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Prominence Giveback (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Prominence Giveback (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Prominence Giveback (HMO) in 2026, please refer to our full plan details page.
Prominence Giveback (HMO) is a HMO plan offered by Universal Health Services, Inc. available for enrollment in 2025 to people living in North Texas. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Prominence Giveback (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 Giveback (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 Giveback (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 $130.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6200.00 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 Giveback (HMO) plan features a $0 prescription drug deductible, allowing your coverage to start on day one. You will pay no copay for Tier 1 preferred generic and Tier 6 select care drugs at standard pharmacies and through standard mail order. For Tier 2 generic drugs, the plan charges a $15 copay for a one-month supply and a $45 copay for a three-month supply at standard pharmacies. For higher-tier medications, costs are based on coinsurance instead of flat copays. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 50% coinsurance at standard pharmacies and through standard mail order. Specialty drugs under Tier 5 are available with a 33% coinsurance for a one-month supply.
Additional Benefits
The Prominence Giveback (HMO) plan offers comprehensive medical coverage with no copay or coinsurance for primary care provider visits, telehealth, and annual preventive exams. For specialized care, members pay a $45 copay for specialist visits, while outpatient hospital services require a $25 to $350 copay with no coinsurance. Inpatient hospital stays require a $250 daily copay for the first six days and no copay for days seven through ninety. This plan also features valuable additional benefits, including home health services with no copay and dental coverage up to a $1,000 annual maximum with no copay for preventive care. Vision benefits provide a $200 annual allowance for eyewear with no copay, while routine hearing exams require a $10 copay. Emergency services are covered with a $130 copay, which is waived if you are admitted to the hospital.
Inpatient Hospital See details
Prominence Giveback (HMO) covers inpatient acute hospital stays with no coinsurance, requiring a $250 daily copay for days 1 to 6 and no copay for days 7 to 90. Inpatient psychiatric care is covered with no coinsurance at a $330 daily copay for days 1 to 5 and no copay thereafter, though prior authorization is required and additional days, upgrades, or non-Medicare-covered stays are not covered.
Outpatient Services See details
Prominence Giveback (HMO) covers outpatient hospital services with a $25 to $350 copay, observation services with a $295 copay per stay, and ambulatory surgical center services with a $25 copay, all with no coinsurance. Outpatient substance abuse services require a $30 copay and no coinsurance, while outpatient blood services are covered with no copay, no deductible, and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Prominence Giveback (HMO) plan with a $55.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Prominence Giveback (HMO) covers Medicare-covered ground and air ambulance services with a $325 copay and no coinsurance, which is waived if you are admitted to the hospital. Prior authorization is required for ambulance services, and transportation services are not covered under this plan.
Emergency Services See details
Prominence Giveback (HMO) covers emergency services with a $130 copay and urgently needed services with a $20 copay, both featuring no coinsurance and copays waived if admitted to the hospital within three days. Worldwide emergency services are partially covered up to a $25,000 maximum with no coinsurance, requiring a $130 copay for emergency care and a $30 copay for urgent care, though worldwide emergency transportation is not covered.
Primary Care See details
Prominence Giveback (HMO) offers primary care physician visits and telehealth services with no copay and no coinsurance. Other covered benefits include specialist visits for a $45 copay, therapy services for a $10 copay, and mental health sessions for a $30 copay, all with no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Prominence Giveback (HMO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are partially covered with no copay and no coinsurance under prior authorization, but exclude 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, home and bathroom safety, and counseling.
Hearing Services See details
Hearing services are covered by Prominence Giveback (HMO), offering annual routine exams and fittings for a $10 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from no copay to $1,725 up to a $600 yearly limit per ear, while OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Prominence Giveback (HMO) partially covers vision services, offering one routine eye exam per year for a $30 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance, providing up to a $200 annual maximum allowance for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Prominence Giveback (HMO) partially covers dental services up to a $1,000 annual maximum, featuring preventive care with no copay and no coinsurance, and comprehensive services with no copay and 10% to 50% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Prominence Giveback (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and a coinsurance of no coinsurance to 20%, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Prominence Giveback (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Medical equipment is covered by the Prominence Giveback (HMO) with no copay and a 20% coinsurance, though prior authorization is required. This benefit partially covers diabetic equipment, as diabetic therapeutic shoes and inserts are covered, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Prominence Giveback (HMO) partially covers diagnostic and radiological services with prior authorization, though diagnostic procedures, lab services, and outpatient X-ray services are not covered. Covered diagnostic services require no copay and no coinsurance, while diagnostic radiological services have a $125 minimum copay and therapeutic radiological services require a 20% minimum coinsurance.
Home Health Services See details
Home Health Services are covered under the Prominence Giveback (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered with no coinsurance under the Prominence Giveback (HMO) plan, though only some services are covered. Standard cardiac rehabilitation, intensive cardiac rehabilitation, and SET for PAD services are not covered and require a $20 copay, while pulmonary rehabilitation services are also not covered and require a $15 copay.
Skilled Nursing Facility (SNF) See details
Prominence Giveback (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization is required and additional days beyond standard Medicare coverage are not covered. For covered stays, you will pay a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100.
Other Services See details
Prominence Giveback (HMO) partially covers other services, offering a chronic illness meal benefit with no copay and no coinsurance, though prior authorization is required. Acupuncture and over-the-counter (OTC) items are not covered under this plan.
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