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Prominence Extra Help (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Prominence Extra Help (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Prominence Extra Help (HMO) in 2025, please refer to our full plan details page.
Prominence Extra Help (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 Extra Help (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 Extra Help (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 Extra Help (HMO), 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 $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:
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Drug Coverage
The Prominence Extra Help (HMO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. After the deductible, you pay coinsurance for your prescriptions. For preferred generics, you pay 24% coinsurance at a standard pharmacy. For standard generics, you pay 25% coinsurance at a standard pharmacy. For preferred brands, you pay 50% coinsurance at a standard pharmacy. For non-preferred drugs, you pay 25% coinsurance at a standard pharmacy. For specialty tier drugs, you pay 15% coinsurance at a standard pharmacy. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Prominence Extra Help (HMO) plan provides comprehensive coverage, including inpatient and outpatient services, with varying cost-sharing. You'll find no copay for inpatient hospital stays, and a $140 copay for emergency services. The plan also includes coverage for primary care, preventive services, and dental, vision, and hearing services, with specific copays and annual maximums for certain services. Additional benefits include ambulance and transportation, home infusion, and dialysis services. While some services, such as hearing aids, and dental have copays, the plan covers services with no copays, such as home health services and durable medical equipment. However, the plan does not cover services such as acupuncture, private duty nursing, or certain rehabilitation services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, there is no copay for Medicare-covered stays, and additional days, non-Medicare-covered stays, and upgrades are not covered; for Inpatient Hospital Psychiatric, additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services are covered, but Individual Sessions and Group Sessions for Outpatient Substance Abuse are not covered. Prior authorization is required for all covered services, and Outpatient Blood Services offers an enhanced benefit with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Prominence Extra Help (HMO) plan, but requires prior authorization. This plan does not specify any cost-sharing details such as copay or coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Prominence Extra Help (HMO) plan. Ground and air ambulance services have a $275 copay, with no coinsurance. Transportation services to any health-related location are covered for up to 48 one-way trips per year, and 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 under the Prominence Extra Help (HMO) plan. Emergency Services has a $140 copay, and Worldwide Emergency Coverage has a $125 copay. Worldwide Emergency Transportation is not covered, and Worldwide Urgent Coverage has a copay.
Primary Care See details
The Prominence Extra Help (HMO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, podiatry services, other health care professional services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $20 copay for routine care, while physician specialist services have a copay between $0 and $5. Individual and group sessions for mental health specialty services, and individual and group sessions for psychiatric services are not covered.
Preventive Services See details
The Prominence Extra Help (HMO) plan covers preventive services including Medicare-covered services, annual physical exams, and additional preventive services. The plan does not cover health education, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, wigs for hair loss, 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, telemonitoring services, home and bathroom safety devices, or counseling services. The plan also covers in-home safety assessments, fitness benefits, remote access technologies, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit.
Hearing Services See details
Hearing services include routine hearing exams and fitting/evaluation for hearing aids, each covered once per year, and prescription hearing aids with a maximum benefit of $600 per year per ear. Prescription hearing aids have a copay between $0 and $1725. OTC hearing aids, and prescription hearing aids for the inner and outer ear are not covered.
Vision Services See details
The Prominence Extra Help (HMO) plan covers vision services, including routine eye exams once per year. Eyewear is covered with a combined maximum benefit of $200 per year, and you are eligible for one pair of contact lenses, eyeglasses (lenses and frames), eyeglass lenses and eyeglass frames per year.
Dental Services See details
Dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered, with a maximum plan benefit of $3,000 per year. 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, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Prominence Extra Help (HMO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Prominence Extra Help (HMO) plan covers Durable Medical Equipment (DME) and Prosthetics/Medical Supplies, with no copay or coinsurance, but requires prior authorization. However, Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, and Outpatient X-Ray Services are not covered. Therapeutic Radiological Services have a copay of at most $20.00.
Home Health Services See details
Home Health Services are covered by the Prominence Extra Help (HMO) plan with no copay and no coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered but not covered in practice. Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Prominence Extra Help (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $50 per day; additional days beyond Medicare-covered SNF stays, and non-Medicare-covered stays are not covered.
Other Services See details
The Prominence Extra Help (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, or Self-Directed Personal Assistance Services. Over-the-counter items are covered, with a maximum benefit of $120.00 every month, and the plan offers nicotine replacement therapy. Meal benefits are covered with prior authorization.
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