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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 2026, 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 4.5 out of 5 stars in 2026.
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 $9.50. 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 $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 $9250.00 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 features an annual prescription drug deductible of $615. Beneficiaries will enjoy no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs when using standard pharmacies or standard mail order. This makes standard generic medications highly accessible and affordable for members. For higher-tier medications, costs are determined by coinsurance percentages rather than flat copays. Tier 3 preferred brand drugs and Tier 5 specialty drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 48% coinsurance at standard pharmacies. These coinsurance rates also apply to standard mail order services for Tier 3 and Tier 4 medications.
Additional Benefits
The Prominence Dual (HMO D-SNP) plan offers comprehensive medical coverage with many essential services featuring no copayments. You will pay no copay and no coinsurance for inpatient hospital stays, preventive care, home health care, and skilled nursing facility services. For outpatient care, doctor visits, emergency services, and durable medical equipment, the plan typically charges no copay but requires a 20% coinsurance. This plan also includes valuable extra benefits to support your wellness, such as a $2,000 annual dental allowance and a $475 eyewear allowance with no copay or coinsurance. Additionally, members receive up to 48 one-way transportation trips per year and a $200 quarterly over-the-counter allowance at no extra cost.
Inpatient Hospital See details
Prominence Dual (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization is required. This benefit is partially covered as additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Prominence Dual (HMO D-SNP) covers outpatient services with no copays, although a 20% coinsurance and prior authorization are generally required. This coverage includes outpatient hospital care, ambulatory surgical center services, outpatient substance abuse treatment, and outpatient blood services, with the deductible waived for the first three pints of blood.
Partial Hospitalization See details
Prominence Dual (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Prominence Dual (HMO D-SNP), featuring a 20% coinsurance and no copay for ground and air ambulance services, with the coinsurance waived if you are admitted to the hospital. Transportation services are partially covered with no copay or coinsurance for up to 48 one-way trips per year to plan-approved health-related locations, though trips to any health-related location are not covered.
Emergency Services See details
Prominence Dual (HMO D-SNP) covers emergency and urgent care services with a 20% coinsurance and no copay, up to a maximum of $115 and $40 per visit, respectively. Worldwide emergency, urgent, and transportation services are also covered up to a $25,000 maximum, with a $115 copay for emergency coverage and a 20% coinsurance for urgent care and transportation.
Primary Care See details
Prominence Dual (HMO D-SNP) covers primary care, specialist, therapy, and psychiatric services with no copay and a 20% coinsurance. Routine chiropractic and podiatry services are partially covered for up to 12 visits per year with a 20% coinsurance and a $10 copay, while other chiropractic services are not covered. Telehealth benefits are also available with no copay and no coinsurance to 20% coinsurance.
Preventive Services See details
Prominence Dual (HMO D-SNP) covers preventive services with no copay and no coinsurance, though additional preventive benefits are only partially covered. Covered services include annual physical exams, in-home safety assessments, telemonitoring, and memory fitness, while sub-services like health education, weight management, alternative therapies, and nutritional benefits are not covered.
Hearing Services See details
Hearing services are partially covered by Prominence Dual (HMO D-SNP), excluding OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids. Covered hearing exams feature no copay and a 20% coinsurance for routine visits, while covered prescription hearing aids have no coinsurance and copays ranging from no copay up to $1,725, with a $3,000 annual maximum.
Vision Services See details
Vision services are partially covered by Prominence Dual (HMO D-SNP), which offers one routine eye exam per year with no copay and a 20% coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing up to a $475 annual maximum benefit for contacts, lenses, frames, and upgrades.
Dental Services See details
Prominence Dual (HMO D-SNP) offers partially covered dental services with no copay and no coinsurance, up to an annual maximum benefit of $2,000. While preventive care, restorative services, and oral surgery are covered, this plan does not cover maxillofacial prosthetics, implant services, or orthodontics.
Home Infusion bundled Services See details
Prominence Dual (HMO D-SNP) covers Home Infusion bundled Services with no copay and no coinsurance, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, insulin, and other drugs, are covered with a coinsurance of 0% to 20%, with insulin specifically requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered by Prominence Dual (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Prominence Dual (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and coverage may be limited to specified manufacturers or preferred vendors.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Prominence Dual (HMO D-SNP) with prior authorization required, as diagnostic procedures and tests are not covered. Covered lab services, radiological services, and outpatient X-rays feature no copay and a 20% coinsurance.
Home Health Services See details
Home health services are covered by Prominence Dual (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Prominence Dual (HMO D-SNP) with no copay and require prior authorization, though only some services are covered. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Prominence Dual (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. The benefit is partially covered because additional days beyond the Medicare-covered limit are not covered, but a prior three-day inpatient hospital stay is not required for admission.
Other Services See details
Prominence Dual (HMO D-SNP) provides coverage for select other services with no copay and no coinsurance, including a meal benefit for chronic illnesses and up to $200 every three months for over-the-counter (OTC) items. While the meal benefit requires prior authorization, some services under this category, such as acupuncture, are not covered.
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