Prominence Meridian (HMO-POS)
Available to residents of Palm Beach County, FL for 2027. Contract H7239, plan 006, segment 0.
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- Plan health benefits
- Benefits in plain text
- Rx cost-sharing for all pharmacies and tiers
- Other plans in Palm Beach County
- Plan website
- Browse the Prominence Meridian (HMO-POS) formulary
2027 drug-by-drug coverage is not published by CMS yet. The drug lookup covers 2026, whose formulary is live.
New for 2027. This plan has no 2026 predecessor in the CMS crosswalk. Every FL plan’s 2026–2027 changes →
Plan details
| Monthly premium (Part C + D) | $159.00 |
|---|---|
| — medical (Part C) part | $153.00 |
| — drug (Part D) part | $6.00? |
| Monthly premium with full Extra Help (LIS) | $159.00?drug (Part D) part $6.00; Extra Help does not cover the medical (Part C) premium |
| Part B premium reduction (giveback) | None |
| Health plan deductible (in-network) | $500.00 |
| In-network out-of-pocket maximum | $3,000.00? |
| Drug deductible | $350.00Tier 1, 2 and 6 exempt |
| Drug out-of-pocket threshold | $2,400.00 |
| Plan type | HMO-POS? |
| Contract / plan | H7239-006-0 |
| Offered by | Prominence Health Plan |
| Parent organization | Universal Health Services, Inc. |
| Formulary tiers | 6 |
| Formulary exception tier | 5? |
| Pharmacy search | www.prominencemedicare.com/get-care/find-a-doctor/provider-and-pharmacy-directories/ |
| Member services | (855)969-5882TTY 711 |
CMS star ratings
- Overall
- 4.5 out of 5 stars for Overall
- Health plan (Part C)
- 4.5 out of 5 stars for Health plan (Part C)
- Drug plan (Part D)
- 3.5 out of 5 stars for Drug plan (Part D)
Published per contract — every plan under contract H7239 shares this rating.
Plan health benefits
| Service | In-network |
|---|---|
| Doctor visits | |
| Primary care doctor | $0 copay |
| Specialist | $5–$10 copay after a $500 deductible(authorization and referral required) |
| Other health care professional | $0–$10 copay(authorization required) |
| Additional telehealth services | $0 copay(authorization required) |
| Preventive care | |
| Medicare-covered preventive services | $0 copay |
| Annual physical exam | $0 copay |
| Kidney disease education | $0 copay |
| Glaucoma screening | $0 copay |
| Diabetes self-management training | $0 copay |
| Diagnostic tests, labs and imaging | |
| Diagnostic tests and procedures | $0 copay(authorization required) |
| Lab services | $0 copay(authorization required) |
| Diagnostic radiology (e.g. MRI, CT) | $15 copay after a $500 deductible(authorization required) |
| Therapeutic radiology | $0 copay after a $500 deductible(authorization required) |
| Outpatient x-rays | $0 copay after a $500 deductible(authorization required) |
| Emergency and urgent care | |
| Emergency room | $150 copay |
| Urgent care | $10 copay |
| Worldwide emergency coverage | $120 copay after a $500 deductible · $25,000 plan limit |
| Worldwide urgent care | $30 copay after a $500 deductible · $25,000 plan limit |
| Worldwide emergency transportation | Not covered |
| Hospital care | |
| Inpatient hospital stay | $100 per day for days 1–5; $0 per day for days 6–90(authorization required) |
| Outpatient hospital services | $350 copay(authorization required) |
| Outpatient observation | $75 copay(authorization required) |
| Ambulatory surgical center | $100 copay after a $500 deductible(authorization required) |
| Outpatient blood services | $0 copay after a $500 deductible(authorization required) |
| Skilled nursing and home health | |
| Skilled nursing facility | $20 per day for days 1–20; $221 per day for days 21–100(authorization required) |
| Home health care | $0 copay after a $500 deductible(authorization required) |
| Kidney dialysis | 20% coinsurance after a $500 deductible(authorization required) |
| Rehabilitation | |
| Occupational therapy | $5 copay after a $500 deductible(authorization required) |
| Physical therapy and speech-language therapy | $10 copay after a $500 deductible(authorization required) |
| Cardiac rehabilitation | $0 copay(authorization required) |
| Pulmonary rehabilitation | $0 copay(authorization required) |
| Mental health and substance use | |
| Inpatient psychiatric hospital stay | $200 per day for days 1–5; $0 per day for days 6–90(authorization required) |
| Outpatient mental health, individual session | $10 copay after a $500 deductible(authorization required) |
| Outpatient mental health, group session | $10 copay after a $500 deductible(authorization required) |
| Psychiatrist, individual session | $10 copay after a $500 deductible(authorization required) |
| Psychiatrist, group session | $10 copay after a $500 deductible(authorization required) |
| Partial hospitalization | $55 copay after a $500 deductible(authorization required) |
| Intensive outpatient program | $55 copay after a $500 deductible(authorization required) |
| Outpatient substance use, individual session | $10 copay after a $500 deductible(authorization required) |
| Outpatient substance use, group session | $10 copay after a $500 deductible(authorization required) |
| Opioid treatment program | $10 copay after a $500 deductible(authorization required) |
| Ambulance and transportation | |
| Ground ambulance | $300 copay(authorization required) |
| Air ambulance | $300 copay(authorization required) |
| Transportation to plan-approved locations | $0 copay(limits apply) |
| Medical equipment and supplies | |
| Durable medical equipment (e.g. wheelchairs, oxygen) | 20% coinsurance after a $500 deductible(authorization required) |
| Prosthetics (e.g. braces, artificial limbs) | 20% coinsurance after a $500 deductible(authorization required) |
| Medical supplies | 20% coinsurance after a $500 deductible(authorization required) |
| Diabetes supplies | $0 copay(authorization required) |
| Diabetic therapeutic shoes or inserts | 20% coinsurance(authorization required) |
| Chiropractic, acupuncture and foot care | |
| Chiropractic (Medicare-covered) | $5 copay after a $500 deductible(authorization required) |
| Routine chiropractic care | $0 copay after a $500 deductible(authorization required, limits apply) |
| Acupuncture | Not covered |
| Foot exams and treatment (Medicare-covered) | $25 copay after a $500 deductible(authorization required) |
| Routine foot care | $0 copay after a $500 deductible(authorization required, limits apply) |
| Dental? | |
| Medicare-covered dental services | $0 copay |
| Oral exams | Not covered |
| Cleanings | Not covered |
| Fluoride treatment | Not covered |
| Dental x-rays | Not covered |
| Other diagnostic dental services | Not covered |
| Other preventive dental services | Not covered |
| Restorative services (fillings, crowns) | Not covered |
| Endodontics (root canals) | Not covered |
| Periodontics (gum disease) | Not covered |
| Dentures and other removable prosthodontics | Not covered |
| Maxillofacial prosthetics | Not covered |
| Implants | Not covered |
| Bridges and other fixed prosthodontics | Not covered |
| Oral and maxillofacial surgery | Not covered |
| Orthodontics | Not covered |
| Adjunctive general services | Not covered |
| Vision? | |
| Eye exam (Medicare-covered) | $25 copay after a $500 deductible |
| Routine eye exam | Not covered |
| Eyewear after cataract surgery (Medicare-covered) | $0 copay |
| Contact lenses | Not covered |
| Eyeglasses (frames and lenses) | Not covered |
| Eyeglass lenses | Not covered |
| Eyeglass frames | Not covered |
| Eyewear upgrades | Not covered |
| Hearing? | |
| Hearing exam (Medicare-covered) | $10 copay after a $500 deductible |
| Routine hearing exam | Not covered |
| Hearing aid fitting and evaluation | Not covered |
| Hearing aids (all types) | Not covered |
| Hearing aids, inner ear | Not covered |
| Hearing aids, outer ear | Not covered |
| Hearing aids, over the ear | Not covered |
| Medicare Part B drugs | |
| Part B insulin | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Chemotherapy and radiation drugs | 0%–20% coinsurance after a $500 deductible(authorization required, step therapy may apply) |
| Other Part B drugs | 0%–20% coinsurance after a $500 deductible(authorization required, step therapy may apply) |
| Other extra benefits? | |
| Over-the-counter (OTC) allowance | Not covered |
| Meals after a hospital stay or for a chronic condition | Not covered |
| Fitness benefit | $0 copay(limits apply) |
| Health education | $0 copay(limits apply) |
| Nutritional / dietary benefit | $0 copay(limits apply) |
| Extra smoking and tobacco cessation counseling | Not covered |
| Enhanced disease management | Not covered |
| Telemonitoring | Not covered |
| Remote access technologies (web/phone, nurse line) | $0 copay(limits apply) |
| Home and bathroom safety devices | Not covered |
| Counseling services | Not covered |
| In-home safety assessment | $0 copay(limits apply) |
| Personal emergency response system (PERS) | Not covered |
| Medical nutrition therapy | Not covered |
| Post-discharge in-home medication reconciliation | Not covered |
| Re-admission prevention | Not covered |
| Wigs for hair loss from chemotherapy | Not covered |
| Weight management programs | Not covered |
| Alternative therapies | Not covered |
| Therapeutic massage | Not covered |
| Adult day health services | Not covered |
| Home-based palliative care | Not covered |
| In-home support services | Not covered |
| Support for caregivers | $0 copay(limits apply) |
In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2027). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed. Contact the plan for the full Evidence of Coverage.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 · Preferred Generic | $0.00 |
| Tier 2 · Generic | $0.00 |
| Tier 3 · Preferred Brand | 25% |
| Tier 4 · Non-Preferred Drug | 50% |
| Tier 5 · Specialty Tier | 29% |
| Tier 6 · Select Care Drugs | $0.00 |
Rx cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | n/a | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | n/a | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | 25% | 25% | n/a | 25% | 25% | 25% |
| Tier 4: Non-Preferred Drug | 50% | 50% | n/a | 50% | 50% | 50% |
| Tier 5: Specialty Tier | 29% | 29% | n/a | n/a | n/a | n/a |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | n/a | $0.00 | $0.00 | $0.00 |
These are the initial coverage phase amounts, as the plan filed them in its benefit package. The deductible and post-threshold phases are not stated per tier in that filing, so they are not shown here rather than being inferred; the plan's annual out-of-pocket threshold is $2,400.00.
Star rating measures
| Measure | 2027 | 2026 |
|---|---|---|
| Staying Healthy: Screenings, Tests and Vaccines | ||
| Breast Cancer Screening · C01 | 5 out of 5 stars for Breast Cancer Screening | too new |
| Colorectal Cancer Screening · C02 | 5 out of 5 stars for Colorectal Cancer Screening | too new |
| Annual Flu Vaccine · C03 | 2 out of 5 stars for Annual Flu Vaccine | too new |
| Managing Chronic (Long Term) Conditions | ||
| Special Needs Plan (SNP) Care Management · C07 | 4 out of 5 stars for Special Needs Plan (SNP) Care Management | too new |
| Care for Older Adults – Medication Review · C08 | 3 out of 5 stars for Care for Older Adults – Medication Review | too new |
| Care for Older Adults - Functional Status Assessment · C09 | 5 out of 5 stars for Care for Older Adults - Functional Status Assessment | new measure |
| Diabetes Care – Eye Exam · C11 | 4 out of 5 stars for Diabetes Care – Eye Exam | too new |
| Diabetes Care – Blood Sugar Controlled · C12 | 5 out of 5 stars for Diabetes Care – Blood Sugar Controlled | too new |
| Kidney Health Evaluation for Patients with Diabetes · C13 | 4 out of 5 stars for Kidney Health Evaluation for Patients with Diabetes | too new |
| Controlling High Blood Pressure · C14 | 4 out of 5 stars for Controlling High Blood Pressure | too new |
| Plan All-Cause Readmissions · C17 | 4 out of 5 stars for Plan All-Cause Readmissions | too new |
| Statin Therapy for Patients with Cardiovascular Disease · C18 | 3 out of 5 stars for Statin Therapy for Patients with Cardiovascular Disease | too new |
| Transitions of Care · C19 | 4 out of 5 stars for Transitions of Care | too new |
| Follow-up after Emergency Department Visit for People with Multiple High-Risk Chronic Conditions · C20 | 5 out of 5 stars for Follow-up after Emergency Department Visit for People with Multiple High-Risk Chronic Conditions | too new |
| Member Experience with Health Plan | ||
| Getting Needed Care · C21 | 3 out of 5 stars for Getting Needed Care | too new |
| Getting Appointments and Care Quickly · C22 | 4 out of 5 stars for Getting Appointments and Care Quickly | too new |
| Customer Service · C23 | 4 out of 5 stars for Customer Service | too new |
| Rating of Health Care Quality · C24 | 4 out of 5 stars for Rating of Health Care Quality | too new |
| Rating of Health Plan · C25 | 4 out of 5 stars for Rating of Health Plan | too new |
| Care Coordination · C26 | 3 out of 5 stars for Care Coordination | too new |
| Member Complaints and Changes in the Health Plan's Performance | ||
| Complaints about the Health Plan · C27 | 3 out of 5 stars for Complaints about the Health Plan | too new |
| Members Choosing to Leave the Plan · C28 | 4 out of 5 stars for Members Choosing to Leave the Plan | not enough data |
| Health Plan Customer Service | ||
| Call Center – Foreign Language Interpreter and TTY Availability · C32 | 5 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability | 3 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability |
| DD1: Drug Plan Customer Service | ||
| Call Center – Foreign Language Interpreter and TTY Availability · D01 | 3 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability | 4 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability |
| DD2: Member Complaints and Changes in the Drug Plan’s Performance | ||
| Complaints about the Drug Plan · D02 | 3 out of 5 stars for Complaints about the Drug Plan | too new |
| Members Choosing to Leave the Plan · D03 | 4 out of 5 stars for Members Choosing to Leave the Plan | not enough data |
| DD3: Member Experience with the Drug Plan | ||
| Rating of Drug Plan · D05 | 5 out of 5 stars for Rating of Drug Plan | too new |
| Getting Needed Prescription Drugs · D06 | 3 out of 5 stars for Getting Needed Prescription Drugs | too new |
| DD4: Drug Safety and Accuracy of Drug Pricing | ||
| MPF Price Accuracy · D07 | 5 out of 5 stars for MPF Price Accuracy | too new |
| Medication Adherence for Diabetes Medications · D08 | 4 out of 5 stars for Medication Adherence for Diabetes Medications | too new |
| Medication Adherence for Hypertension (RAS antagonists) · D09 | 4 out of 5 stars for Medication Adherence for Hypertension (RAS antagonists) | too new |
| Medication Adherence for Cholesterol (Statins) · D10 | 3 out of 5 stars for Medication Adherence for Cholesterol (Statins) | too new |
| Statin Use in Persons with Diabetes (SUPD) · D11 | 4 out of 5 stars for Statin Use in Persons with Diabetes (SUPD) | too new |
| Concurrent Use of Opioids and Benzodiazepines (COB) · D12 | 1 out of 5 stars for Concurrent Use of Opioids and Benzodiazepines (COB) | new measure |
| Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH) · D13 | 5 out of 5 stars for Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH) | new measure |
Measures are paired between the two years by name, not by the C/D number: CMS reuses those numbers, and in 2027 nineteen of them refer to a different measure than they did in 2026. A measure introduced for 2027 has no 2026 score to show. Published per contract — every plan under H7239 shares it.
Benefits in plain text
Prominence Meridian (HMO-POS) (H7239-006-0) is a 2027 HMO-POS Medicare Advantage plan offered by Prominence Health Plan, available to residents of Palm Beach County, FL.
The monthly premium is $159.00.
With full Extra Help (the Low-Income Subsidy), the total monthly premium is $159.00.
The in-network deductible for health services is $500.00.
Its in-network out-of-pocket maximum is $3,000.00.
The drug deductible is $350.00. Tier 1, 2 and 6 exempt.
At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1 (Preferred Generic): $0.00; tier 2 (Generic): $0.00; tier 3 (Preferred Brand): 25%; tier 4 (Non-Preferred Drug): 50%; tier 5 (Specialty Tier): 29%; tier 6 (Select Care Drugs): $0.00.
CMS gives the plan's contract (H7239) an overall rating of 4.5 out of 5 stars.
Email a copy of the plan benefit details
Plan facts come from the CMS plan Landscape file and the CMS plan benefit package (PBP) files.