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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 2026, 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 4.5 out of 5 stars in 2026.
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 $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $5.00. You must continue to pay paying your reduced 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 $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) Medicare prescription drug plan features an annual drug deductible of $615. Beneficiaries will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs filled at standard pharmacies or through standard mail order. For Tier 2 generic medications, standard pharmacy copays are $12 for a one-month supply and $24 for two- or three-month supplies. For higher-tier medications, costs are calculated as a percentage of the drug's cost during the initial coverage phase. Tier 3 preferred brand drugs require a 21% coinsurance, while Tier 4 non-preferred drugs carry a 49% coinsurance for both standard pharmacy and mail order. Additionally, Tier 5 specialty tier drugs require a 25% coinsurance for a one-month supply at a standard pharmacy.
Additional Benefits
The Prominence Extra Help (HMO) plan offers comprehensive medical coverage with no copay or coinsurance for primary care visits, outpatient hospital services, and home health care. For inpatient hospital stays, members pay a $50 daily copay for the first five days and no copay for days six through ninety. Emergency services require a $150 copay, which is waived if admitted, while urgently needed care is available with no copay. This plan also includes key supplemental benefits, such as preventive dental services and routine vision exams with no copay, alongside a $200 annual vision allowance and up to a $3,000 dental limit. Hearing services feature an annual routine exam with no copay and coverage for prescription hearing aids with copays up to $1,725. Additionally, members benefit from no copay on over-the-counter items, chronic illness meals, and up to 48 one-way transportation trips per year.
Inpatient Hospital See details
Prominence Extra Help (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $50 daily copay for days 1 to 5 of acute care (no copay for days 6 to 90) and no copay for psychiatric care. Prior authorization is required for these services, and upgrades, psychiatric additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Prominence Extra Help (HMO) covers outpatient hospital, ambulatory surgical center, and outpatient blood services with no copay and no coinsurance, subject to prior authorization. Outpatient substance abuse services are partially covered under this plan, as individual and group sessions are not covered.
Partial Hospitalization See details
Prominence Extra Help (HMO) covers partial hospitalization services with no copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Prominence Extra Help (HMO) covers ground and air ambulance services with a $275 copay and no coinsurance, which is waived if you are admitted to the hospital. Transportation services are partially covered, offering up to 48 one-way trips per year to plan-approved locations with no copay or coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
Prominence Extra Help (HMO) partially covers emergency services, as worldwide emergency transportation is not covered. Emergency services require a $150 copay and no coinsurance (waived if admitted to the hospital within three days), urgently needed services have no copay or coinsurance, and worldwide emergency and urgent services are covered up to a $25,000 maximum.
Primary Care See details
Prominence Extra Help (HMO) covers primary care, therapies, podiatry, and telehealth with no copay and no coinsurance, while specialist visits require a $0 to $5 copay and no coinsurance. Chiropractic care is partially covered with no copay and no coinsurance, though other chiropractic services are not covered. Some mental health and psychiatric services are covered with no copay and no coinsurance, but individual and group sessions are not covered.
Preventive Services See details
Preventive services are partially covered under the Prominence Extra Help (HMO) plan with no copay and no coinsurance for covered care such as annual physical exams, kidney disease education, and memory fitness. However, the plan does not cover health education, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety modifications, or counseling.
Hearing Services See details
Prominence Extra Help (HMO) partially covers hearing services, offering one routine hearing exam and fitting evaluation per year with no copay and no coinsurance. Prescription hearing aids feature no coinsurance and copays ranging from $0 to $1,725 with a $600 maximum coverage limit per ear yearly, though OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Prominence Extra Help (HMO), as other eye exam services are not covered. Covered benefits have no deductible, no copay, and no coinsurance, providing one routine eye exam and up to a $200 annual allowance for contacts or eyeglasses.
Dental Services See details
Prominence Extra Help (HMO) partially covers dental services up to an annual maximum of $3,000, offering preventive care with no copay and no coinsurance. Covered comprehensive services also have no copay but require a 10% to 50% coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Prominence Extra Help (HMO) with no copay, though prior authorization is required. Under this plan, Medicare Part B chemotherapy, radiation, and other drugs require a coinsurance ranging from no coinsurance up to 20%, while Part B insulin is covered with a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Prominence Extra Help (HMO) plan with no copay and a 20% coinsurance, subject to prior authorization.
Medical Equipment See details
Prominence Extra Help (HMO) covers durable medical equipment with no copay and no coinsurance, though prior authorization is required. For prosthetics, medical supplies, and diabetic equipment, some services are covered, but prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by Prominence Extra Help (HMO), requiring prior authorization with no coinsurance for covered options. While diagnostic procedures, lab services, diagnostic radiological services, and outpatient X-rays are not covered, therapeutic radiological services are covered with a minimum $20 copay and no coinsurance.
Home Health Services See details
Home Health Services are covered under the Prominence Extra Help (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Prominence Extra Help (HMO) plan, meaning there is no coverage for cardiac, intensive cardiac, pulmonary, or SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Prominence Extra Help (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $50 copay for days 21 through 100. Prior authorization is required, and while a prior three-day hospital stay is not required, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Prominence Extra Help (HMO) partially covers other services, offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture, Naloxone, and other additional services are not covered under this plan.
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