Prominence Extra Help (HMO)

Prominence Extra Help (HMO) is a HMO plan offered by Prominence Healthfirst of Texas available for the 2026 plan year 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.

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:

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.

Plan Providers

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpring^SM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.