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Prominence Beyond (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Prominence Beyond (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Prominence Beyond (HMO) in 2025, please refer to our full plan details page.
Prominence Beyond (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 Beyond (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 Beyond (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 Beyond (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.
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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4150.00 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 Beyond (HMO) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you will pay a copay depending on the drug tier. For example, a standard generic drug has a $47 copay. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Prominence Beyond (HMO) plan offers a range of benefits beyond standard Medicare coverage. This includes coverage for inpatient hospital stays with a copay, outpatient services, and ambulance services. The plan also covers a variety of services with copays, such as primary care, specialist visits, hearing exams, and vision care. The plan provides dental coverage with a $4,000 annual maximum, along with coverage for home infusion, dialysis, medical equipment, and skilled nursing facility stays with varying cost-sharing. Additionally, this plan offers a quarterly over-the-counter allowance, and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $175 copay for days 1-5, and no copay for days 6-90; Inpatient Hospital Psychiatric services have no copay.
Outpatient Services See details
Outpatient Services includes coverage for Outpatient Hospital Services and Observation Services with a $100 copay, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services. Outpatient Substance Abuse Services are partially covered, with Individual and Group Sessions not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by Prominence Beyond (HMO), with no copay. Prior authorization is required for coverage.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Prominence Beyond (HMO) plan, with a $175 copay for both ground and air ambulance services. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by Prominence Beyond (HMO) and include a $140 copay, with no coinsurance. Worldwide Emergency Coverage has a $125 copay, and Worldwide Urgent Coverage has no copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic Services have a $10 copay, while Routine Chiropractic Care has a $20 copay. Physician Specialist Services have a $45 copay. Physical Therapy and Speech-Language Pathology Services have a $5 copay. Individual and Group Sessions for Mental Health Specialty Services, and Individual and Group Sessions for Psychiatric Services each have a $5 copay. Routine Foot Care has a $20 copay, and Medicare-covered podiatry services have a $5-$20 copay. Other Health Care Professional Services have a $0-$45 copay. Opioid Treatment Program Services have a $10 copay.
Preventive Services See details
The Prominence Beyond (HMO) plan covers preventive services, including Medicare-covered services, annual physical exams, and other preventive services, with no copay. However, health education, personal emergency response systems, 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 benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
The Prominence Beyond (HMO) plan covers hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, with 1 visit per year for each. Prescription hearing aids are covered with a maximum plan benefit of $800 per year, with a copay between $0 and $1725 for prescription hearing aids (all types). Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Prominence Beyond (HMO) plan covers vision services, including routine eye exams once per year with no copay, and eyewear with a combined maximum benefit of $500 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Prominence Beyond (HMO) covers dental services with a maximum benefit of $4,000 per year. The plan covers oral exams, dental x-rays, other diagnostic services, prophylaxis (cleaning), fluoride treatment, other preventive services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, implant services, prosthodontics, fixed, and oral and maxillofacial surgery. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance that can range from 0% to 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance that can range from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Prominence Beyond (HMO) plan, but prior authorization is required. The plan has a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits for Prominence Beyond (HMO) include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with no copay or coinsurance, but some services are not covered, including DME for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts. Prior authorization is required for all covered services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by the Prominence Beyond (HMO) plan. Diagnostic Procedures/Tests, Lab Services, and Outpatient X-Ray Services are not covered. Diagnostic Radiological Services have a copay of at most $50, and Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Prominence Beyond (HMO) plan, with no copay or coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific services Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, SET for PAD Services, and Additional Cardiac Rehabilitation Services are not covered. Prior authorization is required, and you should check the plan details for copay information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Prominence Beyond (HMO). For days 1-20, the copay is $20, and for days 21-100, the copay is $214.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and a Meal Benefit, with 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 not covered. The OTC benefit has a maximum of $135.00 every three months. The meal benefit requires prior authorization.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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