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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 2025, 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 out of 5 stars in 2025.
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:
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Drug Coverage
The Prominence Beyond (HMO-POS) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions. For example, a standard pharmacy will have a $15 copay for Tier 1 preferred generic drugs, a $47 copay for Tier 2 standard generic drugs, and a $100 copay for Tier 3 preferred brand drugs. For Tier 4 non-preferred drugs, you will pay 33% coinsurance, and for Tier 5 specialty drugs, you will have no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Prominence Beyond (HMO-POS) plan offers a wide range of benefits with varying costs. This plan covers inpatient hospital stays, outpatient services, and emergency services, with copays ranging from $0 to $330. It also includes coverage for primary care, hearing, vision, and dental services, each with its own copay structure. Additional benefits include ambulance services, home health services with no copay, and coverage for durable medical equipment and home infusion services with coinsurance. However, some services like cardiac rehabilitation, certain diagnostic tests, and additional hours of care are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits with the Prominence Beyond (HMO-POS) plan include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, there is a $150 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, there is a $330 copay for days 1-5, and no copay for days 6-90. Additional days and non-Medicare covered stays for both Inpatient Hospital-Acute and Psychiatric services are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by Prominence Beyond (HMO-POS), with copays ranging from $25 to $350 for outpatient hospital services, $150 for observation services, and $25 for ambulatory surgical center services. Outpatient substance abuse services also have a copay, with individual and group sessions costing $10 each, and outpatient blood services are covered as well.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Prominence Beyond (HMO-POS) plan. Ground and Air Ambulance Services have a $300 copay, with no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage are covered by the Prominence Beyond (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services and Worldwide Urgent Coverage have a $30 copay; all services have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Prominence Beyond (HMO-POS) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $10 copay for routine care, Occupational Therapy Services with a $5 copay, Physician Specialist Services with a $50 copay, Mental Health Specialty Services with a $10 copay for individual and group sessions, Podiatry Services with a $5-$20 copay, Other Health Care Professional services with a $0-$50 copay, Psychiatric 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.
Preventive Services See details
The Prominence Beyond (HMO-POS) plan covers preventive services, including Medicare-covered preventive services, annual physical exams, and additional preventive services, with some services requiring prior authorization. Some services that are not covered include health education, Personal Emergency Response System (PERS), 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, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Home and Bathroom Safety Devices and Modifications, and Counseling Services.
Hearing Services See details
Hearing Services include routine hearing exams with a $10 copay, and fitting/evaluation for hearing aids with a $10 copay. Prescription hearing aids (all types) are covered with a copay between $0 and $1725, up to a maximum benefit of $600 per ear every year, but the plan does not cover prescription hearing aids for the inner ear, outer ear, or over the ear. OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with a $30 copay, and also covers eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum plan benefit coverage of $300 every year.
Dental Services See details
The Prominence Beyond (HMO-POS) plan covers a variety of dental services, including oral exams with no copay for up to 2 visits per year, and restorative services with a $50-$100 copay. Other services like maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while 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 Beyond (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Prominence Beyond (HMO-POS) plan covers Durable Medical Equipment (DME) with 20% coinsurance and requires authorization. Prosthetic devices and Medicare-covered medical supplies are covered with 20% coinsurance, but Durable Medical Equipment for use outside the home is not covered. Diabetic Therapeutic Shoes/Inserts are covered with 20% coinsurance, while Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Prominence Beyond (HMO-POS) plan, but Diagnostic Procedures/Tests, Lab Services, and Outpatient X-Ray Services are not covered. Diagnostic Radiological Services have a copay of at most $60.00, and Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Prominence Beyond (HMO-POS) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered. Home health services require authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Prominence Beyond (HMO-POS) plan. Prior authorization is required for these services, but the plan does not cover them.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Prominence Beyond (HMO-POS) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Prominence Beyond (HMO-POS) plan covers Over-the-Counter (OTC) Items with a maximum benefit of $100 every three months, and offers Nicotine Replacement Therapy (NRT) as an OTC benefit. 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 are not covered.
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