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Prominence Extra Help (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Prominence Extra Help (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Prominence Extra Help (HMO) in 2025, please refer to our full plan details page.
Prominence Extra Help (HMO) is a HMO 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 Extra Help (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Prominence Extra Help (HMO).
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 Extra Help (HMO), 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 $3000.00 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 Extra Help (HMO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. In the initial coverage phase, after you pay the deductible, you pay coinsurance for your prescriptions. For example, for standard pharmacy, you pay 25% coinsurance for preferred generic and standard generic drugs, 50% coinsurance for preferred brand drugs, 25% coinsurance for non-preferred drugs, and 15% coinsurance for specialty tier drugs. After your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for your covered drugs.
Additional Benefits
The Prominence Extra Help (HMO) plan offers a range of benefits with varying costs. For inpatient hospital stays, you'll pay a copay for the first few days, with no copay thereafter. Outpatient services have copays depending on the specific service, and emergency services have a copay. This plan covers primary care, hearing, vision, and dental services, with copays for exams and specific procedures. Additionally, it includes coverage for medical equipment, home health, and skilled nursing facilities, each with their own cost structures. This plan also provides an allowance for over-the-counter (OTC) items, and offers a meal benefit for chronic illnesses.
Inpatient Hospital See details
Inpatient Hospital coverage under the Prominence Extra Help (HMO) plan includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a $50 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you'll pay a $330 copay for days 1-5, and no copay for days 6-60.
Outpatient Services See details
The Prominence Extra Help (HMO) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $50, and observation services with a $100 copay. Ambulatory Surgical Center (ASC) services have a $25 copay, while outpatient substance abuse services have a $10 copay for both individual and group sessions. Outpatient blood services are also covered, with three pints deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered under the Prominence Extra Help (HMO) plan, but prior authorization is required. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Prominence Extra Help (HMO) plan. Ground and air ambulance services have a $300 copay, while transportation services to any health-related location are covered for up to 48 one-way trips per year, and transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Prominence Extra Help (HMO) plan. Emergency Services have a $140 copay, Urgently Needed Services have a $30 copay, and Worldwide Emergency Coverage has a $125 copay; all of these services have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Prominence Extra Help (HMO) plan covers primary care physician services, chiropractic services with a $10 copay, occupational therapy services with a $5 copay, physician specialist services with a $15 copay, mental health specialty services with a $10 copay for individual and group sessions, physical therapy and speech-language pathology services with a $10 copay, additional telehealth benefits, and opioid treatment program services with a $10 copay; however, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Prominence Extra Help (HMO) plan covers a variety of preventive services, including Medicare-covered services, annual physical exams, and additional preventive services like in-home safety assessments, fitness benefits, remote access technologies, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs. However, health education, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers, additional smoking cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices, and counseling services are not covered.
Hearing Services See details
Hearing Services include hearing exams and prescription hearing aids. Routine hearing exams have a $10 copay, and the plan covers one exam per year, as well as a fitting/evaluation for a hearing aid. Prescription hearing aids are covered with a maximum benefit of $600 per ear every year, and copays range from $0 to $1725. OTC hearing aids are not covered, as are prescription hearing aids for the inner, outer, and over the ear.
Vision Services See details
The Prominence Extra Help (HMO) plan covers vision services, including eye exams with a $30 copay, and eyewear, including contact lenses, eyeglasses, eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum plan benefit of $200 every year.
Dental Services See details
The Prominence Extra Help (HMO) plan covers a variety of dental services, including oral exams (2 visits per year), dental x-rays (2 per year), and other diagnostic dental services (1 visit every 3 years). The plan also covers prophylaxis (cleaning) (2 visits per year), fluoride treatments (2 visits per year), and other preventive dental services (1 per year), but does not cover maxillofacial prosthetics or orthodontics. The plan has a maximum benefit of $2,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, the copay is $35, and the coinsurance is 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 by the Prominence Extra Help (HMO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires prior authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance, and Diabetic Supplies are not covered, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Prominence Extra Help (HMO) plan. Diagnostic Radiological Services have a copay of $60, while Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Prominence Extra Help (HMO) plan with no copay and no coinsurance; however, 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 Extra Help (HMO) plan. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Prominence Extra Help (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $160.
Other Services See details
The Prominence Extra Help (HMO) plan does not cover 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. Over-the-counter (OTC) items are covered with a maximum benefit of $100.00 every month, and the plan offers Nicotine Replacement Therapy (NRT) as a Part C OTC benefit. The plan also covers a meal benefit for a chronic illness, but it requires prior authorization.
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