up to a $2,000 annual limit with no copay for preventive services and 10% to 50% coinsurance for comprehensive care. Members also receive vision coverage with no copay for eyewear up to a $200 annual maximum, routine hearing exams for a $10 copay, and a $125 quarterly allowance for over-the-counter items. Additionally, the plan covers up to 96 one-way transportation trips with no copay, while durable medical equipment and dialysis require no copay and a 20% coinsurance.
Inpatient Hospital See details
Prominence Plus (HMO) covers inpatient acute hospital stays with no coinsurance, a $100 daily copay for days 1 to 5, and no copay for additional unlimited days. Inpatient psychiatric care is also covered with no coinsurance, a $330 daily copay for days 1 to 5, and no copay for days 6 to 90, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Prominence Plus (HMO) covers outpatient services with no coinsurance, featuring a $25 to $160 copay for outpatient hospital services, a $100 copay per stay for observation services, and a $25 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $10 copay with no coinsurance, while outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Prominence Plus (HMO) plan with a $55.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Prominence Plus (HMO) covers ground and air ambulance services with a $200 copay and no coinsurance, with the copay waived if you are admitted to the hospital. Transportation services are partially covered with no copay and no coinsurance for up to 96 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Prominence Plus (HMO) covers emergency services with a $150 copay and no coinsurance, and urgently needed services with a $10 copay and no coinsurance. Worldwide emergency services are partially covered up to a $25,000 maximum, with a $150 copay for emergency care and a $30 copay for urgent care (both with no coinsurance), though worldwide emergency transportation is not covered.
Primary Care See details
Prominence Plus (HMO) offers primary care physician and telehealth services with no copay and no coinsurance. Other covered professional services—such as specialists, mental health, physical therapy, and podiatry—require no coinsurance and feature copays ranging from $0 to $40, though chiropractic benefits are only partially covered.
Preventive Services See details
Preventive services are partially covered by Prominence Plus (HMO) with no copay and no coinsurance for covered benefits, which include annual physical exams, kidney disease education, and memory fitness. However, sub-services such as health education, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management programs, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation counseling, enhanced disease management, home and bathroom safety devices, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered under Prominence Plus (HMO), featuring a $10 copay and no coinsurance for an annual routine exam, along with one annual fitting evaluation. Prescription hearing aids are covered up to $600 per ear yearly with no coinsurance and copays ranging from no copay to $1,725, though OTC, inner ear, outer ear, and over-the-ear 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 $25 copay and no coinsurance, while other eye exam services are not covered. Covered eyewear has no copay and no coinsurance, providing up to a $200 combined annual maximum for contacts, eyeglass lenses, and frames.
Dental Services See details
Dental services are partially covered by Prominence Plus (HMO) up to a $2,000 annual maximum, featuring no copay and no coinsurance for preventive care, and no copay with 10% to 50% coinsurance for comprehensive procedures. Implant services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Prominence Plus (HMO) covers Home Infusion bundled Services with no copay, although prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and require no coinsurance to 20% coinsurance, while Part B insulin carries a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Prominence Plus (HMO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Prominence Plus (HMO) partially covers medical equipment with no copay and a 20% coinsurance for durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes, though diabetic supplies are not covered. Prior authorization is required for these covered medical equipment benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services under Prominence Plus (HMO) are partially covered and require prior authorization, featuring no copay or coinsurance for covered diagnostic services. Covered diagnostic radiological services require a minimum $20.00 copay and no coinsurance, while therapeutic radiological services require a copay and a minimum 20% coinsurance. Diagnostic procedures/tests, lab services, and outpatient X-ray services are not covered.
Home Health Services See details
Prominence Plus (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under Prominence Plus (HMO) require prior authorization and feature no copay and no coinsurance. While some services are covered, specific sub-services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Prominence Plus (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day hospital stay is not necessary, additional days beyond Medicare coverage are not covered.
Other Services See details
Other Services are partially covered by Prominence Plus (HMO), featuring no copay and no coinsurance for over-the-counter (OTC) items and meal benefits, while acupuncture is not covered. Under this plan, members receive up to $125 every three months in OTC item reimbursements and chronic illness meals with prior authorization.
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