Prominence Plus (HMO)

Texas Medicare Advantage Plan (2024 Plan)


Monthly Premium
by Prominence Health Plan
Additional Coverage
HearingVision
Overall Government Star Rating
 4.0
out of 5 stars

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Plan Name
Prominence Plus (HMO)
Insurance Carrier
Prominence Health Plan
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Network Type
HMO

Prominence Plus (HMO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Texas and offered by the health insurance company Prominence Health Plan. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$3,400
Primary doctor visit
$0 copay
Specialist visit
$0-10 copay per visit
ER visit
$60-125 copay per visit (always covered)
Ambulance
$275 copay

Prominence Plus (HMO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $3,400 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Prominence Plus (HMO) are defined below.

Yes
Part D Prescription Drug Coverage
No
Dental
Yes
Vision
Yes
Hearing

Prominence Plus (HMO) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Prominence Plus (HMO) includes coverage for hearing, vision.

Medicare Advantage health plans can offer even more additional benefits. Prominence Plus (HMO) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Limited coverage
Meals for short duration
Limited coverage
Annual physical exams
Limited coverage
Telehealth
Limited coverage

Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2024, Prominence Plus (HMO) received an overall government quality rating of 4.0 stars out of 5 stars.

Prominence Plus (HMO) performed better than Texas’s State average overall quality score of 3.8 stars.

This Plan’s 5-star Gov’t Quality Score
Texas State Average Score
Overall Government 5 Star Quality Rating
 4.0
 3.8
Summary rating of health plan quality
 4
 3.7
Staying healthy: screenings, tests, & vaccines
 4
 4.0
Managing chronic (long term) conditions
 4
 3.3
Member experience with health plan
 4
 3.5
Member complaints & changes in the health plan's performance
 3
 3.7
Health plan customer service
 5
 4.3
Summary rating of drug plan quality
 3
 3.6
Drug plan customer service
 4
 4.0
Member complaints & changes in the drug plan's performance
 3
 3.7
Member experience with the drug plan
 4
 3.7
Drug safety & accuracy of drug pricing
 3
 3.4

The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.

Prominence Plus (HMO) received 4 stars for its health plan quality score which is better than the Texas State average health plan quality score of 3.7 stars.

Prominence Plus (HMO) received 3 stars for its drug plan quality score which is worse than the Texas State average drug plan quality score of 3.6 stars.


Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$3,400 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
No

Doctor Services

Primary doctor visit
$0 copay
Specialist visit
$0-10 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
$0 copay
Lab services
$0 copay
Diagnostic radiology services (like MRI)
$0 copay
Outpatient x-rays
$0 copay
Emergency care
$60-125 copay per visit (always covered)
Urgent care
$0 copay

Hospital Services

Inpatient hospital coverage
Tier 1
$0 copay per stay
Tier 2
$50 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient hospital coverage
$0 copay

Skilled nursing facility

Skilled nursing facility
$0 per day for days 1 through 20
$50 per day for days 21 through 100

Preventive services

Preventive services
$0 copay

Ambulance

Ground ambulance
$275 copay

Therapy services

Occupational therapy visit
$0 copay
Physical therapy & speech & language therapy visit
$0 copay

Mental health services

Outpatient group therapy with a psychiatrist
$0 copay
Outpatient individual therapy with a psychiatrist
$0 copay
Outpatient group therapy visit
$0 copay
Outpatient individual therapy visit
$0 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
$0 copay
Prosthetics (like braces, artificial limbs)
$0 copay
Diabetes supplies
$0 copay

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseGap coverage phase1Catastrophic coverage phase
Preferred Generic$0.00 copay$0.00 copay


Generic drugs :
$0 copay

Brand-name drugs :
$0 copay

Generic$12.00 copay$12.00 copay
Preferred Brand$35.00 copay
Non-Preferred Drug$100.00 copay
Specialty Tier33%
1 For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs.

Part B Drugs

Chemotherapy drugs
0-20% coinsurance
Other Part B drugs
0-20% coinsurance

Hearing

Hearing exam
$0 copay
Fitting/evaluation
$0 copay
Hearing aids - All types
$0-1,725 copay

Preventive Dental

Oral exam
$0 copay
Cleaning
$0 copay
Fluoride treatment
$0 copay
Dental x-rays
$0 copay

Comprehensive dental

Non-routine services
$0 copay
Diagnostic services
$0 copay
Restorative services
$0 copay
Endodontics
$0 copay
Periodontics
$0 copay
Extractions
$0 copay
Prosthodontics, other oral/maxillofacial surgery, other services
$0 copay

Vision

Routine eye exam
$0 copay
Contact lenses
$0 copay
Eyeglasses (frames & lenses)
$0 copay
Eyeglass frames (only)
$0 copay
Eyeglass lenses (only)
$0 copay
Upgrades
$0 copay

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