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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 2025, 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 out of 5 stars in 2025.
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 $18.30. 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 $590.00 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 $9350.00 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 has a $590.00 deductible for prescription drugs. After the deductible is met, you will pay coinsurance based on the drug tier and pharmacy type. During the initial coverage phase, you will pay coinsurance for your prescriptions. Preferred Generic drugs have a 21% coinsurance at a standard pharmacy. Standard Generic drugs have a 25% coinsurance at a standard pharmacy. Preferred Brand drugs have a 40% coinsurance at a standard pharmacy. Non-Preferred drugs have a 25% coinsurance at a standard pharmacy, and Specialty Tier drugs have a 15% coinsurance at a standard pharmacy. Once your total drug costs reach $2000.00, you enter the next coverage phase.
Additional Benefits
The Prominence Dual (HMO D-SNP) plan offers a wide range of benefits, including coverage for inpatient and outpatient services, with coinsurance typically set at 20%. Emergency, primary care, hearing, vision, and dental services are included. This plan also covers ambulance and transportation services, preventive services, home health services, and medical equipment. You can expect coverage for prescription hearing aids up to $3000 every year, as well as a maximum of $500 per year for vision eyewear. Dental services are covered up to a maximum of $4,000 per year. The plan also offers a monthly over-the-counter benefit of $180.00.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered and require prior authorization. The plan follows the Medicare-defined cost share for tier 1, but the specific copay and coinsurance details are not provided. Additional days, non-Medicare covered stays, and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services and observation services with a 20% coinsurance. Ambulatory Surgical Center (ASC) Services, Individual Sessions for Outpatient Substance Abuse, and Group Sessions for Outpatient Substance Abuse are also covered with a minimum coinsurance of 20% and a maximum coinsurance of 20%. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Prominence Dual (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Prominence Dual (HMO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and there is no copay. Transportation services to a plan-approved health-related location are covered for up to 48 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by Prominence Dual (HMO D-SNP). Emergency Services and Urgently Needed Services have a 20% coinsurance, while Worldwide Emergency Coverage has a $125 copay, and Worldwide Urgent Coverage and Worldwide Emergency Transportation have a 20% coinsurance.
Primary Care See details
The Prominence Dual (HMO D-SNP) plan covers Primary Care Physician Services with a 20% coinsurance, Chiropractic Services with a 20% coinsurance and a $20 copay for routine care (limited to 12 visits per year), Occupational Therapy Services with a 20% coinsurance, Physician Specialist Services with a 20% coinsurance, and Mental Health Specialty Services with a 20% coinsurance. The plan also covers Podiatry Services with a 20% coinsurance (12 visits per year), Other Health Care Professional services and Psychiatric Services with a 20% coinsurance, Physical Therapy and Speech-Language Pathology Services with a 20% coinsurance, Additional Telehealth Benefits with 0% to 20% coinsurance, and Opioid Treatment Program Services with a 20% coinsurance.
Preventive Services See details
The Prominence Dual (HMO D-SNP) plan covers preventive services, including an annual physical exam, in-home safety assessments, personal emergency response systems, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, EKG following a Welcome Visit, and fitness benefits. Health Education, 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 Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services, including routine hearing exams and fitting/evaluation for hearing aids, are covered by Prominence Dual (HMO D-SNP). Routine hearing exams have a coinsurance of at most 20% and are limited to 1 visit every six months, while fitting/evaluation for hearing aids has no coinsurance and is unlimited. Prescription hearing aids are covered with a maximum benefit of $3000 every year; the copay for prescription hearing aids (all types) is between $0 and $1725. Over-the-counter hearing aids are not covered.
Vision Services See details
The Prominence Dual (HMO D-SNP) plan covers vision services, including eye exams with 20% coinsurance, and eyewear with a combined maximum benefit of $500 every year. The plan also covers one pair of contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames per year, as well as upgrades.
Dental Services See details
The Prominence Dual (HMO D-SNP) plan covers dental services, including oral exams (2 per year), dental x-rays (2 per year), other diagnostic dental services (1 every three years), prophylaxis (cleaning) (2 per year), fluoride treatment (2 per year), other preventive dental services (1 per year), restorative services (1 per year), adjunctive general services (unlimited), endodontics (unlimited), periodontics (2 per year), prosthodontics, removable (once per arch per 5 years or once per arch per year depending on service), prosthodontics, fixed (once per arch per 5 years), and oral and maxillofacial surgery (unlimited), up to a maximum of $4,000 per year. However, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. The plan covers Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and also covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Prominence Dual (HMO D-SNP) plan, but require prior authorization. There is a 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered by the Prominence Dual (HMO D-SNP) plan, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Diabetic Equipment is also covered with a coinsurance of 20% for Medicare-covered Diabetic Supplies and Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, each with a coinsurance of at most 20% and no copay, while diagnostic procedures/tests are not covered. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Prominence Dual (HMO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Prominence Dual (HMO D-SNP) plan. Prior authorization is required for this benefit, but none of the specific services are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under Prominence Dual (HMO D-SNP), but the plan does not offer additional days beyond Medicare coverage, and non-Medicare-covered stays are not covered. Prior authorization is required, and the coinsurance information is available in the plan details.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and a Meal Benefit. 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 are not covered. Over-the-counter items have a maximum benefit of $180.00 per month.
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