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Prominence Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Prominence Plus (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Prominence Plus (HMO) in 2026, please refer to our full plan details page.
Prominence Plus (HMO) is a HMO plan offered by Universal Health Services, Inc. available for enrollment in 2025 to people living in North Texas. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Prominence Plus (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 Plus (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 Plus (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.
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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3000.00 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 Plus (HMO) plan features a $0 drug deductible, allowing your prescription coverage to begin immediately with no out-of-pocket deductible costs. There is no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs at standard pharmacies or through standard mail order. For Tier 2 generic drugs, standard pharmacy copays are $12 for a 1-month supply and $24 for a 2-month or 3-month supply, which matches the 3-month standard mail order cost. For higher-tier medications, Tier 3 preferred brands have a standard pharmacy copay of $45 for a 1-month supply, while Tier 4 non-preferred drugs require a $100 copay. Standard 3-month supplies and standard mail orders cost $135 for Tier 3 and $300 for Tier 4. Specialty medications in Tier 5 are subject to a 33% coinsurance for a 1-month supply at standard pharmacies.
Additional Benefits
The Prominence Plus (HMO) plan offers comprehensive medical coverage with predictable costs, featuring no copay and no coinsurance for primary care visits, preventive services, home health care, and cardiac rehabilitation. For specialized care, members pay a low $25 copay for specialist visits and no coinsurance, while emergency room visits incur a $150 copay that is waived if admitted to the hospital. Inpatient hospital stays are also covered with no coinsurance, requiring daily copays for the first five days of acute or psychiatric stays and no copay for subsequent days. This plan also includes key supplemental benefits like dental, vision, hearing, and transportation to help members stay healthy. Preventive dental care, routine eyewear, and over-the-counter items are covered with no copay, while comprehensive dental and hearing services require low cost-sharing. Additionally, members can access up to 96 one-way trips per year to plan-approved locations with no copay and no coinsurance.
Inpatient Hospital See details
Prominence Plus (HMO) partially covers inpatient hospital services with no coinsurance, requiring prior authorization for both acute and psychiatric stays. Acute stays incur a $75 daily copay for days 1 to 5 and no copay for subsequent unlimited days, while psychiatric stays require a $330 daily copay for days 1 to 5 and no copay for days 6 to 90; however, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Prominence Plus (HMO) covers outpatient services with no coinsurance, though prior authorization is required for most treatments. Patients will pay a copay of $25 to $350 for outpatient hospital services ($125 per stay for observation), $25 for ambulatory surgical center visits, $10 for substance abuse sessions, and no copay for outpatient blood services.
Partial Hospitalization See details
Prominence Plus (HMO) covers partial hospitalization services with a $55 copay and no coinsurance. Prior authorization may be required for some of these covered services.
Ambulance and Transportation Services See details
Prominence Plus (HMO) covers ground and air ambulance services with a $250 copay and no coinsurance, with the copay waived if you are admitted to the hospital. Transportation services are partially covered with no copay or coinsurance for up to 96 one-way trips per year to plan-approved health-related locations, while transportation to any health-related location is not covered.
Emergency Services See details
Prominence Plus (HMO) covers emergency services with a $150 copay and urgently needed services with a $30 copay, with no coinsurance for either service and copays waived if admitted to the hospital within three days. Worldwide emergency services are partially covered up to a $25,000 maximum, offering a $150 copay for emergency care and a $30 copay for urgent care with no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Prominence Plus (HMO) provides primary care physician services and telehealth benefits with no copay and no coinsurance, while specialist visits require a $25 copay and no coinsurance. Other covered services like physical, occupational, and mental health therapies have copays ranging from $5 to $10 with no coinsurance, though podiatry and routine chiropractic services are not covered.
Preventive Services See details
Prominence Plus (HMO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are partially covered with no copay and no coinsurance under prior authorization, excluding health education, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, tobacco cessation, disease management, home safety modifications, and counseling.
Hearing Services See details
Prominence Plus (HMO) provides partially covered hearing services, including one annual routine exam and fitting for a $10 copay and no coinsurance, with no deductible. Prescription hearing aids are covered with no coinsurance and copays ranging from no copay up to $1,725 (with a $600 annual maximum benefit per ear), but OTC hearing aids and inner ear, outer ear, or over the ear prescription aids are not covered.
Vision Services See details
Prominence Plus (HMO) vision services are partially covered, featuring a $30 copay and no coinsurance for one routine eye exam per year, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, offering a $225 yearly maximum benefit for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Prominence Plus (HMO) dental services are partially covered, offering no copay and no coinsurance for preventive care, and no copay with 10% to 50% coinsurance for comprehensive care up to a $2,000 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered under the plan.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Prominence Plus (HMO) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the Prominence Plus (HMO) plan with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Prominence Plus (HMO) partially covers medical equipment with no copay and a 20% coinsurance, requiring prior authorization for most services. While durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes are covered, diabetic supplies are not covered under this benefit.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered under Prominence Plus (HMO) with prior authorization required, though diagnostic procedures, lab services, and outpatient X-ray services are not covered. Covered diagnostic radiological services require a $60 minimum copay and no coinsurance, while therapeutic radiological services require both a copay and a 20% minimum coinsurance.
Home Health Services See details
Home Health Services are covered under the Prominence Plus (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Prominence Plus (HMO) with no copay and no coinsurance, subject to prior authorization. While some services are covered, standard 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) care is covered by Prominence Plus (HMO) with no coinsurance, requiring a $20 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not needed for admission, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Prominence Plus (HMO) partially covers Other Services, which excludes acupuncture but includes over-the-counter (OTC) items and a chronic illness meal benefit. Both covered services feature no copay and no coinsurance, with OTC items offering up to $95 every three months via reimbursement and the meal benefit requiring prior authorization.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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