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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 2026, 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 4.5 out of 5 stars in 2026.
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 a $100.00 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 $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) Medicare plan features an annual drug deductible of $100. Beneficiaries enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs at standard pharmacies and through standard mail order. Tier 2 generic drugs are also highly affordable, with a $12 copay for a 1-month supply and a $24 copay for 2-month or 3-month supplies. For brand name and specialty medications, Tier 3 preferred brand drugs have a $47 copay for a 1-month supply, while Tier 4 non-preferred drugs carry a $100 copay for 1 month. Tier 5 specialty drugs require a 31% coinsurance for a 1-month supply at standard pharmacies. Three-month mail-order options are also available for Tier 2, 3, and 4 drugs to help manage long-term prescription costs.
Additional Benefits
The Prominence Beyond (HMO) plan offers robust healthcare coverage with no copays for primary care visits, telehealth services, and annual routine preventive care, while specialist visits require a 45 dollar copay. For hospital care, inpatient stays feature a 215 dollar daily copay for days one through five and no copay for days six through 90, while outpatient services carry a 100 dollar copay per stay. Emergency room visits require a 150 dollar copay, which is waived if you are admitted, and urgent care services are available with no copay. This plan also provides valuable supplemental benefits, including dental care with no copay for preventive services and an annual benefit maximum of 4000 dollars. Vision and hearing benefits feature no copays for routine annual exams, alongside up to a 500 dollar allowance for eyewear and partial coverage for prescription hearing aids. Additionally, members receive a 115 dollar quarterly over-the-counter reimbursement and home health services with no copay.
Inpatient Hospital See details
Prominence Beyond (HMO) covers inpatient acute hospital stays with no coinsurance, featuring a $215 daily copay for days 1 through 5 and no copay for days 6 through 90, while inpatient psychiatric stays are covered with no copay and no coinsurance. Prior authorization is required for these services, and upgrades or non-Medicare-covered stays are not covered.
Outpatient Services See details
Prominence Beyond (HMO) covers outpatient hospital and observation services with a $100 copay per stay and no coinsurance, while Ambulatory Surgical Center (ASC) and outpatient blood services require no copay and no coinsurance. Some outpatient substance abuse services are covered with no copay and no coinsurance, but individual and group sessions are not covered.
Partial Hospitalization See details
Prominence Beyond (HMO) covers partial hospitalization services with no copay and no coinsurance, though prior authorization is required for these services.
Ambulance and Transportation Services See details
Prominence Beyond (HMO) covers Medicare-approved ground and air ambulance services with a $175 copay and no coinsurance, with the copay waived if you are admitted to the hospital. Prior authorization is required for ambulance services, and transportation services to health-related locations are not covered.
Emergency Services See details
Prominence Beyond (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within three days, and urgently needed services with no copay or coinsurance. Worldwide emergency services are partially covered up to a $25,000 maximum with no coinsurance, featuring a $150 copay for emergency care and no copay for urgent care, while worldwide emergency transportation is not covered.
Primary Care See details
Prominence Beyond (HMO) offers primary care physician and telehealth services with no copay and no coinsurance, while specialist visits require a $45 copay and no coinsurance. Other covered services like physical therapy, mental health, and podiatry have copays ranging from $5 to $10 with no coinsurance, though chiropractic care is only partially covered as non-routine chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by Prominence Beyond (HMO) with no copay and no coinsurance for annual physicals, kidney disease education, glaucoma screenings, diabetes training, digital rectal exams, and post-welcome visit EKGs. Additional preventive benefits are partially covered with no copay and no coinsurance (prior authorization required) for memory fitness, telemonitoring, remote access, and in-home safety assessments. Sub-services not covered under this plan include health education, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home palliative care, in-home support, caregiver support, additional tobacco cessation, enhanced disease management, home safety modifications, and counseling.
Hearing Services See details
Hearing services are covered by Prominence Beyond (HMO), offering annual routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $0 to $1,725 up to an $800 maximum coverage limit per ear annually, though OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by Prominence Beyond (HMO), offering one routine eye exam per year with no copay, no coinsurance, and no deductible, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible up to a $500 combined maximum annual benefit for contact lenses, eyeglasses, and upgrades.
Dental Services See details
Prominence Beyond (HMO) offers partially covered dental services with an annual maximum benefit of $4,000, excluding maxillofacial prosthetics, implant services, and orthodontics. Medicare-covered, preventive, and diagnostic dental services have no copay and no coinsurance, while covered comprehensive services require no copay and 10% to 50% coinsurance.
Home Infusion bundled Services See details
Prominence Beyond (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, such as chemotherapy and radiation, carry no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and coinsurance from no coinsurance to 20%.
Dialysis Services See details
Prominence Beyond (HMO) covers dialysis services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Prominence Beyond (HMO) covers durable medical equipment with no copay and a 20% coinsurance, though prior authorization is required. While some prosthetics, medical supplies, and diabetic equipment services are covered with no copay and no coinsurance, specific items including prosthetic devices, medical supplies, diabetic supplies, and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Prominence Beyond (HMO) with prior authorization required. Diagnostic services feature no copay and no coinsurance, though lab services, diagnostic procedures, tests, and outpatient X-ray services are not covered. Covered diagnostic radiological services require a minimum $50 copay, while therapeutic radiological services require a copay and a minimum 20% coinsurance.
Home Health Services See details
Prominence Beyond (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Prominence Beyond (HMO) covers some cardiac rehabilitation services with no coinsurance and a $10 copay, subject to prior authorization. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy for symptomatic peripheral artery disease services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Prominence Beyond (HMO) with no coinsurance, requiring a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day hospital stay is not needed, additional days beyond the standard 100-day benefit are not covered.
Other Services See details
Prominence Beyond (HMO) offers partially covered other services, including a meal benefit for chronic illnesses and a $115 quarterly over-the-counter (OTC) reimbursement with no copay and no coinsurance. Acupuncture, Naloxone, and other miscellaneous services are not covered, and prior authorization is required for the meal benefit.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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