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Prominence Dual (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Prominence Dual (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Prominence Dual (HMO D-SNP) in 2025, please refer to our full plan details page.
Prominence Dual (HMO D-SNP) is a HMO D-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 Dual (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Prominence Dual (HMO D-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 Dual (HMO D-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 Dual (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $18.30. 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 a $590.00 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 $9350.00 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 Dual (HMO D-SNP) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. During the initial coverage phase, after the deductible, you will pay coinsurance for your prescriptions. The coinsurance depends on the drug tier, with the lowest being 15% for specialty tier drugs, and the highest being 39% for preferred brand drugs. After your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs.
Additional Benefits
The Prominence Dual (HMO D-SNP) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying coinsurance costs. You'll find coverage for primary care, preventive services, hearing, vision, and dental services with specific copays and maximum annual benefits. The plan also covers home health services and medical equipment, along with other services like OTC items and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric services, are covered, but additional days and non-Medicare-covered stays are not covered. The plan uses the Medicare-defined cost share for tier 1, with coinsurance details available in the plan documents.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient substance abuse services. Outpatient hospital and observation services have a 20% coinsurance, and outpatient substance abuse services have a 20% coinsurance for individual and group sessions. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Prominence Dual (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including ground and air ambulance, are covered by Prominence Dual (HMO D-SNP), with a 20% coinsurance for ambulance services, and no copay. Transportation Services to a plan-approved health-related location are covered for up to 48 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Urgently Needed Services have a 20% coinsurance, and Worldwide Emergency Transportation has a 20% coinsurance, while Worldwide Emergency Coverage has a $125 copay.
Primary Care See details
The Prominence Dual (HMO D-SNP) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services have a 20% coinsurance. Chiropractic Services, and Occupational Therapy Services, have a 20% coinsurance. For podiatry services, you will pay a $20 copay and a 20% coinsurance. Additional Telehealth Benefits have a coinsurance between 0-20%. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a 20% coinsurance. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered zero dollar preventive services, annual physical exams, and additional preventive services. 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, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered. Other preventive services have 20% coinsurance for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing Services include routine hearing exams with a coinsurance of at most 20% and fitting/evaluation for hearing aids with no coinsurance. Prescription hearing aids are covered with a maximum benefit of $3,000 per year and a copay between $0 and $1725, but inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a 20% coinsurance, routine eye exams (1 every six months), eyewear (lenses and frames), contact lenses, eyeglass lenses, eyeglass frames, and upgrades. The plan offers a combined maximum of $300.00 per year for eyewear.
Dental Services See details
The Prominence Dual (HMO D-SNP) plan covers dental services with a maximum benefit of $4,000 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with varying limits on the number of visits, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Prominence Dual (HMO D-SNP) plan, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay, and the coinsurance is between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Prominence Dual (HMO D-SNP) plan, but require prior authorization. The coinsurance is between 20% and 20%.
Medical Equipment See details
The Prominence Dual (HMO D-SNP) plan covers medical equipment, including Durable Medical Equipment (DME), with a 20% coinsurance and requires prior authorization. Prosthetics and medical supplies are also covered, with a 20% coinsurance for Medicare-covered devices and supplies. Diabetic equipment is covered, with a 20% coinsurance for diabetic supplies and therapeutic shoes/inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Prominence Dual (HMO D-SNP) plan. There is no copay for these services, but you may have to pay up to 20% coinsurance for Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services.
Home Health Services See details
Home Health Services are covered by the Prominence Dual (HMO D-SNP), with no copay or coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Prominence Dual (HMO D-SNP) plan. While the plan covers Cardiac Rehabilitation Services, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not provide Skilled Nursing Facility Services as a supplemental benefit under Part C, and additional days beyond Medicare-covered for Skilled Nursing Facility (SNF) are not covered. The plan charges the Medicare-defined cost share for tier 1, and there is coinsurance.
Other Services See details
The Prominence Dual (HMO D-SNP) plan covers Over-the-Counter (OTC) items with a maximum benefit of $175.00 every month, including Nicotine Replacement Therapy (NRT), but does not cover Acupuncture. The plan also covers a Meal Benefit for chronic illness, but requires prior authorization.
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