A non-government entity
Prominence Beyond (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Prominence Beyond (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Prominence Beyond (HMO-POS) in 2026, please refer to our full plan details page.
Prominence Beyond (HMO-POS) is a HMO-POS 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 Beyond (HMO-POS) 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 Beyond (HMO-POS).
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 Beyond (HMO-POS), 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 $4700.00 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 Beyond (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Prominence Beyond (HMO-POS) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. 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 medications, standard pharmacy copays are $15 for a 1-month supply and $30 for a 3-month supply. For higher-tier medications, standard pharmacy copays for Tier 3 preferred brand drugs are $47 for a 1-month supply and $141 for a 3-month supply. Tier 4 non-preferred drugs require a $100 copay for a 1-month supply and a $300 copay for a 3-month supply. Tier 5 specialty drugs require a 33% coinsurance for a 1-month supply at standard pharmacies.
Additional Benefits
The Prominence Beyond (HMO-POS) Medicare plan delivers robust healthcare coverage with no copay and no coinsurance for primary care doctor visits, telehealth services, and annual preventive physicals. Specialist office visits require a $50 copay, while inpatient acute hospital stays require a $150 daily copay for the first five days with no coinsurance. Emergency care is accessible with a $130 copay and ambulance services require a $300 copay, both featuring no coinsurance. Additional benefits include dental coverage up to a $4,000 annual maximum with no copay for preventive care and no copay with 10% to 50% coinsurance for comprehensive services. Vision benefits provide a routine exam for a $30 copay and a $300 annual eyewear allowance with no copay, while routine hearing exams require a $10 copay. Members also receive home health services with no copay and a $130 over-the-counter item allowance every three months.
Inpatient Hospital See details
Prominence Beyond (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a $150 daily copay for days 1 to 5 of an acute stay and a $330 daily copay for days 1 to 5 of a psychiatric stay, with no copay for subsequent days. While unlimited additional acute days are covered, some services are not covered, including psychiatric additional days, upgrades, and non-Medicare-covered stays.
Outpatient Services See details
Outpatient services are covered by Prominence Beyond (HMO-POS) with no coinsurance, featuring copays ranging from $25 to $350 for outpatient hospital services, $150 per stay for observation services, and $25 for ambulatory surgical center visits. Outpatient substance abuse services require a $10 copay per session with no coinsurance, while outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Prominence Beyond (HMO-POS) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Prominence Beyond (HMO-POS) covers emergency ground and air ambulance services with a $300 copay and no coinsurance, which is waived if you are admitted to the hospital. Routine transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
Prominence Beyond (HMO-POS) covers emergency services with a $130 copay and urgently needed services with a $30 copay, both featuring no coinsurance and waived fees if admitted to the hospital within three days. Worldwide emergency services are partially covered up to a $25,000 maximum benefit with no coinsurance, requiring a $130 copay for emergency care and a $30 copay for urgent care, while worldwide emergency transportation is not covered.
Primary Care See details
Prominence Beyond (HMO-POS) provides primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $50 copay and no coinsurance. Other services like physical therapy, mental health, and podiatry have copays ranging from $5 to $20 and no coinsurance, though chiropractic benefits are only partially covered because other chiropractic services are not covered.
Preventive Services See details
Prominence Beyond (HMO-POS) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are only partially covered, excluding health education, personal emergency response systems, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management programs, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, tobacco cessation, enhanced disease management, home safety modifications, and counseling.
Hearing Services See details
Hearing services covered by Prominence Beyond (HMO-POS) include annual routine exams for a $10 copay and no coinsurance, as well as fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and copays ranging from no copay up to $1,725 (with a $600 annual maximum per ear), while OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are covered by Prominence Beyond (HMO-POS), featuring one annual routine eye exam for a $30 copay and no coinsurance, though other eye exam services are not covered. Eyewear is also covered with no copay, no coinsurance, and no deductible, offering a $300 annual maximum benefit for contacts, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Prominence Beyond (HMO-POS) up to a $4,000 annual maximum, excluding maxillofacial prosthetics, implant services, and orthodontics. Covered preventive care features no copay and no coinsurance, while covered comprehensive services require no copay and 10% to 50% coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Prominence Beyond (HMO-POS) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs have no coinsurance to 20% coinsurance, while Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Prominence Beyond (HMO-POS) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Prominence Beyond (HMO-POS) covers medical equipment with no copay and a 20% coinsurance, subject to prior authorization. This benefit is partially covered, as durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes are covered, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Prominence Beyond (HMO-POS) partially covers diagnostic and radiological services, requiring prior authorization for both. Diagnostic services feature no copay and no coinsurance, though lab services, outpatient X-rays, and diagnostic procedures or tests are not covered. Covered diagnostic radiological services require a minimum $60 copay, while therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Prominence Beyond (HMO-POS) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Prominence Beyond (HMO-POS) with no coinsurance, a $10 copay, and prior authorization required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Prominence Beyond (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and although a prior three-day hospital stay is not necessary for admission, coverage is limited to the standard 100 days as additional days are not covered.
Other Services See details
Prominence Beyond (HMO-POS) partially covers Other Services, providing Over-the-Counter (OTC) items up to $130 every three months and chronic illness meal benefits with no copay and no coinsurance. Acupuncture, Naloxone coverage, and other additional services are not covered under this benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved