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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 2025, 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 2025.
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 $20.30. 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 $590.00 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 $9335.00 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 has an "Enhanced Alternative" drug benefit. You will pay a deductible of $590.00 before your drug coverage begins. In the initial coverage phase, you will pay coinsurance for your prescriptions. For example, you will pay 23% coinsurance for preferred generic drugs at a standard pharmacy. After your total drug costs reach $2000.00, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Prominence Dual (HMO D-SNP) plan offers a range of benefits, including inpatient and outpatient hospital services, with 20% coinsurance applying to many services. It also covers ambulance and transportation services, emergency services, primary care, and preventive services, with varying cost-sharing structures. This plan includes coverage for hearing, vision, and dental services, with specific limits and cost-sharing details for each. Additionally, you'll find coverage for home infusion, dialysis, medical equipment, and diagnostic services, all with associated coinsurance or copays.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered under the Prominence Dual (HMO D-SNP) plan, but additional days and non-Medicare-covered stays for both are not covered. For both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, the cost sharing is the Medicare-defined cost share for tier 1 and coinsurance applies.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services and observation services, are covered by the Prominence Dual (HMO D-SNP) plan, with a 20% coinsurance. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services are also covered, each with a coinsurance of 20%. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Prominence Dual (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Prominence Dual (HMO D-SNP) plan. Ground and Air Ambulance Services have a 20% coinsurance, with no copay, and Transportation Services to plan-approved health-related locations are covered for up to 48 one-way trips per year via rideshare, bus/subway, medical transport, or other methods. Transportation Services to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Prominence Dual (HMO D-SNP) plan. Emergency Services and Urgently Needed Services have a 20% coinsurance, and Worldwide Emergency Coverage has a $125 copay. Worldwide Urgent Coverage and Worldwide Emergency Transportation have a 20% coinsurance.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered by the Prominence Dual (HMO D-SNP) plan. Primary Care Physician Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services have a 20% coinsurance. Chiropractic Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services have a 20% coinsurance. Individual and Group Sessions for Mental Health Specialty Services and Psychiatric Services have a 20% coinsurance. Additional Telehealth Benefits have a coinsurance between 0% and 20%.
Preventive Services See details
The Prominence Dual (HMO D-SNP) plan covers preventive services, including an annual physical exam, with no cost sharing. Additional preventive services are covered, but health education, 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, remote access technologies, home and bathroom safety devices, and counseling services are not covered. Other preventive services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visits have a 20% coinsurance. Additionally, the plan covers fitness and telemonitoring services.
Hearing Services See details
Hearing Services include routine hearing exams with a coinsurance of at most 20% and fitting/evaluation for hearing aids, and prescription hearing aids with a maximum benefit of $3,000 per year and a copay between $0 and $1,725, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered; OTC hearing aids are also not covered. Routine hearing exams are covered for one visit every six months.
Vision Services See details
Vision services include coverage for eye exams with a 20% coinsurance, and also cover routine eye exams once every six months. Eyewear is covered with a combined maximum benefit of $500 per year, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Prominence Dual (HMO D-SNP) plan covers dental services with a maximum benefit of $4,000 per year, including oral exams (2 per year), dental x-rays (2 per year), and other diagnostic dental services (1 every 3 years). The plan also covers prophylaxis (cleaning) twice per year, fluoride treatment twice per year, and other preventive dental services once per year. Orthodontic services are covered under Diagnostic and Preventive Dental. Maxillofacial Prosthetics and Implant Services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including insulin and other Medicare Part B drugs, are covered under the Prominence Dual (HMO D-SNP) plan. Medicare Part B Insulin drugs have a $35 copay and a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Prominence Dual (HMO D-SNP) plan, but require prior authorization. The coinsurance for this benefit is between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with 20% coinsurance for covered supplies. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Prominence Dual (HMO D-SNP) plan. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services all have at most 20% coinsurance, and there is no copay.
Home Health Services See details
Home Health Services are covered by the Prominence Dual (HMO D-SNP) plan with no copay or coinsurance, but prior authorization is required. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Prominence Dual (HMO D-SNP) plan. Prior authorization is required for this benefit, but the plan does not cover any of the sub-services including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays. Prior authorization is required and the coinsurance information is available in the plan details.
Other Services See details
Other Services include Over-the-Counter (OTC) Items, with a maximum benefit of $700 every three months, and Meal Benefits for a chronic illness with prior authorization required. 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, and Self-Directed Personal Assistance Services are not covered.
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