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Prominence Giveback (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Prominence Giveback (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Prominence Giveback (HMO) in 2026, please refer to our full plan details page.
Prominence Giveback (HMO) is a HMO plan offered by Universal Health Services, Inc. available for enrollment in 2026 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 Giveback (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 Giveback (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 Giveback (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. Additionally, this plan comes with a Part B Premium reduction of $185.00. You must continue to pay paying your reduced 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 $7500.00 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 Giveback (HMO) Medicare plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs at standard pharmacies and through standard mail order. For Tier 2 generic drugs, standard pharmacy costs are a $15 copay for a one-month supply and a $30 copay for two- or three-month supplies. Higher-tier prescription medications on this plan require coinsurance rather than flat copayments. Tier 3 preferred brand drugs carry a 25% coinsurance, while Tier 4 non-preferred drugs require a 50% coinsurance for standard pharmacy and mail-order fills. Specialty Tier 5 medications are covered at a 33% coinsurance for a one-month supply at standard pharmacies.
Additional Benefits
The Prominence Giveback (HMO) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care, telehealth visits, and preventive services. If you require specialist visits, physical therapy, or emergency care, you will pay flat copayments, such as a $45 specialist copay or $115 emergency copay, with no coinsurance. For hospital stays, there is no coinsurance, though acute inpatient care requires a $225 daily copay for the first five days and no copay for days six through 90. This plan also includes essential supplemental benefits, providing routine vision and hearing exams with no copay, alongside allowances for eyewear and hearing aids. Dental care is highly accessible, offering preventive services with no copay and comprehensive coverage up to a $1,000 annual limit with no copay and 10% to 50% coinsurance. Additionally, home health services and skilled nursing facility care for the first 20 days are covered with no copay or coinsurance, ensuring affordable recovery support.
Inpatient Hospital See details
Prominence Giveback (HMO) covers inpatient hospital stays with no coinsurance, although prior authorization is required. For acute stays, you will pay a $225 daily copay for days 1 through 5 and no copay for days 6 through 90, while psychiatric stays require a $330 daily copay for days 1 through 5 and no copay for days 6 through 90. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Prominence Giveback (HMO) outpatient services include outpatient hospital care for a $200 copay and observation services for a $295 copay per stay, both with no coinsurance. Ambulatory surgical center services require a $25 copay with no coinsurance, outpatient blood services are covered with no copay or coinsurance, and outpatient substance abuse services are not covered.
Partial Hospitalization See details
Prominence Giveback (HMO) covers partial hospitalization with no copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Prominence Giveback (HMO) covers ground and air ambulance services with a $325 copay and no coinsurance, though prior authorization is required and the copay is waived if you are admitted to the hospital. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Prominence Giveback (HMO) covers emergency services with a $115 copay and urgently needed services with a $35 copay, both with no coinsurance and copays waived if admitted to the hospital within three days. Worldwide emergency services are partially covered up to a $25,000 limit with no coinsurance, featuring a $115 emergency copay and a $30 urgent care copay, though worldwide emergency transportation is not covered.
Primary Care See details
Prominence Giveback (HMO) covers primary care and telehealth visits with no copay and no coinsurance, while specialist visits require a $45 copay and no coinsurance. Physical, occupational, and speech therapy services cost a $25 copay with no coinsurance, psychiatric care has a $20 copay with no coinsurance, and mental health sessions have no copay and no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Prominence Giveback (HMO) with no copay and no coinsurance for covered care, which includes annual physical exams, telemonitoring, and kidney disease education. Excluded sub-services that are not covered include health education, Personal Emergency Response System (PERS), medical nutrition therapy, post-discharge 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, caregiver support, additional smoking and tobacco cessation counseling, enhanced disease management, home and bathroom safety devices and modifications, and counseling services.
Hearing Services See details
Prominence Giveback (HMO) hearing services include one routine exam and fitting evaluation per year with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $0 to $1,725 up to a maximum coverage limit of $600 per ear annually, though inner ear, outer ear, over-the-ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Prominence Giveback (HMO), offering one routine eye exam and eyewear annually with no copay, no coinsurance, and no deductible. While eyeglasses, frames, contacts, and upgrades are covered up to a $200 yearly limit, other eye exam services are not covered.
Dental Services See details
Prominence Giveback (HMO) partially covers dental services, offering preventive care with no copay and no coinsurance, and comprehensive services with no copay and 10% to 50% coinsurance up to a $1,000 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Prominence Giveback (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other Part B drugs carry no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Prominence Giveback (HMO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Prominence Giveback (HMO) covers durable medical equipment and prosthetics with no copay and 20% coinsurance. Diabetic equipment is partially covered with no copay and no coinsurance, though diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Prominence Giveback (HMO) partially covers diagnostic and radiological services with prior authorization, though diagnostic procedures, lab services, and outpatient X-ray services are not covered. Covered diagnostic services have no copay and no coinsurance, while diagnostic radiological services require a minimum $100 copay with no coinsurance, and therapeutic radiological services require a copay and a 20% minimum coinsurance.
Home Health Services See details
Prominence Giveback (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required for these services.
Cardiac Rehabilitation Services See details
Prominence Giveback (HMO) covers some cardiac rehabilitation services with no copay and no coinsurance, though prior authorization is required. However, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Prominence Giveback (HMO) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Prominence Giveback (HMO) partially covers Other Services, providing a meal benefit for chronic illnesses with no copay and no coinsurance, though prior authorization is required. Acupuncture and Over-the-Counter (OTC) items are not covered.
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