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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 2025, 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 out of 5 stars in 2025.
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 $15.50. 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 $590.00 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) plan has an enhanced alternative drug benefit. The plan includes a deductible of $590.00. During the initial coverage phase, after your deductible is met, you will pay varying costs depending on the drug tier. For example, in the standard pharmacy, preferred generic drugs have no copay, while standard generic drugs have a 25% coinsurance. Once your total drug costs reach $2000.00, you enter the next coverage phase.
Additional Benefits
The Prominence Extra Help (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have no copay for acute care days 1-90, while outpatient services have copays between $10 and $350. Emergency and urgent care services have copays ranging from $10 to $140, and the plan also covers transportation, hearing, vision, and dental services. This plan includes coverage for primary care, preventive services with no copay, and home health services with no copay. The plan also offers additional benefits such as OTC items, and a meal benefit for chronic illness. However, some services like cardiac rehabilitation and certain types of medical equipment are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will have no copay for days 1-90. For Inpatient Hospital Psychiatric, you will have a $330 copay for days 1-5 and no copay for days 6-90. Additional days, non-Medicare covered stays, and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
The Prominence Extra Help (HMO) plan covers outpatient hospital services with a copay between $25 and $350, observation services with a $100 copay, and ambulatory surgical center services with a $25 copay. Outpatient substance abuse services are covered with a $10 copay, and outpatient blood services are covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Prominence Extra Help (HMO) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
The Prominence Extra Help (HMO) plan covers ambulance and transportation services, with a $300 copay for both ground and air ambulance services. Transportation services to a plan-approved health-related location are covered for up to 48 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including urgently needed services, are covered by the Prominence Extra Help (HMO) plan. Emergency services have a $140 copay, and urgently needed services have a $10 copay. Worldwide Emergency Coverage has a $125 copay, and Worldwide Urgent Coverage has a $30 copay; Worldwide Emergency Transportation is not covered, though the plan covers up to $25,000 in worldwide emergency services.
Primary Care See details
The Prominence Extra Help (HMO) plan covers primary care physician services, chiropractic services with a $10 copay, occupational therapy with a $5 copay, physician specialist services with a $20 copay, mental health specialty services with a $10 copay for individual and group sessions, podiatry services with a $5-$10 copay, other health care professional services with a $0-$20 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. Prior authorization may be required for some services.
Preventive Services See details
The Prominence Extra Help (HMO) plan covers preventive services including Medicare-covered services with no copay, annual physical exams, and additional preventive services such as in-home safety assessments, fitness benefits, remote access technologies, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. However, the plan does not cover 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-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices, and counseling services.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $10 copay, and prescription hearing aids with a copay between $0 and $1725, but not for inner ear, outer ear, or over-the-ear hearing aids. Routine hearing exams and fitting/evaluation for hearing aids are also covered. OTC hearing aids are not covered.
Vision Services See details
The Prominence Extra Help (HMO) plan covers vision services, including eye exams with a $30 copay. Eyewear is covered with a combined maximum benefit of $200 every year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services are covered, with a maximum plan benefit of $2,000 every year. Oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered, with visit limits and other restrictions. Maxillofacial prosthetics and orthodontics are not covered, and implant services are an optional, supplemental benefit.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. 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 Extra Help (HMO) plan, but require prior authorization. The plan has a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance; however, Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Prominence Extra Help (HMO) plan, with no copay for all diagnostic services. Diagnostic Radiological Services have a copay of at most $60.00, while Therapeutic Radiological Services have a copay of at most $20.00, but Diagnostic Procedures/Tests, Lab Services, and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Prominence Extra Help (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 not covered by the Prominence Extra Help (HMO) plan. Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Prominence Extra Help (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 and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Prominence Extra Help (HMO) plan covers Over-the-Counter (OTC) Items up to $50.00 per month, including nicotine replacement therapy, but 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. The plan also covers a meal benefit for a chronic illness with prior authorization.
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