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Prominence Giveback (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Prominence Giveback (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Prominence Giveback (HMO) in 2026, please refer to our full plan details page.
Prominence Giveback (HMO) is a HMO 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 Giveback (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Prominence Giveback (HMO).
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 Giveback (HMO), 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. Additionally, this plan comes with a Part B Premium reduction of $105.00. You must continue to pay paying your reduced 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 $450.00 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 $6750.00 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 Giveback (HMO) plan features an annual prescription drug deductible of $450. You can save on medication costs with no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs at standard pharmacies and through standard mail order. For Tier 2 generic drugs, you will pay a $12 copay for a one-month supply or a $24 copay for a two- or three-month supply. Higher-tier medications transition to coinsurance costs for standard pharmacy and standard mail order options. Tier 3 preferred brand drugs require a 23% coinsurance, while Tier 4 non-preferred drugs have a 45% coinsurance. Specialty medications in Tier 5 carry a 27% coinsurance for a one-month supply at standard pharmacies.
Additional Benefits
The Prominence Giveback (HMO) plan offers comprehensive medical coverage featuring no copays or coinsurance for primary care visits, telehealth, and preventive services. Specialist visits, routine vision exams, and hearing exams require affordable copays ranging from $5 to $45 with no coinsurance, while inpatient hospital stays require a daily copay of $325 for the first six days. Emergency room visits have a $130 copay, and urgent care is available for a $10 copay, with neither service subject to a deductible. For additional health benefits, the plan provides up to 24 one-way transportation trips and a $200 yearly eyewear allowance with no copays or coinsurance. Preventive dental care is covered with no copay up to a $1,000 annual maximum, while comprehensive dental services require no copay and a 10% to 50% coinsurance. Members also benefit from no copays on home health services and receive up to $50 every three months for over-the-counter item reimbursements.
Inpatient Hospital See details
Prominence Giveback (HMO) covers inpatient hospital services with no coinsurance, requiring a $325 daily copay for days 1 through 6 of an acute stay and a $330 daily copay for days 1 through 5 of a psychiatric stay, with no copay for remaining covered days up to day 90. Prior authorization is required, and certain services such as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Prominence Giveback (HMO) covers outpatient services with no coinsurance, including outpatient hospital services with copays ranging from $25 to $350, observation services at $295 per stay, and ambulatory surgical center services at a $100 copay. Outpatient substance abuse sessions require a $10 copay, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization services are covered under the Prominence Giveback (HMO) plan with a $55.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services under the Prominence Giveback (HMO) plan cover Medicare-covered ground and air ambulance services with a $300 copay (waived if admitted) and no coinsurance. Transportation services are partially covered, offering up to 24 one-way 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
Emergency services under the Prominence Giveback (HMO) plan are covered with a $130 copay and no coinsurance, and urgently needed services are covered with a $10 copay and no coinsurance, with neither service subject to a deductible. Worldwide emergency and urgent services are partially covered up to a $25,000 maximum with no coinsurance and copays of $130 and $30 respectively, though worldwide emergency transportation is not covered.
Primary Care See details
Prominence Giveback (HMO) provides primary care and telehealth services with no copay and no coinsurance, while specialist, mental health, and therapy services require copays ranging from $5 to $45 and no coinsurance. Routine chiropractic and podiatry care are partially covered with copays up to $45 and no coinsurance, though non-routine chiropractic services are not covered.
Preventive Services See details
Prominence Giveback (HMO) covers preventive services with no copay and no coinsurance, though prior authorization is required for certain additional benefits. This benefit is partially covered, as health education, personal emergency response systems (PERS), medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for chemotherapy-related hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, home and bathroom safety modifications, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by the Prominence Giveback (HMO) plan, featuring covered hearing exams with a $10 copay and no coinsurance. Routine hearing exams, fitting and evaluations, OTC hearing aids, and all types of prescription hearing aids are not covered.
Vision Services See details
Prominence Giveback (HMO) vision services are partially covered, as other eye exam services are not covered. One routine annual eye exam is covered with a $30 copay and no coinsurance, and eyewear has no copay or coinsurance up to a $200 yearly limit with no deductibles.
Dental Services See details
Dental Services are partially covered by Prominence Giveback (HMO), featuring no copay and no coinsurance for preventive care up to a $1,000 annual maximum. Covered comprehensive services require no copay with a 10% to 50% coinsurance, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Prominence Giveback (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and up to 20% coinsurance, while chemotherapy and other Part B drugs have no copay and up to 20% coinsurance.
Dialysis Services See details
Prominence Giveback (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Prominence Giveback (HMO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic therapeutic shoes, with no copay and a 20% coinsurance. Prior authorization is required for these services, and while diabetic therapeutic shoes are covered, diabetic supplies are not covered under this plan.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered under the Prominence Giveback (HMO) plan, featuring no copay or coinsurance for diagnostic services, a minimum $60 copay for diagnostic radiological services, and a minimum 20% coinsurance for therapeutic radiological services. Prior authorization is required, and diagnostic procedures, lab services, and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered by Prominence Giveback (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Prominence Giveback (HMO) plan, as none of the sub-services—including standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are covered in practice.
Skilled Nursing Facility (SNF) See details
Prominence Giveback (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a prior three-day hospital stay is not necessary, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Prominence Giveback (HMO), featuring over-the-counter (OTC) items and a chronic illness meal benefit with no copay and no coinsurance, while acupuncture is not covered. The OTC benefit provides up to $50 every three months through reimbursement, and the meal benefit requires prior authorization.
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