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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 2026, 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 2026.
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 $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 $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 features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 select care drugs filled at standard pharmacies or through a three-month standard mail-order supply. This cost-sharing structure makes everyday maintenance medications highly affordable for members. For higher-tier medications, cost-sharing is based on coinsurance rather than flat copays. Tier 3 preferred brand drugs and Tier 5 specialty drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 50% coinsurance. These percentage-based costs apply to standard pharmacy fills and standard mail-order options where available.
Additional Benefits
The Prominence Extra Help (HMO) plan offers comprehensive coverage with no copays and no coinsurance for many essential services, including inpatient hospital stays, outpatient surgery, primary care, and physical therapy. Specialist visits are highly affordable with low copays ranging from $5 to $10 and no coinsurance. Additionally, emergency care is covered with a $150 copay, which is waived if you are admitted, while urgent care services require no copay. This plan also features robust ancillary benefits, including dental coverage with no copays for preventive care, a 10% to 50% coinsurance for comprehensive care, and a generous $4,000 annual maximum. Vision and hearing benefits include routine exams with no copay, along with a $300 annual eyewear allowance and up to $600 per ear for prescription hearing aids. Members also benefit from no copays on durable medical equipment, home health care, and up to 46 one-way transportation trips per year to approved locations.
Inpatient Hospital See details
Inpatient hospital services are covered by Prominence Extra Help (HMO) with no copay and no coinsurance for both acute and psychiatric stays, although prior authorization is required. Note that additional days, non-Medicare-covered stays, and upgrades are not covered under this benefit.
Outpatient Services See details
Prominence Extra Help (HMO) covers outpatient hospital, ambulatory surgical center, and outpatient blood services with no copay and no coinsurance. While some outpatient substance abuse services are covered, individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization is covered by Prominence Extra Help (HMO) with no copay and no coinsurance, though prior authorization is required for these services.
Ambulance and Transportation Services See details
Prominence Extra Help (HMO) covers ground and air ambulance services with a $175 copay (waived if admitted) and no coinsurance. Transportation services are partially covered with no copay or coinsurance for up to 46 one-way trips per year to plan-approved locations, though trips to any health-related location are not covered.
Emergency Services See details
Emergency services are covered by Prominence Extra Help (HMO) with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within three days, while urgently needed services have no copay or coinsurance. Worldwide emergency services are partially covered up to a $25,000 maximum with a $150 copay and no coinsurance for emergency care, but worldwide emergency transportation is not covered.
Primary Care See details
Prominence Extra Help (HMO) features no copay and no coinsurance for primary care, physical therapy, occupational therapy, podiatry, and telehealth, while specialist visits require a $5 to $10 copay and no coinsurance. Chiropractic care is partially covered with a $10 copay and no coinsurance for routine visits (up to 12 per year) but excludes other chiropractic services, and while mental health and psychiatric services are technically listed, individual and group sessions are not covered.
Preventive Services See details
Preventive services are partially covered by Prominence Extra Help (HMO) with no copay and no coinsurance for covered options like annual physical exams and kidney disease education. However, several sub-services are not covered, including health education, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home modifications, and counseling.
Hearing Services See details
Prominence Extra Help (HMO) hearing services are partially covered, offering one routine hearing exam and one fitting evaluation per year with no copay and no coinsurance. Prescription hearing aids have no coinsurance and copays ranging from $0 to $1,725 with a $600 annual maximum benefit per ear, but inner ear, outer ear, over the ear, and over-the-counter hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Prominence Extra Help (HMO) with no copay, no coinsurance, and no deductible. This benefit includes one routine eye exam per year and a $300 annual allowance for eyewear, though other eye exam services are not covered.
Dental Services See details
Dental Services are partially covered by Prominence Extra Help (HMO), featuring a $4,000 annual maximum benefit with no copay and no coinsurance for preventive care. Covered comprehensive services have no copay and a 10% to 50% coinsurance, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Prominence Extra Help (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other Part B drugs have no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Prominence Extra Help (HMO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Prominence Extra Help (HMO) covers Durable Medical Equipment with no copay and no coinsurance, though prior authorization is required. While some other medical and diabetic equipment services are covered with no copay or coinsurance, prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Prominence Extra Help (HMO) partially covers diagnostic and radiological services with no coinsurance, though prior authorization is required. While diagnostic services have no copay, some services are covered but diagnostic procedures, tests, and lab services are not covered; radiological services require a $25 copay for diagnostic and a $20 copay for therapeutic services, while outpatient X-ray services are not covered.
Home Health Services See details
Prominence Extra Help (HMO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Prominence Extra Help (HMO) with no copay and no coinsurance, though prior authorization is required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Prominence Extra Help (HMO) with no coinsurance, featuring no copay for days 1 to 20 and a $35 daily copay for days 21 to 100. Prior authorization is required, and additional days beyond Medicare-covered days are not covered.
Other Services See details
Other services are partially covered by Prominence Extra Help (HMO), featuring a meal benefit for chronic illnesses and up to $300 every three months for over-the-counter items with no copay and no coinsurance. Acupuncture is not covered under this plan.
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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