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Prominence Extra Help (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Prominence Extra Help (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Prominence Extra Help (HMO) in 2026, please refer to our full plan details page.
Prominence Extra Help (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 Extra Help (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 Extra Help (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 Extra Help (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.20. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $25.00. You must continue to pay paying your reduced 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 $615.00 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 Extra Help (HMO) Medicare plan features an annual drug deductible of $615. Under this plan, you will benefit from no copay for Tier 1 (Preferred Generic), Tier 2 (Generic), and Tier 6 (Select Care) medications filled at standard pharmacies. This provides affordable, budget-friendly access to essential everyday prescriptions. For higher-tier medications, cost-sharing is based on coinsurance rather than flat copays. You will pay a 25% coinsurance for Tier 3 (Preferred Brand) drugs and Tier 5 (Specialty) drugs, and a 47% coinsurance for Tier 4 (Non-Preferred) drugs. These coinsurance rates apply to standard retail pharmacies and standard mail-order options.
Additional Benefits
The Prominence Extra Help (HMO) plan offers comprehensive medical coverage, featuring no copay and no coinsurance for primary care doctor visits, telehealth services, and acute inpatient hospital stays. Specialist visits require a $20 copay, while emergency room services carry a $150 copay that is waived if you are admitted to the hospital. Outpatient hospital services are also covered with no coinsurance and copays ranging from $25 to $350. For supplemental care, members enjoy preventive dental services with no copay up to a $2,000 annual maximum and eyewear coverage with no copay up to a $200 yearly limit. The plan also provides a $100 allowance every three months for over-the-counter items with no copay, as well as routine hearing exams for a $10 copay. Skilled nursing facility care and home health services are covered, though prior authorization is required for several of these benefits.
Inpatient Hospital See details
Prominence Extra Help (HMO) partially covers inpatient hospital services, as upgrades, additional days, and non-Medicare-covered stays are not covered. Acute inpatient stays have no copay and no coinsurance, while psychiatric inpatient stays require a $330 daily copay for days 1 through 5, no copay for days 6 through 90, and no coinsurance.
Outpatient Services See details
Prominence Extra Help (HMO) covers outpatient services with no coinsurance, although prior authorization is required for most services. Members will pay copays ranging from $25 to $350 for outpatient hospital services, $100 per stay for observation services, $25 for ambulatory surgical center visits, and $10 for substance abuse sessions, while outpatient blood services feature no copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Prominence Extra Help (HMO) with no coinsurance and copays ranging from no copay to $55. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Prominence Extra Help (HMO) covers ground and air ambulance services with a $300 copay and no coinsurance, which is waived if you are admitted to the hospital. Transportation services are partially covered with no copay and no coinsurance, offering up to 48 one-way trips per year to plan-approved health-related locations, while transport to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Prominence Extra Help (HMO) with a $150 copay and no coinsurance, which is waived if admitted to the hospital within 3 days, and urgently needed services are covered with a $10 copay and no coinsurance. Worldwide emergency services are partially covered up to a $25,000 limit with no coinsurance, offering a $150 copay for emergency care and a $30 copay for urgent care, but worldwide emergency transportation is not covered.
Primary Care See details
Prominence Extra Help (HMO) covers primary care physician services and telehealth benefits with no copay and no coinsurance, while specialist visits require a $20 copay and no coinsurance. Therapy, mental health, and podiatry services have copays ranging from $5 to $10 with no coinsurance. Chiropractic services are partially covered, offering routine care for a $10 copay with no coinsurance, while other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by Prominence Extra Help (HMO) with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. This benefit is partially covered, as excluded services include health education, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Prominence Extra Help (HMO) covers annual routine hearing exams and fitting evaluations with a $10 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from no copay to $1,725 up to a $600 yearly limit per ear, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription aids are not covered.
Vision Services See details
Prominence Extra Help (HMO) offers partially covered vision services, as other eye exam services are not covered. Routine eye exams are covered once per year with a $30 copay and no coinsurance, while eyewear is covered with no copay and no coinsurance up to a $200 annual maximum.
Dental Services See details
Prominence Extra Help (HMO) partially covers dental services, offering preventive care with no copay and no coinsurance up to a $2,000 annual maximum. Comprehensive dental care is covered with no copay and 10% to 50% coinsurance, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Prominence Extra Help (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Prominence Extra Help (HMO) plan with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Prominence Extra Help (HMO) covers medical equipment, including durable medical equipment and prosthetics, with no copay, a 20% coinsurance, and prior authorization requirements. This benefit is partially covered, as diabetic therapeutic shoes and inserts are covered, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Prominence Extra Help (HMO) with no coinsurance, though prior authorization is required. Diagnostic services feature no copay, but diagnostic procedures, tests, and lab services are not covered, while covered radiological services require a minimum $20 copay and exclude outpatient X-ray services.
Home Health Services See details
Home Health Services are covered under the Prominence Extra Help (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Prominence Extra Help (HMO) with no coinsurance, but only some services are covered in practice. Specifically, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered under the plan and require a $5 copay along with prior authorization.
Skilled Nursing Facility (SNF) See details
Prominence Extra Help (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, a prior three-day hospital stay is not required, and additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Prominence Extra Help (HMO) partially covers other services, offering a meal benefit for chronic illnesses and up to $100 every three months for over-the-counter items with no copay and no coinsurance. Acupuncture is not covered under this benefit, and the meal benefit requires prior authorization.
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