A non-government entity
Prominence Health Plan
Plan ID: H7680-9-0
Plan Summary PageProminence Extra Help (HMO)
2027 Prominence Extra Help (HMO) H7680 — 009 — 0 is a Medicare Advantage plan with drug coverage. It has received a 4-out-of-5 star rating from CMS for 2027.
Learn more about Prominence Extra Help (HMO) H7680 - 009 - 0, including the health and drug services it covers, by reading our easy-to-use guide. Or contact a licensed insurance agent for help now.
4 / 5 stars for 2027
$0.00 /mo
Monthly premium
$300.00
Drug deductible
$3400.00
Out-of-pocket maximum (In-Network)
Enroll online
Call to enroll
OR
Get personalized help from a licensed insurance agent
1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
Plan Overview
2027 Prominence Extra Help (HMO) H7680 — 009 — 0 is a HMO offered in South Texas by Prominence Healthfirst of Texas. It has a monthly premium of $0.00.
Premium Breakdown
Monthly plan premium
$0.00
Standard Part B premium (estimated)
$209.50
Note:
CMS has not yet announced the official 2027 standard Medicare Part B premium. The estimated 2027 premium is $209.50, per the 2026 Medicare Trustees Report; we'll update this page when CMS publishes the final amount. Your actual Part B premium may differ based on income (IRMAA), late enrollment penalties, Medicaid assistance, disability status, or other factors. Most people enrolled in Medicare Part B are required to pay this premium.
Special needs plan type
No
Out-of-pocket maximum (In-Network)
$3400.00
Plan Organization:
Prominence Healthfirst of Texas
Parent Company:
Universal Health Services, Inc.
Plan Type:
HMO
Location:
South Texas
Drugs Covered:
Yes
Drug Formulary:
Pharmacies:
Doctors Link:
Deductibles
The amount you must pay each year before your plan starts to pay for covered services or drugs.
Drug deductible
$300
Note:
This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs in certain tiers.
Sign up for Prominence Extra Help (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
Drug Coverage
Prominence Extra Help (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
Drug Benefit Type
Enhanced Alternative
Prescription drug deductible
$300.00
Part D Premium Reduction
This plan's premium may be reduced for you if you qualify for the low-income subsidy (also known as LIS or "Extra help"). The following is what you'll pay for with LIS.
Part D | LIS Full |
|---|---|
$0.00 | $0.00 |
Initial Coverage Phase
After you meet any applicable drug deductible ($300.00 for this plan), you pay the plan's cost sharing until your out-of-pocket costs for covered Part D drugs, including certain payments made on your behalf, reach $2,400 in 2027. You then enter catastrophic coverage and pay nothing for covered Part D drugs for the rest of the calendar year.
Tier | Preferred Pharmacy | Standard Pharmacy | Preferred Mail | Standard Mail |
|---|---|---|---|---|
1. Preferred Generic | - | $0.00 copay | - | - |
2. Generic | - | $0.00 copay | - | - |
3. Preferred Brand | - | 25% coinsurance | - | - |
4. Non-Preferred Drug | - | 35% coinsurance | - | - |
5. Specialty Tier | - | 30% coinsurance | - | - |
6. Select Care Drugs | - | $0.00 copay | - | - |
Catastrophic Coverage Phase
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,400, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
Prominence Extra Help (HMO) also provides the following benefits.
Inpatient Hospital
Inpatient Hospital benefits are covered.
Inpatient Hospital-Acute
Inpatient Hospital-Acute benefits are covered.
| Days 1-5: | Days 6-90: | |
|---|---|---|
| Copayment | 75.00 | 0.00 |
More Details:
Copayment for Medicare-covered stay
0.00
Additional Days for Inpatient Hospital-Acute
Additional Days for Inpatient Hospital-Acute benefits are covered.
More Details:
Number of Additional Days per benefit period
2
Non-Medicare-covered Stay for Inpatient Hospital-Acute
Not covered.
Upgrades for Inpatient Hospital-Acute
Not covered.
Inpatient Hospital Psychiatric
Not covered.
Additional Days for Inpatient Hospital Psychiatric
Not covered.
Non-Medicare-covered Stay for Inpatient Hospital Psychiatric
Not covered.
Outpatient Services
Outpatient Services benefits are covered.
All Outpatient Hospital Services
All Outpatient Hospital Services benefits are covered.
Outpatient Hospital Services
Outpatient Hospital Services benefits are covered.
Cost Sharing:
Observation Services
Not covered.
Ambulatory Surgical Center (ASC) Services
Not covered.
Outpatient Substance Abuse Services
Not covered.
Individual Sessions for Outpatient Substance Abuse
Not covered.
Group Sessions for Outpatient Substance Abuse
Not covered.
Outpatient Blood Services
Not covered.
Partial Hospitalization
Partial Hospitalization benefits are covered.
Partial Hospitalization
Not covered.
Partial Hospitalization
Not covered.
Ambulance and Transportation Services
Ambulance and Transportation Services benefits are covered.
All Ambulance Services
All Ambulance Services benefits are covered.
Ground Ambulance Services
Ground Ambulance Services benefits are covered.
Cost Sharing:
Air Ambulance Services
Air Ambulance Services benefits are covered.
Cost Sharing:
Transportation Services
Not covered.
Transportation Services - Plan Approved Health-related Location
Transportation Services - Plan Approved Health-related Location benefits are covered.
More Details:
Number of trips
36
Transportation Services - Any Health-related Location
Not covered.
Emergency Services
Emergency Services benefits are covered.
Emergency Services
Emergency Services benefits are covered.
Cost Sharing:
More Details:
Enter number of days or hours
3
Urgently Needed Services
Not covered.
Worldwide Emergency Services
Worldwide Emergency Services benefits are covered.
More Details:
Maximum amount
25000.00
Worldwide Emergency Coverage
Worldwide Emergency Coverage benefits are covered.
Cost Sharing:
Worldwide Urgent Coverage
Not covered.
Worldwide Emergency Transportation
Not covered.
Primary Care
Primary Care benefits are covered.
Primary Care Physician Services
Not covered.
Chiropractic Services
Not covered.
Routine Chiropractic Care
Routine Chiropractic Care benefits are covered.
More Details:
Visits
12
Occupational Therapy Services
Not covered.
Physician Specialist Services
Physician Specialist Services benefits are covered.
Cost Sharing:
Mental Health Specialty Services
Not covered.
Individual Sessions for Mental Health Specialty Services
Not covered.
Group Sessions for Mental Health Specialty Services
Not covered.
Podiatry Services
Podiatry Services benefits are covered.
More Details:
Enhanced benefits (7f)
Routine Foot Care
Visits
12
Other Health Care Professional
Other Health Care Professional benefits are covered.
More Details:
Minimum copayment
0.00
Maximum copayment
20.00
Psychiatric Services
Not covered.
Individual Sessions for Psychiatric Services
Not covered.
Group Sessions for Psychiatric Services
Not covered.
Physical Therapy and Speech-Language Pathology Services
Not covered.
Additional Telehealth Benefits
Not covered.
Opioid Treatment Program Services
Not covered.
Preventive Services
Preventive Services benefits are covered.
Medicare-covered Zero Dollar Preventive Services
Medicare-covered Zero Dollar Preventive Services benefits are covered.
Annual Physical Exam
Not covered.
Additional Preventive Services
Not covered.
Health Education
Not covered.
In-Home Safety Assessment
Not covered.
Personal Emergency Response System (PERS)
Not covered.
Medical Nutrition Therapy (MNT)
Not covered.
Post discharge In-Home Medication Reconciliation
Not covered.
Re-admission Prevention
Not covered.
Wigs for Hair Loss Related to Chemotherapy
Not covered.
Weight Management Programs
Not covered.
Alternative Therapies
Not covered.
Therapeutic Massage
Not covered.
Adult Day Health Services
Not covered.
Nutritional/Dietary Benefit
Not covered.
Home-Based Palliative Care
Not covered.
In-Home Support Services
Not covered.
Support for Caregivers of Enrollees
Not covered.
Additional Sessions of Smoking and Tobacco Cessation Counseling
Not covered.
Fitness Benefit
Not covered.
Enhanced Disease Management
Not covered.
Telemonitoring Services
Not covered.
Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)
Not covered.
Home and Bathroom Safety Devices and Modifications
Not covered.
Counseling Services
Not covered.
Kidney Disease Education Services
Not covered.
Other Preventive Services
Other Preventive Services benefits are covered.
Glaucoma Screening
Not covered.
Diabetes Self-Management Training
Not covered.
Digital Rectal Exams
Not covered.
EKG following Welcome Visit
Not covered.
Hearing Services
Hearing Services benefits are covered.
Hearing Exams
Not covered.
Routine Hearing Exams
Routine Hearing Exams benefits are covered.
More Details:
Number of visits
1
Fitting/Evaluation for Hearing Aid
Fitting/Evaluation for Hearing Aid benefits are covered.
More Details:
Number of visits
1
Prescription Hearing Aids
Prescription Hearing Aids benefits are covered.
More Details:
Maximum amount
600.00
Prescription Hearing Aids (all types)
Prescription Hearing Aids (all types) benefits are covered.
More Details:
Minimum copayment
0.00
Maximum copayment
1725.00
Prescription Hearing Aids - Inner Ear
Not covered.
Prescription Hearing Aids - Outer Ear
Not covered.
Prescription Hearing Aids - Over the Ear
Not covered.
OTC Hearing Aids
Not covered.
Vision Services
Vision Services benefits are covered.
Eye Exams
Not covered.
Routine Eye Exams
Routine Eye Exams benefits are covered.
More Details:
Number of visits
1
Eyewear
Eyewear benefits are covered.
More Details:
Combined maximum amount
175.00
Contact Lenses
Contact Lenses benefits are covered.
More Details:
Number of pairs
1
Eyeglasses (lenses and frames)
Eyeglasses (lenses and frames) benefits are covered.
More Details:
Number of eyeglasses
1
Eyeglass lenses
Eyeglass lenses benefits are covered.
More Details:
Number of pairs of lenses
1
Eyeglass frames
Eyeglass frames benefits are covered.
More Details:
Number of eyeglass frames
1
Upgrades
Not covered.
Dental Services
Dental Services benefits are covered.
Medicare Dental Services
Not covered.
Other Dental Services
Other Dental Services benefits are covered.
More Details:
Maximum amount
2500.00
Oral Exams
Oral Exams benefits are covered.
More Details:
Number of visits
2
Dental X-Rays
Dental X-Rays benefits are covered.
More Details:
Number of X-Rays
2
Other Diagnostic Dental Services
Other Diagnostic Dental Services benefits are covered.
More Details:
Number of visits
1
Prophylaxis (Cleaning)
Prophylaxis (Cleaning) benefits are covered.
More Details:
Number of visits
2
Fluoride Treatment
Fluoride Treatment benefits are covered.
More Details:
Number of visits
2
Other Preventive Dental Services
Other Preventive Dental Services benefits are covered.
More Details:
Number of visits
1
Orthodontic Services
Not covered.
Restorative Services
Restorative Services benefits are covered.
Cost Sharing:
More Details:
Number of visits
1
Adjunctive General Services
Adjunctive General Services benefits are covered.
Cost Sharing:
Endodontics
Endodontics benefits are covered.
Cost Sharing:
Periodontics
Periodontics benefits are covered.
Cost Sharing:
More Details:
Number of visits
1
Description
Periodontal Maintenance at 0% coinsurance (2 of prophylaxis, scaling, or periodontal maintenance). 10% coinsurance for full mouth debridement. All other covered codes at 50% coinsurance at 1 per site/quad every 2 calendar years.
Prosthodontics, removable
Prosthodontics, removable benefits are covered.
Cost Sharing:
More Details:
Number of visits
1
Description
Either once per arch per 5 years or once per arch per year depending on service
Maxillofacial Prosthetics
Not covered.
Implant Services
Not covered.
Prosthodontics, fixed
Prosthodontics, fixed benefits are covered.
Cost Sharing:
More Details:
Number of visits
1
Description
Once per arch per 5 years
Oral and Maxillofacial Surgery
Oral and Maxillofacial Surgery benefits are covered.
Cost Sharing:
Orthodontics
Not covered.
Home Infusion bundled Services
Not covered.
Dialysis Services
Dialysis Services benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Medical Equipment
Medical Equipment benefits are covered.
Durable Medical Equipment (DME)
Not covered.
Prosthetics/Medical Supplies - Non-Medicare benefit
Not covered.
Prosthetic Devices
Not covered.
Medical Supplies
Not covered.
Diabetic Equipment
Not covered.
Diabetic Supplies
Not covered.
Diabetic Therapeutic Shoes/Inserts
Not covered.
Diabetic Equipment
Not covered.
Diagnostic and Radiological Services
Diagnostic and Radiological Services benefits are covered.
All Diagnostic services
Not covered.
Diagnostic Procedures/Tests
Not covered.
Lab Services
Not covered.
All Radiological Services
Not covered.
Diagnostic Radiological Services
Not covered.
Therapeutic Radiological Services
Therapeutic Radiological Services benefits are covered.
Cost Sharing:
More Details:
Minimum copayment
20.00
Outpatient X-Ray Services
Not covered.
Home Health Services
Not covered.
Cardiac Rehabilitation Services
Not covered.
Skilled Nursing Facility (SNF)
Skilled Nursing Facility (SNF) benefits are covered.
| Days 1-20: | Days 21-100: | |
|---|---|---|
| Copayment | 0.00 | 50.00 |
Additional Days beyond Medicare-covered for Skilled Nursing Facility (SNF)
Not covered.
Other Services
Other Services benefits are covered.
Acupuncture
Not covered.
Over-the-Counter (OTC) Items
Over-the-Counter (OTC) Items benefits are covered.
More Details:
Maximum plan benefit coverage amount
325.00
Attestation
The Nicotine Replacement Therapy (NRT) being offered does not duplicate any Part D OTC or formulary drugs.
Meal Benefit
Not covered.
Dual Eligible SNPs with Highly Integrated Services
Not covered.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
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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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