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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 2025, 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 2025.
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) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay for your prescriptions depending on the drug tier and pharmacy. For example, in the Standard Pharmacy, you will pay a $0 copay for Tier 1 (Preferred Generic) and Tier 5 (Specialty Tier) drugs, $47 for Tier 2 (Standard Generic), and $97 for Tier 3 (Preferred Brand). For Tier 4 (Non-Preferred Drug), you will pay 33% coinsurance. Once your total drug costs reach $2,000, you will enter the next coverage phase.
Additional Benefits
The Prominence Plus (HMO) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays depending on the service. The plan also includes coverage for ambulance and transportation services, emergency services, and primary care, with some services like chiropractic and specialist visits having copays. Additionally, the plan covers preventive services with no copay, along with hearing, vision, and dental services, each with specific coverage limits and copays. This plan also offers coverage for home infusion, dialysis, and medical equipment, as well as home health services, skilled nursing, and diagnostic services. However, certain services like cardiac rehabilitation, acupuncture, and private duty nursing are not covered. The plan provides additional benefits such as over-the-counter items and a meal benefit for chronic illnesses.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under Prominence Plus (HMO), including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, there is a $50 copay for days 1-5, and no copay for days 6-90, while additional days are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Inpatient Hospital Psychiatric benefits do not cover additional days or non-Medicare-covered stays.
Outpatient Services See details
Outpatient Services are covered by the Prominence Plus (HMO) plan, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services. Outpatient substance abuse individual and group sessions are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Prominence Plus (HMO) plan, but requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Prominence Plus (HMO) plan. Ground and air ambulance services have a copay of $175, with no coinsurance, while transportation services to a plan-approved health-related location are covered for up to 24 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Prominence Plus (HMO) plan. Emergency Services has a $140 copay, and Worldwide Emergency Coverage has a $125 copay; both have no coinsurance. Worldwide Emergency Transportation is not covered, and Worldwide Urgent Coverage has a copay.
Primary Care See details
The Prominence Plus (HMO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, podiatry services, other health care professional services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $10 copay for routine care, and physician specialist services have a $10-$30 copay. Mental health specialty services and psychiatric services do not cover individual or group sessions.
Preventive Services See details
The Prominence Plus (HMO) plan covers Medicare-covered preventive services, annual physical exams, and additional preventive services, including in-home safety assessments, fitness benefits, and remote access technologies, with no copay. However, health education, personal emergency response systems, medical nutrition therapy, 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 benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered. The plan also covers Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit with no copay.
Hearing Services See details
Hearing Services under the Prominence Plus (HMO) plan include coverage for routine hearing exams and fitting/evaluation for hearing aids, with one visit per year, and prescription hearing aids with a maximum benefit of $600 per year, with copays between $0 and $1725. Prescription hearing aids for the inner, outer, and over the ear are not covered, as well as OTC hearing aids.
Vision Services See details
The Prominence Plus (HMO) plan covers vision services, including routine eye exams with one visit per year. Eyewear is covered with a combined maximum benefit of $300 per year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Prominence Plus (HMO) plan covers dental services with a maximum benefit of $4,000 per year, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services, with varying copays and visit limits. Restorative services have a copay of $50-$100, endodontics have a copay of $100, periodontics have a copay of $0-$100, prosthodontics (removable) have a copay of $50-$100, implant services have a copay of $100, prosthodontics (fixed) have a copay of $50-$100, and oral and maxillofacial surgery have a copay of $50-$100. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Prominence Plus (HMO) plan and require prior authorization. For Medicare Part B Insulin Drugs, you will pay a $35 copay and 0-20% coinsurance. Other Medicare Part B drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Prominence Plus (HMO) plan, but require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits, including Durable Medical Equipment (DME) and Prosthetics/Medical Supplies, are covered with no copay and no coinsurance, but Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. Diabetic Equipment benefits are covered, but limited to specific manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by the Prominence Plus (HMO) plan. Diagnostic Procedures/Tests, and Lab Services are not covered, while Diagnostic Radiological Services have a copay of at most $25, and Therapeutic Radiological Services have a copay of at most $20; Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Prominence Plus (HMO) plan with no copay or coinsurance, but authorization is required. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but this plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Prominence Plus (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day. Additional days beyond Medicare-covered for SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Prominence Plus (HMO) plan does not cover acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, or Self-Directed Personal Assistance Services. Over-the-counter (OTC) items are covered with a maximum benefit of $150 every three months. The plan also covers a meal benefit for chronic illnesses, but prior authorization is required.
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