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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 2026, 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 4.5 out of 5 stars in 2026.
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 $4.80. 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 $615.00 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 $9250.00 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 features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs at standard pharmacies or through standard mail order. For Tier 2 generic drugs, standard pharmacy copays are $12 for a one-month supply and $24 for two- or three-month supplies, with standard mail order costing a $24 copay for a three-month supply. Higher-tier medications require coinsurance instead of flat copays. Tier 3 preferred brands carry a 19% coinsurance, while Tier 4 non-preferred drugs require a 48% coinsurance for both standard pharmacies and mail orders. Additionally, Tier 5 specialty drugs have a 25% coinsurance for a one-month supply at standard pharmacies.
Additional Benefits
The Prominence Dual (HMO D-SNP) plan offers robust medical coverage featuring no copays for most services, although many outpatient and diagnostic benefits require a twenty percent coinsurance. Inpatient hospital care, home health services, and skilled nursing facility stays are covered with no copay and no coinsurance. Primary, specialist, and emergency care also feature no copay, though they are generally subject to a twenty percent coinsurance. For supplemental benefits, members receive dental care with no copay and no coinsurance up to a four thousand dollar annual maximum, alongside routine vision and hearing exams. The plan also includes up to forty-two free one-way trips to approved health locations and a five hundred fifty-five dollar quarterly over-the-counter allowance with no copays. Prescription hearing aids and Part B drugs are also covered, though they may require specific copays or coinsurance depending on the service.
Inpatient Hospital See details
Prominence Dual (HMO D-SNP) partially covers inpatient hospital services, offering acute and psychiatric care with no copay and no coinsurance, though prior authorization is required. However, upgrades, additional days, and non-Medicare-covered stays are not covered under these hospital benefits.
Outpatient Services See details
Prominence Dual (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services, with no copays and a 20% coinsurance. Prior authorization is required for these services, and no deductible applies to outpatient blood services.
Partial Hospitalization See details
Partial hospitalization services are covered by the Prominence Dual (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Prominence Dual (HMO D-SNP) covers ambulance services with a 20% coinsurance and no copay for both ground and air transport, subject to prior authorization. Transportation services are partially covered, providing up to 42 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though trips to any other health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Prominence Dual (HMO D-SNP) with a 20% coinsurance and no copay, capped at a maximum of $115 per visit for emergency care and $40 per visit for urgently needed services. Worldwide emergency, urgent, and transportation services are also covered up to a $25,000 maximum limit, requiring a $115 copay and 20% coinsurance for emergency care, and a 20% coinsurance with no copay for urgent care and transportation.
Primary Care See details
Prominence Dual (HMO D-SNP) covers primary care, specialist, therapy, psychiatric, and mental health services with no copay and 20% coinsurance, while chiropractic services are not covered. Telehealth benefits feature no copay and coinsurance ranging from no coinsurance to 20%, and podiatry is covered with a $20 copay or 20% coinsurance for up to 12 routine visits per year.
Preventive Services See details
Prominence Dual (HMO D-SNP) preventive services are partially covered with no copay and no coinsurance for annual physicals, kidney disease education, in-home safety assessments, PERS, and memory fitness. Glaucoma screenings, diabetes self-management training, digital rectal exams, and post-welcome visit EKGs are covered with no copay and a 20% coinsurance. Several supplemental services, such as health education, weight management, nutritional therapy, and home-based support, are not covered.
Hearing Services See details
Hearing services are covered by Prominence Dual (HMO D-SNP), including routine exams with no copay and 20% coinsurance, and prescription hearing aids with no coinsurance and a copay ranging from $0 to $1,725 up to a $3,000 annual limit. This benefit is partially covered because over-the-counter (OTC) hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are partially covered by Prominence Dual (HMO D-SNP), offering one routine eye exam per year with no copay and 20% coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible up to a $290 annual combined limit for contacts, eyeglasses, and upgrades.
Dental Services See details
Prominence Dual (HMO D-SNP) offers partially covered dental services with no copay and no coinsurance up to a maximum annual benefit of $4,000. Covered services include preventive care, cleanings, and oral surgery, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Prominence Dual (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs are covered with no copay and 0% to 20% coinsurance, while Part B insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Prominence Dual (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Prominence Dual (HMO D-SNP) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Prior authorization is required for these benefits, and coverage may be limited to preferred vendors or specified manufacturers.
Diagnostic and Radiological Services See details
Prominence Dual (HMO D-SNP) covers diagnostic and radiological services, including lab tests, X-rays, and therapeutic radiology, with no copay and a 20% coinsurance. Prior authorization is required for all of these covered services.
Home Health Services See details
Prominence Dual (HMO D-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 Dual (HMO D-SNP) plan with no copay and a 20% coinsurance, subject to prior authorization. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Prominence Dual (HMO D-SNP) with no copay or coinsurance, although prior authorization is required. While the plan does not require a three-day prior inpatient hospital stay for admission, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Prominence Dual (HMO D-SNP) partially covers other services, offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. The OTC benefit provides up to $555 every three months via reimbursement, though acupuncture, OTC naloxone, and other additional services are not covered.
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