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Prominence Extra Help (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Prominence Extra Help (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Prominence Extra Help (HMO) in 2025, please refer to our full plan details page.
Prominence Extra Help (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 Extra Help (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 Extra Help (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 Extra Help (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $3.30. 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 $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 Extra Help (HMO) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay coinsurance for your prescriptions. During the initial coverage phase, you will pay coinsurance percentages that vary depending on the drug tier. For example, standard generic drugs have a 25% coinsurance, and preferred brand drugs have a 50% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs.
Additional Benefits
The Prominence Extra Help (HMO) plan offers a variety of benefits, including coverage for inpatient and outpatient services, with prior authorization often required. The plan covers emergency services with a copay, and also includes coverage for ambulance and transportation services, with a copay for ground and air ambulance. This plan provides coverage for preventive, hearing, vision, and dental services. Hearing services include routine exams and hearing aids, and vision services cover eye exams and eyewear. Dental services cover a range of services up to a $4,000 annual maximum.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, but additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered. Prior authorization is required for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services, all of which require prior authorization. Outpatient substance abuse services are partially covered, with individual and group sessions not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Prominence Extra Help (HMO) plan, but requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Prominence Extra Help (HMO) plan, with no coinsurance. Ground and air ambulance services have a copay of $175, but the copay is waived if admitted to the hospital. Transportation services to a plan-approved health-related location are covered for up to 48 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Prominence Extra Help (HMO) plan. Emergency Services have a $140 copay, while Worldwide Emergency Coverage has a $125 copay. Worldwide Urgent Coverage is covered with no copay, and Worldwide Emergency Transportation is not covered.
Primary Care See details
The Prominence Extra Help (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-$35 copay. Mental health specialty services and psychiatric services do not cover individual or group sessions.
Preventive Services See details
The Prominence Extra Help (HMO) plan covers preventive services including Medicare-covered services with no copay, annual physical exams, in-home safety assessments, fitness benefits, remote access technologies, kidney disease education, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. Health education, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, 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, additional smoking cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices, and counseling services are not covered.
Hearing Services See details
Hearing services include routine hearing exams and fitting/evaluation for hearing aids, each covered once per year, and prescription hearing aids with a maximum benefit of $600 per year per ear. Prescription hearing aids (all types) have a copay between $0 and $1725.
Vision Services See details
The Prominence Extra Help (HMO) plan covers vision services including routine eye exams once per year, and eyewear including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames once per year with a combined maximum benefit of $300 per year. This plan has no deductible for any of these services.
Dental Services See details
The Prominence Extra Help (HMO) plan offers dental services with a maximum benefit of $4,000 per year. This plan covers oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery, but does not cover maxillofacial prosthetics or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Prominence Extra Help (HMO), including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered with a coinsurance of 20%. Prior authorization is required.
Medical Equipment See details
Medical Equipment benefits are covered under the Prominence Extra Help (HMO) plan. Durable Medical Equipment (DME) and Prosthetics/Medical Supplies have 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.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Prominence Extra Help (HMO), but Diagnostic Procedures/Tests, and Lab Services are not covered. Diagnostic Radiological Services have a copay of at most $25, and Therapeutic Radiological Services have a copay of at most $20.
Home Health Services See details
Home Health Services are covered by the Prominence Extra Help (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but none of the sub-services are covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Prominence Extra Help (HMO), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $35.
Other Services See details
Other Services include over-the-counter items with a $125 monthly allowance and meal benefits requiring prior authorization. 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.
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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