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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 Washoe County. 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 $9.50. 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 $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 Extra Help (HMO) plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 select care drugs when using standard pharmacies or standard three-month mail orders. This coverage ensures that many common and essential medications are available to you at no cost. For other prescription tiers, costs are calculated as a percentage of the drug price. You will pay a 25% coinsurance for Tier 3 preferred brand drugs and Tier 5 specialty drugs, though Tier 5 coverage is limited to a one-month supply. Tier 4 non-preferred drugs require a higher coinsurance of 50% at standard pharmacies and standard mail order.
Additional Benefits
The Prominence Extra Help (HMO) plan offers comprehensive coverage with predictable, low out-of-pocket costs for essential medical services. Members enjoy no copays and no coinsurance for primary care visits, telehealth, preventive services, and acute inpatient hospital stays. For emergency care, outpatient services, and specialist visits, the plan features reasonable copays and generally eliminates coinsurance, helping you manage your healthcare budget effectively. Beyond basic medical care, the plan provides valuable extra benefits including routine dental care with no copay, and comprehensive dental covered up to a $2,000 yearly limit with 10% to 50% coinsurance. You also receive no-copay transportation for up to 46 one-way trips annually, a $200 allowance for eyewear, and a $150 over-the-counter item allowance every three months. Hearing exams, routine chiropractic care, and home health services are also covered with minimal to no copays, ensuring well-rounded support for your daily health needs.
Inpatient Hospital See details
Prominence Extra Help (HMO) partially covers inpatient hospital services with no coinsurance, requiring prior authorization for both acute and psychiatric stays. Acute stays have no copay, while psychiatric stays require a $330 daily copay for days 1 through 5 and no copay for days 6 through 90; additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Prominence Extra Help (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 visits. Outpatient substance abuse sessions require a $10 copay, while outpatient blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Partial hospitalization is covered by Prominence Extra Help (HMO) with a $55.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Prominence Extra Help (HMO) covers Medicare-approved 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 46 one-way transportation 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 Extra Help (HMO) covers emergency services with a $150 copay and no coinsurance, and urgently needed services with a $10 copay and no coinsurance, with copays waived if admitted to the hospital within three days. Worldwide emergency services are partially covered up to a $25,000 maximum with no coinsurance, featuring 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 and telehealth services with no copay and no coinsurance, while specialist, mental health, and therapy services feature copays ranging from $0 to $15 and no coinsurance. Chiropractic services are partially covered with a $10 copay and no coinsurance for routine care, while other chiropractic services are not covered.
Preventive Services See details
Prominence Extra Help (HMO) covers preventive services, such as annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are partially covered with prior authorization, but sub-services including health education, PERS, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, home safety modifications, and counseling are not covered.
Hearing Services See details
Prominence Extra Help (HMO) covers annual routine hearing exams and fitting evaluations for 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 $600 per ear annually), but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Prominence Extra Help (HMO) provides partially covered vision services, including one annual routine eye exam for a $30 copay and no coinsurance, while other eye exams are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing up to a $200 annual allowance for contact lenses, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental Services are partially covered by Prominence Extra Help (HMO) with a $2,000 yearly maximum, featuring no copay and no coinsurance for preventive care. Covered comprehensive services require no copay and 10% to 50% coinsurance, though orthodontics, implant services, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Prominence Extra Help (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs require coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by the Prominence Extra Help (HMO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Prominence Extra Help (HMO) partially covers medical equipment with no copay and a 20% coinsurance, with prior authorization required for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts. Diabetic supplies are not covered under this plan.
Diagnostic and Radiological Services See details
Prominence Extra Help (HMO) partially covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Diagnostic services have no copay, but diagnostic procedures, tests, and lab services are not covered; diagnostic and therapeutic radiological services require a minimum $20 copay, while outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered by Prominence Extra Help (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by the Prominence Extra Help (HMO) plan with no coinsurance and a $5 copay, with prior authorization required. While some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Prominence Extra Help (HMO) with no coinsurance, featuring 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 inpatient hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Prominence Extra Help (HMO) partially covers other services, offering over-the-counter (OTC) items up to $150 every three months and meal benefits for chronic illnesses with no copay and no coinsurance. Acupuncture and dual-eligible SNP services are not covered under this plan.
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