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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 2025, 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 out of 5 stars in 2025.
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 $165.00. 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 a $250.00 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 $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 has a $250 deductible for prescription drugs. After the deductible is met, your cost sharing will depend on the drug tier and pharmacy used. For drugs in the initial coverage phase, you may pay a copay of $15, $47, or $100 depending on the tier and pharmacy. For non-preferred drugs, you'll pay 30% coinsurance. Specialty tier drugs have no copay. Once your total drug costs reach $2,000, you will enter the next coverage phase.
Additional Benefits
The Prominence Giveback (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services have copays ranging from $25-$200. Ambulance services have a $325 copay, and emergency services have copays between $35 and $125. This plan covers primary care, mental health services with no copay, hearing exams, and dental services with a $1,000 annual maximum. It also includes home health services with no copay and vision benefits, including routine eye exams and eyewear. However, the plan does not cover certain services like outpatient substance abuse, transportation services, and some dental and vision services.
Inpatient Hospital See details
Inpatient Hospital-Acute has a copay of $285 for days 1-6, and no copay for days 7-90. Inpatient Hospital Psychiatric has a copay of $330 for days 1-5, and no copay for days 6-60. Additional days, non-Medicare stays, and upgrades are not covered for either benefit.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the Prominence Giveback (HMO) plan. Outpatient Hospital Services have a copay of $25-$200, Observation Services have a copay of $295 per stay, and Ambulatory Surgical Center (ASC) Services have a copay of $25. Outpatient Substance Abuse Services, including individual and group sessions, are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered with prior authorization required. There is no information about the cost of services.
Ambulance and Transportation Services See details
The Prominence Giveback (HMO) plan covers ambulance services, including ground and air ambulance, with a $325 copay for each service and no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage have a copay of $110, $35, and $125, respectively, with no coinsurance. Worldwide Urgent Coverage has a copay of $30, and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Prominence Giveback (HMO) plan covers primary care physician services, chiropractic services (with a $15 copay), occupational therapy services (with a $25 copay), physician specialist services (with a $45 copay), and physical therapy and speech-language pathology services (with a $25 copay). This plan also covers individual and group sessions for mental health and psychiatric services with no copay, and opioid treatment program services with a $10 copay. Additionally, this plan does not cover routine chiropractic care or podiatry services.
Preventive Services See details
The Prominence Giveback (HMO) plan covers preventive services including annual physical exams, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs with no copay. Additional preventive services are covered, but require prior authorization, and the plan does not cover health education, personal emergency response systems, medical nutrition therapy, post discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, 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, additional smoking cessation counseling, enhanced disease management, home and bathroom safety devices, or counseling services.
Hearing Services See details
Hearing Services include routine hearing exams and fitting/evaluation for hearing aids, with one visit covered per year, and prescription hearing aids with a maximum plan benefit of $600 per year, and no copay for prescription hearing aids (all types) up to $1725. Inner ear, outer ear, and over the ear prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams, eyewear, and upgrades, with no deductible. Routine eye exams are limited to one per year. Eyewear has a combined maximum benefit of $200 per year and includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, all limited to one per year.
Dental Services See details
Dental services are covered, with a maximum benefit of $1,000 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services are covered, along with restorative services with a copay of $50-$100, adjunctive general services with a copay of $0-$50, endodontics with a $100 copay, periodontics with a copay of $0-$100, prosthodontics (removable) with a copay of $50-$100, prosthodontics (fixed) and oral and maxillofacial surgery with a copay of $50-$100, and implant services. 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 between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Prominence Giveback (HMO) plan, but require prior authorization. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance; however, DME for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Prominence Giveback (HMO) plan. Diagnostic services do not have a copay, but Diagnostic Procedures/Tests and Lab Services are not covered. Radiological services have a copay of up to $100 for Diagnostic Radiological Services and a coinsurance of up to 20% for Therapeutic Radiological Services, but Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Prominence Giveback (HMO) plan with no copay and no coinsurance, however, additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Prominence Giveback (HMO) plan, but the plan does not cover any specific services within the benefit. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Prominence Giveback (HMO) plan, but require prior authorization. You will have no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Prominence Giveback (HMO) plan does not cover acupuncture, over-the-counter items, 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. The plan covers meal benefits for a chronic illness, but prior authorization is required.
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