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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 Washoe County. 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 $21.30. 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 $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 has an enhanced alternative drug benefit. The plan has a deductible of $590.00. In the initial coverage phase, after you meet your deductible, you will pay varying amounts for your prescriptions based on the drug tier and pharmacy. For example, you will pay no copay for preferred generic drugs at a standard pharmacy, and 25% coinsurance for standard generic drugs at a standard pharmacy. After your total drug costs reach $2000.00, you enter the next coverage phase.
Additional Benefits
The Prominence Extra Help (HMO) plan offers a variety of benefits, including inpatient hospital stays with no copay for the majority of days, outpatient services with copays ranging from $10-$160, and emergency services with a $140 copay. The plan also covers vision services with a $30 copay for eye exams, and dental services with a $2,000 annual maximum. This plan includes coverage for hearing exams with a $10 copay, and prescription hearing aids, as well as home health services with no copay. Additionally, the plan provides coverage for ambulance services with a $300 copay, and offers an over-the-counter (OTC) benefit of $75 per month.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Prominence Extra Help (HMO) plan. For Inpatient Hospital-Acute, there is no copay for days 1-90. For Inpatient Hospital Psychiatric, there is a $330 copay for days 1-5, and no copay for days 6-90. Additional days and non-Medicare-covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services for the Prominence Extra Help (HMO) plan includes coverage for outpatient hospital services with a copay of $25-$160, observation services with a $100 copay, ambulatory surgical center services with a $25 copay, and outpatient substance abuse services with a $10 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Prominence Extra Help (HMO) plan. You will pay a $55 copay for this benefit, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a $300 copay per service. Transportation services to a plan-approved health-related location are covered for 48 one-way trips per year, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Prominence Extra Help (HMO) plan. Emergency Services have a $140 copay, and Urgently Needed Services have a $10 copay, while Worldwide Emergency Coverage has a $125 copay. Worldwide Urgent Coverage has a $30 copay, and Worldwide Emergency Transportation is not covered.
Primary Care See details
The Prominence Extra Help (HMO) plan covers primary care physician services, chiropractic services with a $10 copay, occupational therapy services with a $5 copay, physician specialist services with a $15 copay, mental health specialty services with a $10 copay, podiatry services with a $10 copay, other health care professional services with a copay between $0 and $15, psychiatric services with a $10 copay, physical therapy and speech-language pathology services with a $10 copay, additional telehealth benefits, and opioid treatment program services with a $10 copay. Routine Chiropractic Care is limited to 12 visits per year.
Preventive Services See details
The Prominence Extra Help (HMO) plan covers preventive services including Medicare-covered preventive services, annual physical exams, and additional preventive services, though health education, Personal Emergency Response Systems (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. This plan also covers kidney disease education services, and other preventive services including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing Services include hearing exams and prescription hearing aids. Hearing exams have a $10 copay, and include routine hearing exams with 1 visit per year, and fitting/evaluation for hearing aids with 1 visit per year. Prescription hearing aids are covered up to a maximum of $600 per ear per year, with a copay ranging from $0 to $1725; however, inner ear, outer ear, and over the ear prescription hearing aids are not covered, and 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 and routine eye exams once per year. The plan also covers eyewear with a combined maximum benefit of $200 per year, and it covers contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, each once per year.
Dental Services See details
The Prominence Extra Help (HMO) plan provides dental services with a $2,000 annual maximum, and covers oral exams (2 per year), dental x-rays (2 per year), other diagnostic dental services (1 visit every three years), prophylaxis (cleaning) (2 per year), fluoride treatment (2 per year), other preventive dental services (1 per year), restorative services (1 per year), adjunctive general services (unlimited), endodontics (unlimited), periodontics (2 per year), prosthodontics (removable) (1 visit, either once per arch per 5 years or once per arch per year depending on service), prosthodontics (fixed) (1 visit per arch per 5 years), and oral and maxillofacial surgery (unlimited). However, 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, including Medicare Part B Insulin Drugs. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Prominence Extra Help (HMO) plan. You will pay 20% coinsurance for these services, and prior authorization is required.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and authorization required, 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. Diagnostic Procedures/Tests, and Lab Services are not covered, while Diagnostic Radiological Services have a copay of at most $60, Therapeutic Radiological Services have a copay of at most $20, and 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, 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. The plan does not cover 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Prominence Extra Help (HMO) plan, but require prior authorization. For days 1-20, the copay is $20 per day, and for days 21-100, the copay is $214 per day. Additional days beyond Medicare-covered, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Prominence Extra Help (HMO) plan covers Over-the-Counter (OTC) items, with a maximum benefit coverage of $75.00 every month, including Nicotine Replacement Therapy (NRT). However, acupuncture, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing, and many other services are not covered.
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