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Prominence Diabetes and Heart Care Plus (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Prominence Diabetes and Heart Care Plus (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 Care Plus (HMO C-SNP) in 2026, please refer to our full plan details page.
Prominence Diabetes and Heart Care Plus (HMO C-SNP) is a HMO C-SNP 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 Diabetes and Heart Care Plus (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 Care Plus (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 Care Plus (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 Care Plus (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 $5.00. 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 $100.00 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 $3400.00 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 Care Plus (HMO C-SNP) plan features an annual drug deductible of $100. Members benefit from no copay on Tier 1 preferred generic drugs and Tier 6 select care drugs filled at standard pharmacies or through standard mail order. For Tier 2 generic medications, standard pharmacy copays start at $15 for a one-month supply and go up to $45 for a three-month supply. For higher-tier medications, Tier 3 preferred brand drugs have a standard pharmacy copay of $45 for a one-month supply, while Tier 4 non-preferred drugs require a $100 copay. Tier 5 specialty drugs incur a 31% coinsurance for a one-month supply at standard pharmacies. Three-month mail order options are also available for Tiers 1 through 4 to help manage your prescription costs.
Additional Benefits
The Prominence Diabetes and Heart Care Plus (HMO C-SNP) plan offers comprehensive medical coverage with no copays and no coinsurance for primary care, preventive services, and urgent care. Specialist visits feature no copay to a $10 copay, while inpatient acute hospital stays carry a $150 copay and outpatient hospital services require a $200 copay. Emergency room visits require a $150 copay, which is waived if you are admitted to the hospital within three days. Beyond standard medical care, members enjoy valuable supplemental benefits including routine dental, vision, and hearing exams with no copays or deductibles. The plan provides a $200 annual eyewear allowance, up to 24 one-way transportation trips to plan-approved locations, and a $200 over-the-counter reimbursement every three months. Essential services like home health and durable medical equipment are also fully covered with no copays and no coinsurance.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Prominence Diabetes and Heart Care Plus (HMO C-SNP), with acute stays requiring a $150 copay and no coinsurance, and psychiatric stays requiring no copay and no coinsurance. Prior authorization is required for these services, and additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Prominence Diabetes and Heart Care Plus (HMO C-SNP) covers outpatient hospital services with a $200 copay and no coinsurance, while ambulatory surgical center and outpatient blood services require no copay and no coinsurance. For outpatient substance abuse services, some services are covered but individual and group sessions are not covered.
Partial Hospitalization See details
Prominence Diabetes and Heart Care Plus (HMO C-SNP) covers partial hospitalization services with no copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Prominence Diabetes and Heart Care Plus (HMO C-SNP) covers ground and air ambulance services with a $275 copay (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 health-related location are not covered.
Emergency Services See details
Emergency services under the Prominence Diabetes and Heart Care Plus (HMO C-SNP) are covered with a $150 copay (waived if admitted to the hospital within three days) and no coinsurance, while urgently needed services feature no copay and no coinsurance. Worldwide emergency services are partially covered up to a $25,000 maximum limit with no coinsurance, requiring a $150 copay for emergency care and a $30 copay for urgent care, though worldwide emergency transportation is not covered.
Primary Care See details
Prominence Diabetes and Heart Care Plus (HMO C-SNP) provides primary care, physical therapy, occupational therapy, and telehealth with no copay and no coinsurance, and specialist visits with a $0 to $10 copay and no coinsurance. Chiropractic services are partially covered, offering routine visits for a $20 copay and no coinsurance while other chiropractic services are not covered. Some mental health and psychiatric services are covered, but individual and group sessions are not covered.
Preventive Services See details
Preventive services under the Prominence Diabetes and Heart Care Plus (HMO C-SNP) are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive services are partially covered with no copay and no coinsurance (prior authorization required), offering select benefits like telemonitoring and personal emergency response systems, while services such as health education, weight management, and nutritional benefits are not covered.
Hearing Services See details
Prominence Diabetes and Heart Care Plus (HMO C-SNP) covers annual routine hearing exams and fitting evaluations with no copay, no coinsurance, and no deductible. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $0 to $1,725 up to a $600 annual maximum per ear, though OTC hearing aids as well as prescription inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Vision services are covered by Prominence Diabetes and Heart Care Plus (HMO C-SNP) with no copay, no coinsurance, and no deductible, though the benefit is partially covered because other eye exam services are not covered. Eligible members receive one routine eye exam per year and a $200 annual maximum allowance for eyewear, which covers one pair of contact lenses or eyeglasses.
Dental Services See details
Dental services are partially covered by the Prominence Diabetes and Heart Care Plus (HMO C-SNP) plan, offering preventive care with no copay and no coinsurance, and comprehensive care with no copay and 10% to 50% coinsurance up to a $3,000 annual limit. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Prominence Diabetes and Heart Care Plus (HMO C-SNP) covers home infusion bundled services with no copay, subject to prior authorization and step therapy. Covered Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Prominence Diabetes and Heart Care Plus (HMO C-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Prominence Diabetes and Heart Care Plus (HMO C-SNP) covers durable medical equipment with no copay and no coinsurance, although prior authorization is required. While some medical equipment services are covered, prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered in practice.
Diagnostic and Radiological Services See details
Prominence Diabetes and Heart Care Plus (HMO C-SNP) partially covers diagnostic and radiological services with prior authorization required, offering diagnostic services with no copayment and no coinsurance, though diagnostic procedures, tests, and lab services are not covered. Covered therapeutic radiological services require a 20% coinsurance and no copayment, while diagnostic radiological and outpatient X-ray services are not covered.
Home Health Services See details
Prominence Diabetes and Heart Care Plus (HMO C-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Prominence Diabetes and Heart Care Plus (HMO C-SNP) with no copay and no coinsurance, though prior authorization is required. While some services are covered, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Prominence Diabetes and Heart Care Plus (HMO C-SNP) covers Skilled Nursing Facility (SNF) stays with no coinsurance and no required prior three-day hospital stay, though prior authorization is necessary. There is no copay for days 1 through 20 and a $50 daily copay for days 21 through 100, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Prominence Diabetes and Heart Care Plus (HMO C-SNP) partially covers other services, providing over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance, while acupuncture is not covered. The OTC benefit offers up to $200 every three months via reimbursement, and the meal benefit 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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