A non-government entity
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 South 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 $3400.00 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:
Sign up for Prominence Plus (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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 pharmacy. For example, generic drugs have a $12 or $45 copay, while preferred brand drugs have a $100 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs. This plan may also have a reduced premium if you qualify for the low-income subsidy.
Additional Benefits
The Prominence Plus (HMO) plan offers a range of benefits, including no copay for inpatient hospital stays for the first 90 days, and coverage for ambulance services with a $275 copay. Emergency services have a $140 copay, and primary care visits range from no copay to a $20 copay, with specialist visits costing $10. This plan includes coverage for preventive services with no copay, and also covers hearing and vision services, including routine exams and eyewear. Dental services are covered up to $3,000 per year. Additionally, the plan covers home health services with no copay, skilled nursing facility stays, and offers an over-the-counter allowance and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits for Prominence Plus (HMO) include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. For Inpatient Hospital-Acute, there is no copay for days 1-90, and additional days are covered for up to 5 additional days per benefit period. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services, with prior authorization required for each. Outpatient substance abuse services are partially covered, but individual and group sessions are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Prominence Plus (HMO) plan, but requires prior authorization. There is no information available about the cost of services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including ground and air ambulance services, are covered by Prominence Plus (HMO), each with a $275 copay. Transportation services to any health-related location are covered for up to 24 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Prominence Plus (HMO) plan. Emergency Services have a $140 copay, and Worldwide Emergency Coverage has a $125 copay, while Urgently Needed Services have no copay. Worldwide Urgent Coverage has a $30 copay, and Worldwide Emergency Transportation is not covered.
Primary Care See details
The Prominence Plus (HMO) plan covers Primary Care Physician Services, Chiropractic Services with a $20 copay for routine care, Occupational Therapy Services with no copay or coinsurance, Physician Specialist Services with a $10 copay, Podiatry Services with a $20 copay, and Other Health Care Professional services with a copay between $0 and $10. The plan does not cover Individual or Group Sessions for Mental Health Specialty Services or Individual or Group Sessions for Psychiatric Services. Physical Therapy and Speech-Language Pathology Services are covered with no copay or coinsurance. Additional Telehealth Benefits and Opioid Treatment Program Services are also covered with a copay.
Preventive Services See details
The Prominence Plus (HMO) plan covers preventive services, including Medicare-covered services with no copay. Additional preventive services, such as in-home safety assessments, fitness benefits, telemonitoring services, and remote access technologies are covered. However, health education, personal emergency response systems, medical nutrition therapy, post-discharge in-home 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, support for caregivers, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing Services for Prominence Plus (HMO) includes routine hearing exams and fitting/evaluation for hearing aids, each covered once per year, as well as prescription hearing aids with a maximum benefit of $600 per year per ear and a copay ranging from $0 to $1725. Over-the-counter hearing aids, and hearing aids for the inner or outer ear are not covered.
Vision Services See details
The Prominence Plus (HMO) plan covers vision services, including eye exams with no deductible and routine eye exams once per year. Eyewear is also covered, with a combined maximum benefit of $200 every year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered once per year.
Dental Services See details
The Prominence Plus (HMO) plan offers dental services with a maximum benefit of $3,000 per year, covering oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. 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 under the Prominence Plus (HMO) plan, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay and 0-20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Prominence Plus (HMO) plan. This benefit requires prior authorization and has a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered under the Prominence Plus (HMO) plan, but specific services like Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. There is no copay or coinsurance for Durable Medical Equipment and Prosthetics/Medical Supplies - Non-Medicare benefit.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by the Prominence Plus (HMO) plan. While there is no copay for diagnostic services, diagnostic procedures/tests and lab services are not covered. Therapeutic Radiological Services have a copay of at most $20.00. Outpatient X-Ray Services and Diagnostic Radiological 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, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Prominence Plus (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $50.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and a Meal Benefit, but Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and other services are not covered. The OTC benefit provides up to $120 every three months for eligible items, and the Meal Benefit requires prior authorization.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved