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Prominence Diabetes and Heart (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Prominence Diabetes and Heart (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Prominence Diabetes and Heart (HMO C-SNP) in 2025, please refer to our full plan details page.
Prominence Diabetes and Heart (HMO C-SNP) is a HMO C-SNP 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 out of 5 stars in 2025.
It's important to know that Prominence Diabetes and Heart (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Prominence Diabetes and Heart (HMO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Prominence Diabetes and Heart (HMO C-SNP).
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 Diabetes and Heart (HMO C-SNP), 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 $3100.00 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 Diabetes and Heart (HMO C-SNP) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay different copays depending on the drug tier and pharmacy. For example, you'll pay a $15 copay for preferred generic drugs at a standard pharmacy, while specialty tier drugs have no copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. However, you may still have to pay for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Prominence Diabetes and Heart (HMO C-SNP) plan offers a wide variety of benefits with varying costs. You can expect copays for services like primary care, specialist visits, and outpatient services, while some services like preventive care and home health services have no copay. The plan also includes coverage for hearing, vision, and dental services, with specific limits on the types of services covered and annual maximums. This plan provides coverage for both inpatient and outpatient hospital stays, as well as emergency and ambulance services. It also offers additional benefits like transportation to health-related locations, and covers services like home infusion, dialysis, and medical equipment with coinsurance. Other notable benefits include coverage for over-the-counter items and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization required. For Inpatient Hospital-Acute, you'll pay a $50 copay for days 1-5, and no copay for days 6-90, while Inpatient Hospital Psychiatric has a $330 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay of $25 to $350, observation services with a $125 copay, ambulatory surgical center services with a $25 copay, outpatient substance abuse services with a $10 copay for both individual and group sessions, and outpatient blood services. Prior authorization is required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Prominence Diabetes and Heart (HMO C-SNP) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Prominence Diabetes and Heart (HMO C-SNP) plan. Ground and air ambulance services have a $300 copay, which is waived if admitted to the hospital, with no coinsurance. Transportation Services to a plan-approved health-related location are covered for up to 24 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered with a $140 copay and no coinsurance. Urgently Needed Services are covered with a $30 copay and no coinsurance. Worldwide Emergency Coverage has a $125 copay, while Worldwide Urgent Coverage has a $30 copay; Worldwide Emergency Transportation is not covered.
Primary Care See details
The Prominence Diabetes and Heart (HMO C-SNP) plan covers primary care physician services, chiropractic services with a $10 copay, occupational therapy services with a $5 copay, physician specialist services with a $0-$20 copay, mental health specialty services with a $10 copay, podiatry services with a $5-$20 copay, other health care professional services with a $0-$20 copay, psychiatric services with a $10 copay, physical therapy and speech-language pathology services with a $10 copay, additional telehealth benefits, and opioid treatment program services with a $10 copay. Routine Chiropractic care is not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, annual physical exams, and additional preventive services that require prior authorization. Additional services covered include In-Home Safety Assessment, Personal Emergency Response System (PERS), Fitness Benefit, Telemonitoring Services, Remote Access Technologies, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, while Health Education, 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 Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services includes routine hearing exams with a $10 copay, and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $0 and $1725, with a maximum plan benefit of $600 per year. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a $30 copay, as well as coverage for routine eye exams (1 per year), contact lenses (1 pair per year), eyeglasses (lenses and frames, 1 per year), eyeglass lenses (1 pair per year), and eyeglass frames (1 per year), with a combined maximum benefit of $200 per year for eyewear. Upgrades are also covered.
Dental Services See details
Dental Services are covered, with a $2,000 annual maximum. Oral exams, dental x-rays, and other preventive services are covered. Restorative services, endodontics, periodontics, prosthodontics, and oral and maxillofacial surgery are covered with copays ranging from $0 to $100. Maxillofacial prosthetics and orthodontics are not covered, and implant services are offered as a supplemental benefit.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, with coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered and require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
The Prominence Diabetes and Heart (HMO C-SNP) plan covers Durable Medical Equipment with a 20% coinsurance and no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have no copay, and require prior authorization, with a 20% coinsurance for Medicare-covered Prosthetic Devices and Medical Supplies. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance and no copay, but Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered under the Prominence Diabetes and Heart (HMO C-SNP) plan. Diagnostic procedures/tests, lab services, and outpatient X-ray services are not covered. Diagnostic Radiological Services have a copay of at most $60, while Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Prominence Diabetes and Heart (HMO C-SNP) plan with no copay and no coinsurance, although prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required, and there is a copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Prominence Diabetes and Heart (HMO C-SNP) plan. For days 1-20, there is a $20 copay, and for days 21-100, there is a $214 copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under Other Services, 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 are not covered. The plan covers Over-the-Counter (OTC) Items, with a maximum benefit of $100 every three months. The plan also covers a Meal Benefit, but requires prior authorization.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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