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Prominence Heart (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Prominence Heart (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Prominence Heart (HMO C-SNP) in 2025, please refer to our full plan details page.
Prominence Heart (HMO C-SNP) is a HMO C-SNP 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 Heart (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Prominence Heart (HMO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Prominence Heart (HMO C-SNP).
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 Heart (HMO C-SNP), 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2400.00 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 Heart (HMO C-SNP) plan has an enhanced alternative drug benefit. The plan has no deductible. In the initial coverage phase, you will pay a copay for your prescriptions. For example, you will pay a $12 copay for preferred generic drugs at a standard pharmacy. You will pay 33% coinsurance for non-preferred drugs. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Prominence Heart (HMO C-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services, including mental health and substance abuse, also have copays. Emergency services have copays, with additional coverage for urgent and worldwide care. The plan includes coverage for primary care, vision, dental, and hearing services, each with specific copays or coverage limits. Other benefits include home health services, dialysis, and medical equipment with coinsurance requirements. Additionally, the plan covers over-the-counter items and nicotine replacement therapy.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $50 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you pay a $330 copay for days 1-5, and no copay for days 6-90. Additional days, non-Medicare covered stays, and upgrades for both services are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $25 and $160, Observation Services with a $100 copay, Ambulatory Surgical Center (ASC) Services with a $25 copay, Outpatient Substance Abuse Services with a $10 copay for both Individual and Group Sessions, and Outpatient Blood Services. Outpatient Blood Services also offers an enhanced benefit with a three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered under the Prominence Heart (HMO C-SNP) plan, with a copay of $55.00. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Prominence Heart (HMO C-SNP) plan. Ground and air ambulance services have a $300 copay, with no coinsurance, and there is no copay if admitted to the hospital. Transportation services to a plan-approved health-related location are covered for 24 one-way trips per year, with no copay or coinsurance, but transportation services to any health-related location are not covered.
Emergency Services See details
The Prominence Heart (HMO C-SNP) plan covers emergency services with a $140 copay and no coinsurance, urgently needed services with a $10 copay and no coinsurance, and worldwide emergency coverage with a $125 copay and no coinsurance, and worldwide urgent coverage with a $30 copay and no coinsurance. Worldwide emergency transportation is not covered.
Primary Care See details
The Prominence Heart (HMO C-SNP) plan covers Primary Care Physician Services, Chiropractic Services with a $10 copay, Occupational Therapy Services with a $5 copay, Physician Specialist Services with a copay between $0 and $35, Mental Health Specialty Services with a $10 copay for individual and group sessions, Podiatry Services with a copay between $10 and $25, Other Health Care Professional services with a copay between $0 and $35, 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 is required for Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services.
Preventive Services See details
The Prominence Heart (HMO C-SNP) plan covers Medicare-covered preventive services, annual physical exams, and additional preventive services with prior authorization. Additional services include in-home safety assessments, personal emergency response systems, fitness benefits, telemonitoring services, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. Other services like health education, medical nutrition therapy, and counseling services are not covered.
Hearing Services See details
Hearing services with the Prominence Heart (HMO C-SNP) plan include hearing exams with a $10 copay, along with coverage for routine hearing exams and fitting/evaluation for hearing aids, each limited to one visit per year. Prescription hearing aids are covered up to a maximum of $600 per year, with a copay ranging from $0 to $1725, while OTC hearing aids are not covered.
Vision Services See details
The Prominence Heart (HMO C-SNP) plan covers vision services, including eye exams with a $30 copay, and also covers eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $200 every year. Upgrades are also covered.
Dental Services See details
Dental Services are covered, with a $2,000 annual maximum. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments are covered, and restorative services, prosthodontics (removable and fixed), and oral and maxillofacial surgery have copays ranging from $0 to $100. Other diagnostic services are covered, but maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Insulin has a $35 copay, with coinsurance between 0% and 20% for Medicare Part B insulin drugs, while other Medicare Part B drugs have coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs also have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Prominence Heart (HMO C-SNP) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical equipment benefits under the Prominence Heart (HMO C-SNP) plan include Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetic Devices with a coinsurance between 20% and 20%, but exclude Durable Medical Equipment for use outside the home. Medical Supplies have a 20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have a coinsurance between 20% and 20%, and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic procedures/tests, and lab services are not covered. Diagnostic Radiological Services have a copay of at most $60, while Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Prominence Heart (HMO C-SNP) 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 Heart (HMO C-SNP) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Prominence Heart (HMO C-SNP) 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 stays for SNF are not covered.
Other Services See details
The Prominence Heart (HMO C-SNP) plan does not cover 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. Over-the-counter items are covered, with a maximum benefit of $110 every three months, and the plan offers Nicotine Replacement Therapy (NRT) as a Part C OTC benefit. The meal benefit is covered and requires prior authorization.
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