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Prominence Diabetes and Heart Giveback (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Prominence Diabetes and Heart Giveback (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Prominence Diabetes and Heart Giveback (HMO C-SNP) in 2026, please refer to our full plan details page.
Prominence Diabetes and Heart Giveback (HMO C-SNP) is a HMO C-SNP plan offered by Universal Health Services, Inc. available for enrollment in 2026 to people living in South Texas. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Prominence Diabetes and Heart Giveback (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Prominence Diabetes and Heart Giveback (HMO C-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 Diabetes and Heart Giveback (HMO C-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 Diabetes and Heart Giveback (HMO C-SNP), 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. Additionally, this plan comes with a Part B Premium reduction of $155.00. You must continue to pay paying your reduced 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 $250.00 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 $7500.00 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 Diabetes and Heart Giveback (HMO C-SNP) plan features an annual drug deductible of $250. This plan offers savings on essential medications, providing no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs at standard pharmacies and through standard mail order. For Tier 2 generic medications, you will pay a copay of $15 for a one-month supply or $30 for a two- or three-month supply. Higher-tier prescriptions are subject to coinsurance rather than set copays, with Tier 3 preferred brand drugs requiring a 25% coinsurance at standard pharmacies and mail order. Tier 4 non-preferred drugs carry a 50% coinsurance, while Tier 5 specialty drugs require a 30% coinsurance for a one-month supply at standard pharmacies. These structured costs help you easily plan your healthcare budget based on your specific prescription needs.
Additional Benefits
The Prominence Diabetes and Heart Giveback (HMO C-SNP) plan offers comprehensive medical coverage with many essential services featuring no copay or coinsurance. Members enjoy no copays for primary care visits, telehealth, preventive services, home health care, and routine vision and hearing exams. For hospital care, inpatient stays require a daily copay of $325 for acute stays (days 1 to 6) or $330 for psychiatric stays (days 1 to 5), with no copay for the remaining days. Specialist visits range from no copay to a $45 copay, while emergency room visits require a $115 copay and urgent care is $35. Additional benefits include preventive dental coverage with no copay up to a $1,000 annual limit, a $200 eyewear allowance, and a $160 quarterly allowance for over-the-counter items. Durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by Prominence Diabetes and Heart Giveback (HMO C-SNP) with no coinsurance, requiring a copay of $325 per day for days 1 to 6 for acute stays and $330 per day for days 1 to 5 for psychiatric stays, with no copay for remaining days up to 90. Prior authorization is required, and additional days or non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Prominence Diabetes and Heart Giveback (HMO C-SNP), featuring a $200 copay for outpatient hospital services and a $295 copay per stay for observation services, both with no coinsurance. Ambulatory surgical center services require a $25 copay with no coinsurance, outpatient blood services are covered with no copay or coinsurance, and outpatient substance abuse services are not covered.
Partial Hospitalization See details
The Prominence Diabetes and Heart Giveback (HMO C-SNP) plan covers partial hospitalization services with no copay and no coinsurance. Prior authorization is required to access these covered benefits.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Prominence Diabetes and Heart Giveback (HMO C-SNP), featuring ground and air ambulance services for a $325 copay and no coinsurance, which is waived if you are admitted to the hospital. While some transportation services are covered, trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Prominence Diabetes and Heart Giveback (HMO C-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if admitted to the hospital within three days, and urgent care with a $35 copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $25,000 maximum limit with a $115 emergency copay and no coinsurance for urgent care, though worldwide emergency transportation is not covered.
Primary Care See details
Prominence Diabetes and Heart Giveback (HMO C-SNP) features primary care, telehealth, and opioid treatment services with no copay and no coinsurance, while specialist and other health professional visits range from a $0 to $45 copay with no coinsurance. Physical, occupational, speech, and psychiatric therapies are covered with copays ranging from $20 to $25 and no coinsurance, but podiatry, routine chiropractic, and mental health specialty sessions are not covered.
Preventive Services See details
Preventive Services are partially covered by the Prominence Diabetes and Heart Giveback (HMO C-SNP) with no copay and no coinsurance for covered benefits, which include annual physical exams, kidney disease education, and telemonitoring. While select supplemental benefits like memory fitness and in-home safety assessments are covered, others such as health education, nutritional benefits, and weight management programs are not covered.
Hearing Services See details
Prominence Diabetes and Heart Giveback (HMO C-SNP) covers hearing services, providing one routine exam and fitting evaluation per year with no copay or coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $0 to $1,725 (up to a $600 maximum benefit per ear annually), but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Prominence Diabetes and Heart Giveback (HMO C-SNP) offers partially covered vision services with no copay, no coinsurance, and no deductible. While other eye exam services are not covered, the plan covers one routine eye exam per year and provides a $200 annual maximum allowance for eyewear, including contact lenses and eyeglasses.
Dental Services See details
Prominence Diabetes and Heart Giveback (HMO C-SNP) offers dental services with no copay and no coinsurance for preventive care, up to a $1,000 yearly maximum. Comprehensive dental services are partially covered with no copay and 10% to 50% coinsurance, though implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Prominence Diabetes and Heart Giveback (HMO C-SNP) covers Home Infusion bundled Services with no copay, subject to prior authorization. Under this benefit, Medicare Part B insulin drugs require a $35 copay and 0% to 20% coinsurance, while chemotherapy and other Part B drugs require no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Prominence Diabetes and Heart Giveback (HMO C-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Prominence Diabetes and Heart Giveback (HMO C-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance. Diabetic equipment is partially covered with no copay and no coinsurance, but diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Prominence Diabetes and Heart Giveback (HMO C-SNP) and require prior authorization, with no copay or coinsurance for covered diagnostic services. While diagnostic procedures, lab services, and outpatient X-rays are not covered, covered diagnostic radiological services require a minimum $100 copay and therapeutic radiological services carry a 20% coinsurance.
Home Health Services See details
Home health services are covered by the Prominence Diabetes and Heart Giveback (HMO C-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Prominence Diabetes and Heart Giveback (HMO C-SNP) covers some cardiac rehabilitation services with no coinsurance, though cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for PAD services are not covered. Prior authorization is required, and these non-covered services carry copays of either $15 or $20.
Skilled Nursing Facility (SNF) See details
Prominence Diabetes and Heart Giveback (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered benefit are not covered.
Other Services See details
Prominence Diabetes and Heart Giveback (HMO C-SNP) partially covers other services, providing a chronic illness meal benefit and up to $160 every three months for over-the-counter items with no copay and no coinsurance. Acupuncture is not covered under this plan, and prior authorization is required for the meal benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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.
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