Plan year 2027 · Medicare AdvantageCMS files of Sept. 22 and Oct. 1, 2026
Prominence Diabetes and Heart Giveback, 2027
H7680Contract015Plan
HMO C-SNP · special needs plan, chronic or disabling condition · 8 counties in Texas
Run by Prominence Healthfirst of Texas (contract H7680), sold as Prominence Health Plan, owned by Universal Health Services, Inc.
Prominence Diabetes and Heart Giveback (H7680-015) costs $0 a month in 2027, the same as in 2026, with an in-network out-of-pocket limit of $3,100.
What changes from 2026 to 2027?
| What you pay or get | 2026 | 2027 | Change |
|---|---|---|---|
| Skilled nursing facility, in network | $20 a day for days 1–20, then $218 a day for days 21–100 | $20 a day for days 1–20, then $221 a day for days 21–100 | ▲up $30for a 30-day stay |
| Eyewear, yearly limit | $200 a year | $100 a year | ▼down $100 |
| 20 lines do not change | |||
| Monthly premium | $0 | $0 | no change |
| In-network out-of-pocket limit | $3,100 | $3,100 | no change |
| Drug deductible | $0 | $0 | no change |
| Part B premium reduction, monthly | $50 | $50 | no change |
| Primary care visit | $0 copay | $0 copay | no change |
| Specialist visit | $0 copay | $0 copay | no change |
| Emergency room | $150 copay | $150 copay | no change |
| Medical deductible, in network | none | none | no change |
| Hospital stay, in network | $100 a day for days 1–5, then $0 a day for days 6–90 | $100 a day for days 1–5, then $0 a day for days 6–90 | no change |
| Ground ambulance, in network | $300 copay | $300 copay | no change |
| Comprehensive dental, yearly limit | not offered | not offered | no change |
| Hearing aids, yearly limit for both ears | $600 a year | $600 a year | no change |
| Over-the-counter items, yearly | $460 a year | $460 a year | no change |
| Counties served | 8 | 8 | no change |
| Drug tier 1, preferred generic | $0 | $0 | no change |
| Drug tier 2, generic | $15 | $15 | no change |
| Drug tier 3, preferred brand | $45 | $45 | no change |
| Drug tier 4, non-preferred drug | $100 | $100 | no change |
| Drug tier 5, specialty tier | 33% of the cost | 33% of the cost | no change |
| Drug tier 6, select care drugs | $0 | $0 | no change |
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS plan benefit package files, 2027 and 2026; CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026). Plan details can change during the year; confirm on Medicare Plan Finder.
What will prescriptions cost?
| Tier | What the tier holds | 2026 | 2027 |
|---|---|---|---|
| Tier 1 | Preferred Generic | $0 | $0 |
| Tier 2 | Generic | $15 | $15 |
| Tier 3 | Preferred Brand | $45 | $45 |
| Tier 4 | Non-Preferred Drug | $100 | $100 |
| Tier 5 | Specialty Tier | 33% of the cost | 33% of the cost |
| Tier 6 | Select Care Drugs | $0 | $0 |
Source: CMS plan benefit package files, 2027 and 2026. Insulin is capped at $35 a month by law. A drug's tier is set by the plan's formulary.
How does it compare with plans sold where it is?
In the counties it serves, 8 chronic or disabling condition special needs plans are sold for 2027, this one included. Against the others, 1 plan has a lower out-of-pocket limit, 6 a higher one. On the premium, 6 the same, 1 a higher one.
Out-of-pocket limits of the 8 chronic or disabling condition special needs plans
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).
Where is it sold, and what does it cost there?
The premium and the out-of-pocket limit are the same in all 8 counties: $0 a month and $3,100.
Texas
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).
Who runs this plan?
- Plan ID
- H7680-015
- Legal name of the contract
- Prominence Healthfirst of Texas
- Sold as
- Prominence Health Plan
- Parent company
- Universal Health Services, Inc.
- Plan type
- HMO C-SNP
- 2026 star rating of the contract
- 4.5 of 5 overall; health plan 4 of 5, drug plan 4 of 5
- Members, September 2026
- 474
- Plan website, as filed with CMS
- www.prominencemedicare.com
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS 2026 Star Ratings (October 2025); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11). CMS publishes the 2027 Star Ratings in October 2026.
What else should you check?
- Other 2027 plans in Potter, TXWhere most of its members live; premiums and limits side by side
- Every Prominence Health Plan plan for 2027Its contracts, counties and plans that end
- The other 12 plans of contract H7680Same company, same contract
- Is your prescription covered?Coverage share and tier for 2,259 drugs
Data, not advice. These are the plan's filed amounts, not a quote for you; confirm on Medicare Plan Finder or call the plan before you enroll.