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Prominence Dual (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Prominence Dual (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Prominence Dual (HMO D-SNP) in 2026, please refer to our full plan details page.
Prominence Dual (HMO D-SNP) is a HMO D-SNP 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 4.5 out of 5 stars in 2026.
It's important to know that Prominence Dual (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Prominence Dual (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Prominence Dual (HMO D-SNP).
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 Dual (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.20. 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 $9250.00 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 Dual (HMO D-SNP) plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 (Preferred Generic) and Tier 6 (Select Care Drugs) at standard pharmacies or through standard mail order. For Tier 2 (Generic) drugs, you will pay a $12 copay for a 1-month supply or a $24 copay for a 2-month or 3-month supply at standard pharmacies. Higher-tier medications require coinsurance rather than flat copays. Tier 3 (Preferred Brand) drugs require 20% coinsurance, while Tier 4 (Non-Preferred Drug) medications carry a 47% coinsurance for standard pharmacy and standard mail order options. Tier 5 (Specialty Tier) drugs require a 25% coinsurance for a 1-month supply at standard pharmacies.
Additional Benefits
The Prominence Dual (HMO D-SNP) plan offers robust healthcare coverage with no copay for most core medical services, though a 20% coinsurance typically applies to outpatient care, doctor visits, and emergency services. Inpatient hospital stays, skilled nursing facility care, and home health services are fully covered with no copay and no coinsurance. Additionally, members can access preventive dental care, vision eyewear, and over-the-counter items with no copay and no coinsurance, subject to plan limits. Routine hearing and vision exams are also available with no copay and a 20% coinsurance.
Inpatient Hospital See details
Prominence Dual (HMO D-SNP) covers inpatient acute and psychiatric hospital services with no copay and no coinsurance, although prior authorization is required. This benefit is partially covered because additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Prominence Dual (HMO D-SNP) covers outpatient services—including outpatient hospital, ambulatory surgical center, substance abuse, and blood services—with no copay and a 20% coinsurance. Prior authorization is required for these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Prominence Dual (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
Prominence Dual (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, which is waived if you are admitted to the hospital. Transportation services are partially covered with no copay and no coinsurance for up to 48 yearly one-way trips to plan-approved health-related locations, but transportation to any health-related location is not covered.
Emergency Services See details
Prominence Dual (HMO D-SNP) covers emergency services with a 20% coinsurance and no copay, and urgently needed services with a 20% coinsurance and no copay. Worldwide emergency, urgent, and transportation services are also covered up to a $25,000 limit, requiring a $115 copay and no coinsurance for emergency care, and a 20% coinsurance and no copay for urgent and transportation services.
Primary Care See details
Prominence Dual (HMO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and 20% coinsurance, while telehealth benefits range from no coinsurance to 20% coinsurance with no copay. Chiropractic services are partially covered, requiring a $20 copay and 20% coinsurance for up to 12 routine visits per year, while other chiropractic services are not covered.
Preventive Services See details
Prominence Dual (HMO D-SNP) offers partially covered preventive services with no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, in-home safety assessments, and memory fitness. However, several additional preventive services are not covered, including health education, medical nutrition therapy, weight management programs, and alternative therapies.
Hearing Services See details
Hearing services under Prominence Dual (HMO D-SNP) are partially covered, offering hearing exams with no copay and a 20% coinsurance for routine visits. Prescription hearing aids have no coinsurance with copays ranging from $0 to $1,725 up to a $3,000 annual maximum, but OTC hearing aids and inner ear, outer ear, or over the ear prescription aids are not covered.
Vision Services See details
Vision services are partially covered by Prominence Dual (HMO D-SNP), as other eye exam services are not covered, but members receive one annual routine eye exam with no copay and 20% coinsurance. Eyewear is covered with no copay, no coinsurance, and no deductible, up to a $500 annual maximum benefit for contacts, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered under the Prominence Dual (HMO D-SNP) plan, featuring no copay and no coinsurance for covered preventive and comprehensive treatments up to a $4,000 annual maximum. While many diagnostic, restorative, and surgical procedures are included, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Prominence Dual (HMO D-SNP) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs have no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin requires a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the Prominence Dual (HMO D-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Prominence Dual (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic services, with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and coverage may be limited to preferred vendors or specified manufacturers.
Diagnostic and Radiological Services See details
Prominence Dual (HMO D-SNP) covers diagnostic and radiological services with no copays, though a 20% minimum coinsurance and prior authorization are required. Diagnostic services are partially covered because lab services are covered, but diagnostic procedures and tests are not.
Home Health Services See details
Home Health Services are covered under the Prominence Dual (HMO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Prominence Dual (HMO D-SNP) with no copay, but only some services are covered in practice. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Prominence Dual (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. The plan allows for admission without a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Prominence Dual (HMO D-SNP), featuring a meal benefit for chronic illness and over-the-counter (OTC) items with no copay and no coinsurance. The OTC benefit provides up to $555 every three months via reimbursement, while acupuncture, Naloxone, and certain other services are not covered.
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