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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 2026, 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 4.5 out of 5 stars in 2026.
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 $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 $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:
Sign up for Prominence Extra Help (HMO)
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Drug Coverage
The Prominence Extra Help (HMO) plan features an annual drug deductible of $615. You will benefit from no copay on Tier 1 preferred generic drugs and Tier 6 select care drugs when using standard pharmacies or standard mail order. For Tier 2 generic drugs, you will pay a $12 copay for a one-month supply or a $24 copay for two- and three-month supplies at standard pharmacies. Brand-name and specialty medications are subject to coinsurance rather than flat copayments under this plan. Tier 3 preferred brand drugs require a 20% coinsurance, and Tier 4 non-preferred drugs carry a 45% coinsurance at standard pharmacies and standard mail order. Tier 5 specialty drugs are covered at a 25% coinsurance for a one-month supply at standard pharmacies.
Additional Benefits
The Prominence Extra Help (HMO) plan offers affordable medical coverage with no copays for primary care visits, telehealth, preventive services, and home health care. Specialist visits require a low $15 copay, while inpatient acute hospital stays cost a $50 daily copay for the first five days and no copay for subsequent days. Emergency room visits carry a $150 copay, and urgent care has a $20 copay, both of which are waived if you are admitted to the hospital. For dental care, the plan provides preventive services with no copay and covers comprehensive care up to a $2,000 annual limit, while routine vision exams have a $25 copay and eyewear is covered up to $195 with no copay. Routine hearing exams require a $10 copay, and the plan covers up to $220 every three months for over-the-counter items with no copay. Additionally, members can access up to 44 one-way trips per year to plan-approved locations with no copay.
Inpatient Hospital See details
Prominence Extra Help (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring prior authorization. Acute stays cost a $50 daily copay for days 1-5 and no copay for days 6-90, while psychiatric stays require a $330 daily copay for days 1-5 and no copay for days 6-90, with upgrades and non-Medicare-covered stays not covered.
Outpatient Services See details
Outpatient services are covered by Prominence Extra Help (HMO) with no coinsurance, featuring a $0 to $50 copay for outpatient hospital services, a $100 copay per stay for observation services, and a $25 copay for ambulatory surgical center services. Additionally, outpatient substance abuse sessions require a $10 copay and no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization services are covered by Prominence Extra Help (HMO) with a $55.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Prominence Extra Help (HMO) covers ground and air ambulance services with a $300 copay and no coinsurance, which is waived if you are admitted to the hospital. Transportation services are partially covered, offering up to 44 one-way trips per year to plan-approved locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Prominence Extra Help (HMO) covers emergency services with a $150 copay and urgently needed services with a $20 copay, both featuring no coinsurance and copays that are waived if you are admitted to the hospital within three days. Worldwide emergency services are partially covered with no coinsurance up to a $25,000 lifetime maximum, 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 Extra Help (HMO) offers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $15 copay and no coinsurance. Other covered benefits, such as physical therapy ($10 copay), occupational therapy ($5 copay), and mental health services ($10 copay), require no coinsurance, though podiatry and routine chiropractic services are not covered.
Preventive Services See details
Prominence Extra Help (HMO) preventive services are partially covered with no copay and no coinsurance for covered benefits like annual physical exams, memory fitness, and remote access technologies. However, several supplemental services, including health education, personal emergency response systems (PERS), and medical nutrition therapy, are not covered.
Hearing Services See details
Prominence Extra Help (HMO) covers routine hearing exams and fittings for a $10 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $0 to $1,725 (up to a $600 maximum per ear annually), though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered under the Prominence Extra Help (HMO) plan, offering one routine eye exam per year for a $25 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $195 annual maximum for contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Prominence Extra Help (HMO) dental services are partially covered up to a $2,000 yearly maximum, offering preventive care with no copay and no coinsurance. Covered comprehensive dental services require no copay and 10% to 50% coinsurance, while orthodontics, implants, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Prominence Extra Help (HMO) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry no copay and a 0% to 20% coinsurance, while Medicare Part B insulin drugs require a $35 copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Prominence Extra Help (HMO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Prominence Extra Help (HMO) covers durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes and inserts with no copay and a 20% coinsurance, subject to prior authorization. This medical equipment benefit is partially covered, as diabetic supplies are not covered by the plan.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered under the Prominence Extra Help (HMO) plan, as diagnostic procedures, lab services, and outpatient X-ray services are not covered. Covered diagnostic services require prior authorization with no copay and no coinsurance, while covered diagnostic radiological services carry a minimum $60.00 copay with no coinsurance, and therapeutic radiological services require a 20% coinsurance and a copay.
Home Health Services See details
Home Health Services are covered under the Prominence Extra Help (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Prominence Extra Help (HMO) with no copay, no coinsurance, and prior authorization required. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Prominence Extra Help (HMO) with no coinsurance and no prior three-day hospital stay required, though prior authorization is needed. There is no copay for days 1 through 20 and a $160 daily copay for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Prominence Extra Help (HMO) partially covers other services, offering over-the-counter (OTC) items and a chronic illness meal benefit with no copay and no coinsurance, while acupuncture is not covered. The OTC benefit provides up to $220 every three months via reimbursement, and the meal benefit requires prior authorization.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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