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Prominence Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Prominence Plus (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Prominence Plus (HMO) in 2026, please refer to our full plan details page.
Prominence Plus (HMO) is a HMO plan offered by Universal Health Services, Inc. available for enrollment in 2025 to people living in Palm Beach County. The overall rating for this plan is not yet available for 2026.
It's important to know that Prominence Plus (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 Plus (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 Plus (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.
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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2000.00 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 Plus (HMO) Medicare plan offers a $0 drug deductible, allowing your prescription coverage to begin immediately without any upfront out-of-pocket costs. You will pay 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 routine medications exceptionally affordable and predictable for members. For higher-tier medications, cost-sharing is structured by tier at standard pharmacies. Tier 3 preferred brand drugs have a $47 copay for a 1-month supply, while Tier 4 non-preferred drugs require a $97 copay for a 1-month supply. Specialty medications in Tier 5 carry a 33% coinsurance for a 1-month supply, and standard mail-order options are available for extended 3-month supplies of Tier 3 and Tier 4 prescriptions.
Additional Benefits
The Prominence Plus (HMO) plan offers comprehensive medical coverage with many essential services available with no copay and no coinsurance, including primary care, preventive services, and outpatient hospital care. For inpatient hospital stays, members pay a $50 daily copay for days one through five, followed by no copay for additional days. Emergency room visits require a $150 copay and ambulance services require a $175 copay, both of which are waived upon hospital admission. Specialist office visits are highly affordable, requiring only a $5 to $10 copay and no coinsurance. Supplemental benefits include no copay for routine dental, vision, and hearing exams, alongside a $4,000 annual dental allowance with 0% to 50% coinsurance for comprehensive care. Skilled nursing facility stays are covered with no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
Prominence Plus (HMO) covers inpatient acute hospital stays with no coinsurance and a $50 daily copay for days 1 through 5, followed by no copay for days 6 and beyond. Inpatient psychiatric hospital stays are also covered with no copay and no coinsurance, though prior authorization is required for both benefits, and upgrades or non-Medicare-covered stays are not covered.
Outpatient Services See details
Prominence Plus (HMO) outpatient services, including outpatient hospital, ambulatory surgical center, and blood services, are covered with no copay and no coinsurance. For outpatient substance abuse, some services are covered but individual and group sessions are not covered.
Partial Hospitalization See details
Prominence Plus (HMO) covers partial hospitalization services with no copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Prominence Plus (HMO) covers emergency ground and air ambulance services with a $175 copay and no coinsurance per trip, which is waived if you are admitted to the hospital. Transportation services are partially covered with no copay and no coinsurance for up to 24 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Prominence Plus (HMO) covers emergency services with a $150 copay—waived if admitted to the hospital within three days—and no coinsurance, while urgently needed services are covered with no copay and no coinsurance. Worldwide emergency and urgent services are partially covered up to a $25,000 maximum limit with no coinsurance and a $150 emergency copay, though worldwide emergency transportation is not covered.
Primary Care See details
Prominence Plus (HMO) provides primary care, occupational therapy, physical therapy, speech therapy, and routine podiatry services with no copay and no coinsurance. Specialist visits require a $5 to $10 copay and no coinsurance, though individual and group sessions for mental health and psychiatric services, along with non-routine chiropractic care, are not covered.
Preventive Services See details
Prominence Plus (HMO) covers preventive services, annual physical exams, kidney disease education, and select screenings with no copay and no coinsurance. Additional preventive benefits are partially covered, offering no copay or coinsurance for memory fitness, in-home safety assessments, and remote access technologies, while services like health education, personal emergency response systems (PERS), and nutritional benefits are not covered.
Hearing Services See details
Prominence Plus (HMO) hearing services include annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $0 to $1,725 up to a $600 yearly maximum per ear, while inner ear, outer ear, over the ear, and over-the-counter hearing aids are not covered.
Vision Services See details
Prominence Plus (HMO) partially covers vision services with no copay, no coinsurance, and no deductible, providing one routine eye exam and up to $300 annually for eyewear. While contacts, eyeglasses, and upgrades are covered, other eye exam services are not covered.
Dental Services See details
Dental services are partially covered by Prominence Plus (HMO) up to a maximum annual benefit of $4,000, with no copay and no coinsurance for preventive care. Covered comprehensive services have no copay and a 0% to 50% coinsurance, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the Prominence Plus (HMO) plan with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry no coinsurance to 20% coinsurance, with insulin drugs also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered by Prominence Plus (HMO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Prominence Plus (HMO) covers Durable Medical Equipment with no copay and no coinsurance, subject to prior authorization. However, other medical equipment services are not covered in practice, including prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts.
Diagnostic and Radiological Services See details
Prominence Plus (HMO) partially covers diagnostic and radiological services with no coinsurance, requiring no copay for diagnostic services but requiring prior authorization. Diagnostic radiological services have a minimum $25 copay and therapeutic radiological services have a minimum $20 copay, while diagnostic procedures, lab services, and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered by Prominence Plus (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Prominence Plus (HMO) indicates some services are covered for cardiac rehabilitation with no copay and no coinsurance, though prior authorization is required. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Prominence Plus (HMO) covers skilled nursing facility (SNF) care with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. Patients pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare benefit are not covered.
Other Services See details
Other services under Prominence Plus (HMO) are partially covered, featuring over-the-counter (OTC) items and a chronic illness meal benefit with no copay and no coinsurance. Acupuncture and Naloxone are not covered, and the meal benefit requires prior authorization.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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