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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 Washoe County. 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 $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 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 drug deductible of $615. Under this plan, you will pay no copay for Tier 1 (Preferred Generic), Tier 2 (Generic), and Tier 6 (Select Care Drugs) prescriptions filled at standard pharmacies or through standard mail-order services. This makes essential and generic medications highly affordable for policyholders looking to minimize out-of-pocket costs. For higher-tier medications, cost-sharing is based on coinsurance rates at standard pharmacies and mail-order services. You will pay a 24% coinsurance for Tier 3 (Preferred Brand) drugs and a 48% coinsurance for Tier 4 (Non-Preferred Drug) options. Additionally, Tier 5 (Specialty Tier) drugs require a 25% coinsurance for a one-month supply at standard pharmacies.
Additional Benefits
The Prominence Dual (HMO D-SNP) plan offers comprehensive medical coverage with no copay and no coinsurance for essential services like inpatient hospital stays, skilled nursing, home health, and preventive care. For outpatient hospital care, emergency visits, specialist consultations, and diagnostic testing, members pay no copay and a 20% coinsurance. While many medical services require prior authorization, they generally feature no deductibles. Supplemental benefits include dental care with no copay and no coinsurance up to a $4,000 annual limit, as well as routine vision exams with no copay and a 20% coinsurance. Members also receive eyewear coverage up to $510 annually and up to 48 one-way transportation trips per year to approved locations with no copay and no coinsurance. Furthermore, the plan provides an over-the-counter allowance of up to $462 every three months and chronic illness meals with no copay and no coinsurance.
Inpatient Hospital See details
Prominence Dual (HMO D-SNP) partially covers inpatient acute and psychiatric hospital services with no copay and no coinsurance, though prior authorization is required. Additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Prominence Dual (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for these outpatient services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Prominence Dual (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Prominence Dual (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, with the coinsurance waived if you are admitted to the hospital. The plan also covers up to 48 one-way transportation trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Prominence Dual (HMO D-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay, with maximum per-visit costs of $115 and $40 respectively. Worldwide emergency, urgent, and transportation services are also covered up to a $25,000 maximum, with a 20% coinsurance or a $115 copay depending on the service.
Primary Care See details
Prominence Dual (HMO D-SNP) covers primary care, specialist visits, therapy, and mental health services with no copay and a 20% coinsurance, or up to 20% coinsurance for telehealth. Chiropractic care is partially covered, offering up to 12 routine visits per year with no copay and 20% coinsurance, while other chiropractic services are not covered.
Preventive Services See details
Preventive Services under the Prominence Dual (HMO D-SNP) are partially covered with no copay and no coinsurance for covered services, including annual physical exams, kidney disease education, and glaucoma screenings. While in-home safety assessments, telemonitoring, and memory fitness are included, other supplemental benefits like health education, nutritional/dietary services, and weight management programs are not covered.
Hearing Services See details
Hearing Services under Prominence Dual (HMO D-SNP) are partially covered, offering routine hearing exams with no copay and a 20% coinsurance, alongside prescription hearing aids featuring no coinsurance and copays ranging from $0 to $1,725 up to a $3,000 annual maximum. OTC hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Prominence Dual (HMO D-SNP) offers partially covered vision services with no deductibles, featuring one routine eye exam per year with no copay and a 20% coinsurance, though other eye exam services are not covered. Covered eyewear, including contacts and eyeglasses, has no copay and no coinsurance up to a combined maximum benefit of $510 every year.
Dental Services See details
Prominence Dual (HMO D-SNP) offers partially covered dental services with no copay and no coinsurance for covered preventive and comprehensive care, up to a $4,000 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Prominence Dual (HMO D-SNP) with no copay, while associated Medicare Part B chemotherapy, radiation, and other drugs have a coinsurance of 0% to 20%. Covered Medicare Part B insulin drugs require a $35 copay and 0% to 20% coinsurance, with prior authorization required for services.
Dialysis Services See details
Dialysis services are covered under the Prominence Dual (HMO D-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Prominence Dual (HMO D-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance, subject to prior authorization. Diabetic equipment is partially covered, meaning diabetic therapeutic shoes and inserts are covered under these same terms, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Prominence Dual (HMO D-SNP) diagnostic and radiological services are partially covered and require prior authorization, featuring no copay and a 20% coinsurance for covered lab services, radiological services, and outpatient X-rays. While these services are generally covered, diagnostic procedures and tests are not covered under this plan.
Home Health Services See details
Prominence Dual (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Prominence Dual (HMO D-SNP) covers some cardiac rehabilitation services with no copay and a prior authorization requirement. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered in practice and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Prominence Dual (HMO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. While the plan allows for admission with less than a three-day prior inpatient hospital stay, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Prominence Dual (HMO D-SNP) partially covers other services, offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance, while acupuncture is not covered. The OTC benefit provides up to $462 every three months via reimbursement, and the meal benefit requires prior authorization.
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