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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 Washoe County. 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 an enhanced alternative drug benefit. The deductible for prescription drugs is $590.00. In the initial coverage phase, after you meet your deductible, you will pay varying costs based on the drug tier. For example, for standard generic drugs, you pay 25% coinsurance. Once your total drug costs reach $2,000.00, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Prominence Dual (HMO D-SNP) plan offers a variety of benefits. Many services, such as primary care, outpatient services, and vision exams, have a 20% coinsurance. Preventive services, including annual physical exams, have no copay. The plan also includes coverage for hearing aids, with a maximum benefit of $3,000 per year and copays up to $1725. Dental services are covered up to $4,000 per year, and home health services have no copay or coinsurance. Additionally, the plan provides an over-the-counter item benefit of up to $140 per month.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization. For both, the plan uses the Medicare-defined cost share for tier 1, but additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services. Outpatient Hospital and Observation Services have a 20% coinsurance, while outpatient substance abuse services have a 20% coinsurance for both individual and group sessions. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial hospitalization is covered, 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, with a 20% coinsurance for both ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered for up to 48 one-way trips per year, while transportation to any health-related location is not covered.
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. Worldwide Urgent Coverage and Worldwide Emergency Transportation have a 20% coinsurance.
Primary Care See details
The Prominence Dual (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, occupational therapy services, physician specialist services, physical therapy, speech-language pathology services, and additional telehealth benefits have a 20% coinsurance. Chiropractic services, podiatry services, psychiatric services, and opioid treatment program services have a 20% coinsurance.
Preventive Services See details
The Prominence Dual (HMO D-SNP) plan covers preventive services, including annual physical exams, with no copay. Additional preventive services include In-Home Safety Assessment, Personal Emergency Response System (PERS), Fitness Benefit, Telemonitoring Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. However, Health Education, 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, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing services include hearing exams and prescription hearing aids. Hearing exams have a coinsurance of at most 20% for routine hearing exams, with no deductible. Prescription hearing aids have a maximum plan benefit of $3,000 per year, with a copay between $0 and $1725 for prescription hearing aids of all types, though inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with 20% coinsurance, and one routine eye exam every six months. Eyewear is covered up to a combined maximum of $500 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Prominence Dual (HMO D-SNP) plan covers a range of dental services, with a maximum plan benefit of $4,000 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, prosthodontics, fixed, and oral and maxillofacial surgery are covered, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Prominence Dual (HMO D-SNP) plan, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the Prominence Dual (HMO D-SNP) plan, but require prior authorization. You will pay a 20% coinsurance for these services.
Medical Equipment See details
The Prominence Dual (HMO D-SNP) plan covers Durable Medical Equipment with a 20% coinsurance, and Prosthetics/Medical Supplies with no copay and a 20% coinsurance. Diabetic Therapeutic Shoes/Inserts are covered with a 20% coinsurance, while Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for lab services with a coinsurance of at most 20%, while diagnostic procedures/tests are not covered. Radiological services, 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 prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but 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. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required, and coinsurance applies, with the specific amount defined by Medicare.
Other Services See details
Other Services include Over-the-Counter (OTC) items and a meal benefit, but acupuncture, Dual Eligible SNPs, and many other services are not covered. Over-the-counter items are covered up to $140 per month, and the meal benefit requires prior authorization.
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