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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 2025, 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 out of 5 stars in 2025.
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 $3250.00 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 has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay different copays depending on the drug tier and the pharmacy you use. For example, you may pay $12 for a standard generic drug. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. However, you may still pay for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Prominence Plus (HMO) plan offers a wide array of benefits, including inpatient and outpatient hospital services, with varying copays depending on the service. The plan also covers primary care, preventive, hearing, vision, and dental services, with copays for exams and specific procedures. Additionally, the plan includes coverage for ambulance, emergency, and home health services, as well as durable medical equipment and home infusion services. This plan also provides coverage for partial hospitalization, cardiac rehabilitation, and skilled nursing facilities with copays. Other notable benefits include coverage for over-the-counter items and a meal benefit for chronic illnesses. However, it's important to note that certain services like routine chiropractic care, podiatry, and some dental and vision procedures are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $50 copay for days 1-5, and no copay for days 6-90, and for Inpatient Hospital Psychiatric you will pay a $330 copay for days 1-5, and no copay for days 6-60. Additional days and upgrades for Inpatient Hospital-Acute and Additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $25 and $350; observation services with a $125 copay; ambulatory surgical center services with a $25 copay; and outpatient substance abuse services, individual and group sessions, each with a $10 copay. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Prominence Plus (HMO) plan, requiring prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a $300 copay, and transportation services to plan-approved health-related locations. 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 Plus (HMO) plan. Emergency Services have a $140 copay, Urgently Needed Services have a $30 copay, and Worldwide Emergency Coverage has a $125 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Prominence Plus (HMO) plan covers primary care physician services, chiropractic services with a $10 copay, occupational therapy services with a $5 copay, physician specialist services with a $20 copay, and physical therapy and speech-language pathology services with a $10 copay. The plan also covers mental health specialty services, psychiatric services, opioid treatment program services with a $10-$10 copay, and additional telehealth benefits, with varying copays for individual and group sessions. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Prominence Plus (HMO) plan covers preventive services including Medicare-covered services, annual physical exams, and additional preventive services, with some services requiring prior authorization, and some services not covered. Additional covered services include In-Home Safety Assessment, Fitness Benefit, Telemonitoring Services, Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Other services such as Health Education, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and others are not covered.
Hearing Services See details
The Prominence Plus (HMO) plan covers hearing exams for a $10 copay, as well as fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with a maximum plan benefit of $600 per year and a copay between $0 and $1725. OTC hearing aids, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
The Prominence Plus (HMO) plan covers vision services, including eye exams with a $30 copay. Eyewear benefits are also covered, with a combined maximum of $200 per year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames.
Dental Services See details
The Prominence Plus (HMO) plan offers dental services with a $2,000 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventative dental services are covered, with varying limits on the number of visits per year. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with copays ranging from $0 to $100. Maxillofacial prosthetics and orthodontics are not covered, and implant services are offered as an optional, supplemental benefit.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay with 0-20% coinsurance; for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Prominence Plus (HMO) plan, with a coinsurance between 20% and 20%. Prior authorization is required for coverage.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies and Services are covered, with a coinsurance for Medicare-covered Diabetic Supplies. Diabetic Supplies are not covered, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Prominence Plus (HMO) plan. Diagnostic procedures/tests and lab services are not covered, but there is no copay for diagnostic services. Radiological services are covered, with a copay of at most $60 for diagnostic radiological services and coinsurance of at most 20% for therapeutic radiological services; outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered by the Prominence Plus (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Prominence Plus (HMO) plan, but the specific services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for these services, and there is a copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Prominence Plus (HMO) plan, but require prior authorization. For days 1-20, there is a $20 copay, and for days 21-100, there is a $214 copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Prominence Plus (HMO) plan does not cover 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. The plan covers Over-the-Counter (OTC) items with a maximum benefit of $85.00 every three months, including Nicotine Replacement Therapy (NRT). The plan also covers a Meal Benefit for chronic illness with prior authorization, but does not have a maximum coverage amount.
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