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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 South 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 $185.00. 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 $7500.00 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 drug deductible, meaning your prescription coverage begins immediately. Beneficiaries enjoy no copay for Tier 1 preferred generic and Tier 6 select care drugs at standard pharmacies and through standard mail order. Tier 2 generic medications are also highly affordable, costing a $15 copay for a one-month supply or a $30 copay for a three-month supply. For higher-tier medications, costs are structured as coinsurance at standard pharmacies and mail order services. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 50% coinsurance. Specialty drugs under Tier 5 require a 33% coinsurance for a one-month supply at standard pharmacies.
Additional Benefits
The Prominence Giveback (HMO) plan offers robust medical coverage featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits require a $45 copay, while inpatient hospital stays charge a daily copay for the first several days before shifting to no copay. Emergency room care is covered with a $115 copay, which is waived if you are admitted to the hospital. For supplemental care, members benefit from routine vision and hearing exams with no copay, as well as allowances for eyewear and hearing aids. Preventive dental services are available with no copay, while comprehensive dental care requires a 10% to 50% coinsurance up to a $1,000 annual maximum. Other essential needs, such as durable medical equipment and dialysis, are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Prominence Giveback (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, but does not cover additional days, upgrades, or non-Medicare-covered stays. Acute care requires a $325 daily copay for days 1 through 6 and no copay for days 7 through 90, while psychiatric care requires a $330 daily copay for days 1 through 5 and no copay for days 6 through 90.
Outpatient Services See details
Prominence Giveback (HMO) covers outpatient hospital services with a $25 to $200 copay, observation services with a $295 copay per stay, and ambulatory surgical center services with a $25 copay, all with no coinsurance. Outpatient blood services feature no copay or coinsurance, and while some outpatient substance abuse services are covered with no copay or coinsurance, individual and group sessions are not covered.
Partial Hospitalization See details
Prominence Giveback (HMO) covers partial hospitalization services with no copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services under the Prominence Giveback (HMO) plan cover Medicare-approved ground and air ambulance services with a $325 copay and no coinsurance, which is waived if you are admitted to the hospital. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Prominence Giveback (HMO) emergency services are partially covered because worldwide emergency transportation is not covered. Covered emergency care has a $115 copay and urgently needed services have a $35 copay (both with no coinsurance and copays waived if admitted within 3 days), while worldwide emergency and urgent care are covered up to $25,000 with no coinsurance and copays of $115 and $30 respectively.
Primary Care See details
Prominence Giveback (HMO) covers primary care and telehealth with no copay and no coinsurance, specialist visits for a $45 copay and no coinsurance, and therapy services (physical, occupational, speech) for a $25 copay and no coinsurance. Mental health services have no copay and no coinsurance, psychiatric services require a $20 copay and no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by Prominence Giveback (HMO) with no copay and no coinsurance, though some additional preventive benefits are only partially covered. Excluded sub-services include health education, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by Prominence Giveback (HMO), featuring one routine hearing exam and fitting evaluation per year with no copay and no coinsurance. Prescription hearing aids are covered up to $600 per ear annually with no coinsurance and copays ranging from no copay to $1,725, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Prominence Giveback (HMO) vision services are partially covered, excluding other eye exam services but offering one routine eye exam per year with no copay, no coinsurance, and no deductible. Covered eyewear, including contacts, frames, and lenses, also features no copay or coinsurance up to a $200 combined maximum benefit limit every year.
Dental Services See details
Dental services are partially covered by Prominence Giveback (HMO) up to a $1,000 annual maximum. Preventive and diagnostic benefits feature no copay and no coinsurance, while covered comprehensive services require no copay and 10% to 50% coinsurance; however, 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. Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Prominence Giveback (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Prominence Giveback (HMO) covers durable medical equipment and prosthetics with no copay and a 20% coinsurance, subject to prior authorization. Diabetic equipment is covered with no copay and no coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Prominence Giveback (HMO) diagnostic and radiological services are partially covered and require prior authorization, featuring covered diagnostic services with no copay and no coinsurance. Diagnostic radiological services require a minimum $100 copay, while therapeutic radiological services have a minimum 20% coinsurance. Diagnostic procedures, lab services, and outpatient X-ray services are not covered under this plan.
Home Health Services See details
Prominence Giveback (HMO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Prominence Giveback (HMO) with no copay and no coinsurance, though prior authorization is required. While some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Prominence Giveback (HMO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization is required, and the plan does not cover additional days beyond the standard Medicare-covered limit.
Other Services See details
Other services are partially covered by the Prominence Giveback (HMO) plan, featuring over-the-counter (OTC) items and a chronic illness meal benefit with no copay and no coinsurance. Acupuncture, Naloxone OTC items, and other miscellaneous services are not covered, and the meal benefit requires prior authorization.
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