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Prominence Dual (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Prominence Dual (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Prominence Dual (HMO D-SNP) in 2025, please refer to our full plan details page.
Prominence Dual (HMO D-SNP) is a HMO D-SNP 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 Dual (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Prominence Dual (HMO D-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 Dual (HMO D-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 Dual (HMO D-SNP), 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 $9350.00 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 Dual (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier. For standard pharmacy, you will pay no copay for preferred generic drugs, 25% coinsurance for standard generic drugs, 47% coinsurance for preferred brand drugs, 25% coinsurance for non-preferred drugs, and no copay for specialty tier drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for your drugs.
Additional Benefits
The Prominence Dual (HMO D-SNP) plan offers a range of health benefits with varying cost-sharing. Inpatient and outpatient services, including mental health, are covered with coinsurance, typically 20%. Emergency and ambulance services are covered, with a $125 copay for worldwide emergency services. This plan also includes coverage for preventive, hearing, vision, and dental services. Dental services have a $2,000 annual maximum benefit. Additionally, the plan provides home infusion, dialysis, medical equipment, and home health services, and offers an allowance for over-the-counter (OTC) items.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but the plan does not cover additional days, non-Medicare-covered stays, or upgrades for either. The cost-sharing for covered services is the Medicare-defined cost share for tier 1, with no copay and coinsurance information provided.
Outpatient Services See details
Outpatient Services are covered, including Outpatient Hospital Services and Observation Services with a 20% coinsurance, and Ambulatory Surgical Center (ASC) Services with a minimum and maximum coinsurance of 20%. Outpatient Substance Abuse Services are covered with a minimum and maximum coinsurance of 20% for both individual and group sessions, while Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Prominence Dual (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Prominence Dual (HMO D-SNP) plan, including ground and air ambulance services with a 20% coinsurance, and transportation services to plan-approved health-related locations for up to 48 one-way trips per year. Transportation services to any health-related location are not covered. There is no copay for ambulance services.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Urgently Needed Services have a 20% coinsurance, and Worldwide Emergency Coverage has a $125 copay and a 20% coinsurance for Worldwide Urgent Coverage and Worldwide Emergency Transportation.
Primary Care See details
The Prominence Dual (HMO D-SNP) plan covers primary care physician services with a 20% coinsurance. Chiropractic services are covered with a 20% coinsurance, and routine care has a $10 copay for 12 visits per year. Occupational therapy services, physician specialist services, and physical therapy/speech-language pathology services have a 20% coinsurance. Mental health specialty services, psychiatric services, and opioid treatment program services have a 20% coinsurance, and additional telehealth benefits have a 0%-20% coinsurance. Podiatry services are covered with a 20% coinsurance and a $10 copay, while other health care professional services have a 20% coinsurance.
Preventive Services See details
The Prominence Dual (HMO D-SNP) plan covers preventive services, including annual physical exams, additional preventive services with prior authorization, kidney disease education services, and other preventive services. Some additional preventive services such as health education, medical nutrition therapy, and others are not covered. Fitness benefits, telemonitoring services, glaucoma screening, and diabetes self-management training are covered.
Hearing Services See details
Hearing services are covered, including hearing exams with a coinsurance of at most 20% and fitting/evaluation for hearing aids. Prescription hearing aids are covered with a maximum copay of $1725 and a yearly benefit maximum of $3000, while OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a 20% coinsurance. This plan also covers eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The Prominence Dual (HMO D-SNP) plan covers dental services, including 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 per year, or once per arch per 5 years), prosthodontics fixed (1, per arch, every 5 years), and oral and maxillofacial surgery (unlimited), with a $2,000 annual maximum benefit. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a $35 copay and coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Prominence Dual (HMO D-SNP) plan. There is a 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with 20% coinsurance for some services. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Prominence Dual (HMO D-SNP) plan. Diagnostic Procedures/Tests are not covered, while Lab Services are covered with a coinsurance of at most 20%. Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are covered with a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Prominence Dual (HMO D-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 Dual (HMO D-SNP) plan. This includes 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. The plan does not provide Skilled Nursing Facility Services as a supplemental benefit under Part C, but does allow for admission without a 3-day inpatient hospital stay.
Other Services See details
Other Services includes coverage for over-the-counter (OTC) items with a $200 allowance every three months, and meal benefits that require prior authorization. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and many other services are not covered.
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