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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 South 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 $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 (HMO C-SNP) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay for your prescriptions depending on the drug tier. For example, you will pay a $15 copay for preferred generic drugs at a standard pharmacy. 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 pay a share of the costs for excluded drugs.
Additional Benefits
The Prominence Diabetes and Heart (HMO C-SNP) plan offers a range of benefits, including inpatient hospital stays with no copay for the first 90 days, and coverage for outpatient services, ambulance, and emergency services. The plan also covers primary care, preventive services, hearing, vision, dental, home infusion, dialysis, medical equipment, diagnostic and radiological services, home health, and skilled nursing facility services. Other benefits include a quarterly allowance for over-the-counter items. This plan provides coverage for essential services, such as ambulance, emergency services, and outpatient services, with varying copays. It also offers dental, vision, and hearing benefits, providing financial assistance for exams and hearing aids. While the plan offers comprehensive coverage, some services like certain mental health treatments and home modifications are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Prominence Diabetes and Heart (HMO C-SNP) plan. For Inpatient Hospital-Acute, there is no copay for days 1-90 of your stay, and for Inpatient Hospital Psychiatric, additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient blood services are covered by the Prominence Diabetes and Heart (HMO C-SNP) plan, though prior authorization is required for all services. Outpatient substance abuse services are partially covered, but individual and group sessions for outpatient substance abuse are not covered.
Partial Hospitalization See details
Partial Hospitalization benefits are covered, but require prior authorization. There is no information about the cost of services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground and Air Ambulance Services have a $275 copay, and there is no coinsurance. Transportation Services to a plan-approved health-related location are covered for 24 one-way trips per year. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered. Emergency Services have a $140 copay, and Worldwide Emergency Coverage has a $125 copay, while Worldwide Urgent Coverage has a $30 copay; all have no coinsurance. 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, occupational therapy services, physician specialist services, podiatry services, other health care professional services, physical therapy and speech-language pathology services, additional telehealth benefits and opioid treatment program services. Routine chiropractic care has a $20 copay for 12 visits per year, while physician specialist services have a $0 - $10 copay. Mental Health Specialty Services and Psychiatric Services individual and group sessions are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with no copay, annual physical exams, and additional preventive services. This plan also covers 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. However, Health Education, Medical Nutrition Therapy (MNT), 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 include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams and fitting/evaluation for hearing aids are covered once per year. Prescription hearing aids are covered with a maximum plan benefit of $600 per ear every year, and a copay between $0 and $1725. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Prominence Diabetes and Heart (HMO C-SNP) plan covers vision services, including eye exams and eyewear. The plan covers one routine eye exam every year, and provides $200 annually for eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames.
Dental Services See details
Dental services are covered, with a maximum plan benefit of $3,000 per year. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments are covered for a limited number of visits per year, while other diagnostic dental services and other preventive dental services are also covered for a limited number of visits. Restorative services, endodontics, adjunctive general services, and oral and maxillofacial surgery are covered, while maxillofacial prosthetics and orthodontics are not covered, and implant services are an optional supplemental benefit.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, and a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Prominence Diabetes and Heart (HMO C-SNP) plan and require prior authorization. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) and Prosthetics/Medical Supplies, with no copay or coinsurance. However, Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts 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. There is no copay for any of the covered services. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, and Outpatient X-Ray Services are not covered. 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 or coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the sub-services are covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Prominence Diabetes and Heart (HMO C-SNP) plan, but require prior authorization. There is no copay for days 1-20, and a $50 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items, with a maximum benefit of $120.00 every three months, and a meal benefit that requires prior authorization. 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.
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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* 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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