A non-government entity
Prominence Diabetes and Heart Giveback (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Prominence Diabetes and Heart Giveback (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 Giveback (HMO C-SNP) in 2026, please refer to our full plan details page.
Prominence Diabetes and Heart Giveback (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 4.5 out of 5 stars in 2026.
It's important to know that Prominence Diabetes and Heart Giveback (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 Giveback (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 Giveback (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 Giveback (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. Additionally, this plan comes with a Part B Premium reduction of $50.00. 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 $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:
Sign up for Prominence Diabetes and Heart Giveback (HMO C-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Prominence Diabetes and Heart Giveback (HMO C-SNP) Medicare plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. Beneficiaries enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs at standard pharmacies and standard 3-month mail order. For Tier 2 generic medications, standard pharmacy copays are $15 for a 1-month supply, $30 for a 2-month supply, and $45 for a 3-month supply. Higher-tier medications under this plan include Tier 3 preferred brand drugs with a $45 copay for a 1-month supply and Tier 4 non-preferred drugs with a $100 copay for a 1-month supply. Specialty medications in Tier 5 require a 33% coinsurance for a 1-month supply at standard pharmacies. Standard mail-order options for a 3-month supply are also available, costing $135 for Tier 3 and $300 for Tier 4 drugs.
Additional Benefits
The Prominence Diabetes and Heart Giveback (HMO C-SNP) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care, telehealth, and preventive services. Specialist visits and therapy services require copays of up to $35 or no copay, while emergency care has a $150 copay and no coinsurance. For hospital stays, members pay a $100 daily copay for the first five days of inpatient care and no copay for days six through ninety. This plan also includes valuable supplemental benefits, such as preventive dental care with no copay and a $200 annual allowance for eyewear with no copay. Routine hearing exams are available for a $10 copay, and members receive up to 24 one-way transportation trips per year to approved locations with no copay. Additionally, the plan provides up to $115 every three months for over-the-counter items with no copay, while durable medical equipment and dialysis services require a 20% coinsurance and no copay.
Inpatient Hospital See details
Prominence Diabetes and Heart Giveback (HMO C-SNP) partially covers inpatient hospital services with no coinsurance, requiring prior authorization. Acute stays require a $100 copay for days 1 through 5 and no copay for days 6 through 90, while psychiatric stays require a $330 copay for days 1 through 5 and no copay for days 6 through 90; however, additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Prominence Diabetes and Heart Giveback (HMO C-SNP) covers outpatient services with no coinsurance, though prior authorization is required for most care. Members pay copays of $25 to $350 for outpatient hospital services, $125 per stay for observation services, $25 for ambulatory surgical center services, $10 for outpatient substance abuse sessions, and no copay for outpatient blood services.
Partial Hospitalization See details
Prominence Diabetes and Heart Giveback (HMO C-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Prominence Diabetes and Heart Giveback (HMO C-SNP) covers ground and air ambulance services with a $300 copay per trip (waived if admitted) and no coinsurance. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, though trips to any other health-related locations are not covered.
Emergency Services See details
Prominence Diabetes and Heart Giveback (HMO C-SNP) covers emergency services with a $150 copay and no coinsurance, and urgent care with a $30 copay and no coinsurance. Worldwide emergency and urgent services are partially covered up to a $25,000 limit with no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Prominence Diabetes and Heart Giveback (HMO C-SNP) offers primary care and telehealth services with no copay and no coinsurance. Specialist visits, mental health, podiatry, and physical, occupational, and speech therapies are covered with copays ranging from $0 to $35 and no coinsurance, while chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by Prominence Diabetes and Heart Giveback (HMO C-SNP) with no copay and no coinsurance, though additional preventive benefits are only partially covered. Not covered under these additional services are health education, medical nutrition therapy, medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by the Prominence Diabetes and Heart Giveback (HMO C-SNP) plan, which features routine hearing exams for a $10 copay, fitting evaluations with no copay, and no coinsurance for either service. Prescription hearing aids are covered with no coinsurance and copays ranging from no copay to $1,725 with a $600 maximum annual benefit per ear, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Prominence Diabetes and Heart Giveback (HMO C-SNP), featuring one annual routine eye exam for a $30 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing up to a $200 annual maximum allowance for contacts, eyeglasses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Prominence Diabetes and Heart Giveback (HMO C-SNP) with up to a $2,000 annual maximum, featuring no copay and no coinsurance for preventive care. Covered comprehensive services require no copay and 10% to 50% coinsurance, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Prominence Diabetes and Heart Giveback (HMO C-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy may be required. Associated Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while covered Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Prominence Diabetes and Heart Giveback (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Prominence Diabetes and Heart Giveback (HMO C-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic equipment is partially covered with no copay and a 20% coinsurance for therapeutic shoes and inserts, 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 Giveback (HMO C-SNP) plan, with prior authorization required for all covered services. Covered diagnostic services feature no copay and no coinsurance, though lab services, outpatient X-rays, and diagnostic procedures/tests are not covered. Diagnostic radiological services require a minimum $60.00 copay with no coinsurance, while therapeutic radiological services require both a copay and a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Prominence Diabetes and Heart Giveback (HMO C-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by the Prominence Diabetes and Heart Giveback (HMO C-SNP) with no coinsurance, though prior authorization is required. While some services are covered, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Prominence Diabetes and Heart Giveback (HMO C-SNP) with no coinsurance, requiring a daily copay of $20 for days 1 through 20 and $218 for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Prominence Diabetes and Heart Giveback (HMO C-SNP) partially covers other services, offering a meal benefit and over-the-counter (OTC) items with no copay and no coinsurance. The OTC benefit provides up to $115 every three months through reimbursement, while acupuncture is not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved