A non-government entity
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 Palm Beach County. The overall rating for this plan is not yet available for 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 $4.80. 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:
Sign up for Prominence Dual (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Prominence Dual (HMO D-SNP) plan features an annual drug deductible of $615. Under this plan, members enjoy no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 select care drugs at standard pharmacies and standard mail order. This plan provides affordable access to everyday medications with zero-dollar coverage for these essential tiers. For brand-name and specialty medications, costs are structured around coinsurance. Tier 3 preferred brand drugs and Tier 5 specialty drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 50% coinsurance at standard pharmacies. These coinsurance percentages also apply to standard mail order deliveries, allowing you to easily calculate your out-of-pocket prescription drug costs.
Additional Benefits
The Prominence Dual (HMO D-SNP) plan offers comprehensive medical coverage with no copays and no coinsurance for critical services like inpatient hospital stays, skilled nursing facility care, and home health services. For outpatient care, including doctor visits, emergency services, dialysis, and medical equipment, members will pay no copay and a standard 20% coinsurance. There are also no deductibles for outpatient blood services and routine hearing exams, helping to keep your healthcare costs low. Beyond medical care, this plan features robust supplemental benefits, including up to $4,000 in covered dental care and a $500 annual eyewear allowance with no copays or coinsurance. You also receive up to 44 one-way transportation trips to plan-approved locations and a $675 quarterly over-the-counter allowance at no cost. Hearing aids are also covered with no coinsurance and copays ranging from no copay to $1,725, up to a $3,000 annual maximum.
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, upgrades for acute stays, and non-Medicare-covered stays are not covered under this plan.
Outpatient Services See details
Prominence Dual (HMO D-SNP) outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, are covered with no copay and a 20% coinsurance. Prior authorization is required for these covered services, which also feature 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 to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Prominence Dual (HMO D-SNP), with ground and air ambulance services requiring a 20% coinsurance and no copay, which is waived if you are admitted to the hospital. Transportation services are partially covered with no copay or coinsurance for up to 44 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Prominence Dual (HMO D-SNP) covers emergency services with a 20% coinsurance and no copay (up to $115 per visit), and urgently needed services with a 20% coinsurance and no copay (up to $40 per visit). Worldwide emergency services are covered up to a $25,000 lifetime maximum, featuring a $115 copay and no coinsurance for emergency care, and a 20% coinsurance with no copay for urgent care and emergency transportation.
Primary Care See details
Prominence Dual (HMO D-SNP) covers primary care, specialist visits, mental health, physical therapy, and other professional services with no copays and 20% coinsurance (0% to 20% for telehealth). Chiropractic benefits are 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 are covered by Prominence Dual (HMO D-SNP), offering no copay and no coinsurance for annual physical exams, kidney disease education, and select additional benefits like telemonitoring. Other preventive services, including glaucoma screenings and diabetes self-management training, are covered with no copay and 20% coinsurance. Additional preventive benefits are only partially covered, as services such as health education, weight management, alternative therapies, and nutritional counseling are not covered.
Hearing Services See details
Prominence Dual (HMO D-SNP) hearing services are partially covered, offering routine hearing exams with no copay, a 20% coinsurance, and no deductible. Prescription hearing aids feature no coinsurance and a copay ranging from $0 to $1,725 with a $3,000 annual maximum, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are covered under the Prominence Dual (HMO D-SNP) plan, which offers one routine eye exam annually with no copay and a 20% coinsurance, while other eye exam services are not covered. Eyewear is also covered with no copay and no coinsurance, providing up to a $500 annual maximum allowance for contacts, frames, lenses, and upgrades.
Dental Services See details
Prominence Dual (HMO D-SNP) offers partially covered dental services with no copay and no coinsurance up to a maximum annual benefit of $4,000. Covered services include preventive and comprehensive care such as cleanings, exams, and orthodontics, while maxillofacial prosthetics and implant services are not covered.
Home Infusion bundled Services See details
Prominence Dual (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy may be required. Associated Medicare Part B drugs, including chemotherapy and other infusion drugs, carry a coinsurance of 0% to 20%, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Prominence Dual (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Prominence Dual (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and certain supplies may be limited to preferred manufacturers or vendors.
Diagnostic and Radiological Services See details
Prominence Dual (HMO D-SNP) covers diagnostic and radiological services, including lab services, X-rays, and therapeutic radiological services, with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Home Health Services See details
Prominence Dual (HMO D-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Prominence Dual (HMO D-SNP) with no copay and require prior authorization, meaning some services are covered, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Prominence Dual (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required and additional days beyond Medicare-covered limits are not covered. Admission to a participating facility does not require a prior three-day inpatient hospital stay.
Other Services See details
Prominence Dual (HMO D-SNP) partially covers other services, offering a meal benefit for chronic illnesses and over-the-counter (OTC) items with no copay and no coinsurance. The OTC benefit provides up to $675 every three months through reimbursement, while acupuncture, Naloxone, and other miscellaneous services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved