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Prominence Diabetes and Heart Giveback (HMO C-SNP) H7680-015 • 2027 • Moore County, TX

CMS Rating: ☆☆☆☆☆ (4.0 out of 5 stars*)
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$3100.00In-network
Part B Giveback
−$50.00 reduction
Prescription Coverage
Enhanced, $0.00 deductible
Additional Benefits
Dental, Vision, Hearing
Service Area
Moore County, TX
Local Enrollment
14 beneficiaries in Moore County
Last update:

Introduction

CMS Plan ID H7680-015 identifies Prominence Diabetes and Heart Giveback, a Medicare Advantage Chronic Condition Special Needs Plan (C-SNP) offered by Prominence Health Plan. Its provider network is a Health Maintenance Organization (HMO), and Medicare Part D prescription drug coverage is included. For 2027, the plan has a $0.00 monthly premium, $0.00 medical deductible, and $3100.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $0.00.

Enrollment in this plan requires you to live in Moore County, Texas. CMS reports 14 beneficiaries enrolled in this plan in Moore County. New members can call the plan directly at (855)969-5882 (TTY 711) for assistance.

Eligibility

Prominence Diabetes and Heart Giveback is a Chronic Condition Special Needs Plan (C-SNP) designed for people with qualifying health conditions.

Special Needs Plan Type
Chronic Condition Special Needs Plan (C-SNP)
Medicare Requirement
Must have Medicare Part A and Part B
Special Needs Requirement
This plan is for individuals with cardiovascular disorders, chronic heart failure, and/or diabetes mellitus.
Service Area Requirement
Must live in the plan's service area
Prescription Drug Coverage
Medicare Part D prescription drug coverage is included.

Compare Similar Plans in Moore County

Although no other HMO C-SNP plans meet the comparison criteria in Moore County, you may have other Medicare Advantage options. Browse all Medicare Advantage SNP plans available in Moore County, or explore our Texas Medicare Special Needs directory for statewide information on plan availability, premiums, out-of-pocket costs, CMS ratings, and enrollment.

Plan Benefits

Prominence Diabetes and Heart Giveback has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H7680-015.

You can also compare 2027 costs and coverage with last year, side-by-side: Plan H7680-015-0 Cost Compare.

Office Visits

Primary care
In-network: $0 copay
Specialist
In-network: $0-$35 copay

Preventive and Wellness Services

Annual wellness exam
In-network: $0 copay
Telehealth benefit
In-network: $0 copay
Routine chiropractic
Not covered
Fitness benefits
Coming soon
Health education
Not covered
Counseling services
Not covered
Over-the-counter drug benefits
In-network: $0 copay
Health transportation (non-emergency)
Coming soon

Diagnostic, Lab, and Imaging Services

Diagnostic radiology services
In-network: $60 copay
Lab services
In-network: $0 copay
Outpatient x-rays
In-network: $0 copay
Diagnostic tests and procedures
In-network: $0 copay

Emergency and Urgent Care Services

Emergency room care
$150 copay
Worldwide emergency care
Coming soon
Urgent care
$30 copay
Inpatient hospital care
Tier 1
$100 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Tier 2
$250 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Skilled Nursing Facility
Tier 1
$20 per day for days 1-20
$221 per day for days 21-100
Ground ambulance
In-network: $300 copay

Mental Health Services

Outpatient individual therapy
In-network: $10 copay
Outpatient group therapy
In-network: $10 copay
Inpatient psychiatric hospital care
Tier 1
$100 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Tier 2
$250 per day for days 1-5
$0 per day for days 6-90
$0 per stay

Rehabilitation Services

Physical therapy and speech and language therapy
In-network: $20 copay
Occupational therapy
In-network: $5 copay

Medical Equipment and Supplies

Diabetes supplies
In-network: $0 copay
Durable medical equipment
In-network: 20% coinsurance
Prosthetics
In-network: 20% coinsurance

Medicare Part B Drugs

Chemotherapy
In-network: 0%-20% coinsurance
Other Part B drugs (Medicare-covered)
In-network: 0%-20% coinsurance

Dental Services

Oral exam
In-network: $0 copay
Dental x-rays
In-network: $0 copay
Cleaning
In-network: $0 copay
Periodontics
In-network: 0%-50% coinsurance
Endodontics
In-network: 0%-50% coinsurance
Restorative services
In-network: 0%-50% coinsurance
Implant services
Not covered
Orthodontics
Not covered
Oral/Maxillofacial surgery
In-network: 0%-50% coinsurance

Vision Services

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

Hearing Services

Hearing exam
In-network: $0 copay
Fitting/evaluation
In-network: $0 copay
Prescription hearing aids
In-network: $0-$1725 copay
OTC hearing aids
Not covered

Additional and Special Needs Services

Adult day health services
Not covered
Home-based palliative care
Not covered
Personal emergency response system
Coming soon
Weight management programs
Not covered
Wigs for chemotherapy-related hair loss
Coming soon
Alternative therapies
Not covered
Massage therapy
Not covered
Home/bathroom safety devices
Not covered

Certain preventive services are covered 100% by Prominence Diabetes and Heart Giveback as a Part B benefit.

Prescription Drug Coverage

Prominence Diabetes and Heart Giveback includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.

Prescription Drug Plan Premium

The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.

Prominence Diabetes and Heart Giveback (H7680-015-0) Prescription Drug Plan Premium Details
Part D Premium Component Amount
Basic Part D Premium:$0.00
Supplemental Part D Premium:$0.00
Total Part D Premium:$0.00
Low-Income Premium Subsidy:$6.27
Low-Income Premium Subsidy Paid by CMS:$0.00
Low-Income Subsidy Premium:$0.00

For more details, visit the Social Security Extra Help program .

Prescription Drug Plan Deductible

This plan has a $0.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Prominence Health Plan starts contributing towards your prescription costs.

Prescription Drug Plan Out-of-Pocket Costs

Beyond premiums and deductibles, Prominence Diabetes and Heart Giveback may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

Prominence Diabetes and Heart Giveback (H7680-015-0) Pharmacy Out-of-Pocket Costs by Drug Tier
Drug Tier Retail Mail Order
Preferred Generic$0.00 copay$0.00 copay
Generic$15.00 copay$15.00 copay
Preferred Brand$45.00 copay$45.00 copay
Non-Preferred Drug$100.00 copay$100.00 copay
Specialty Tier33% coinsurance33% coinsurance
Select Care Drugs$0.00 copay$0.00 copay
*Deductible does not apply.

CMS 5-Star Performance Ratings (Contract ID: H7680)

Medicare assigns star ratings to plans based on quality and performance across multiple measures, including customer service, member experience, and health outcomes. Ratings are updated annually by the Centers for Medicare & Medicaid Services (CMS) and are shown on a 1 to 5 star scale, with 5 stars representing the highest quality.

2027 Medicare Star Ratings for Contract H7680
CMS Measure Star Rating
2027 Overall Rating ☆☆☆☆☆
Staying Healthy: Screenings, Tests, Vaccines ☆☆☆☆☆
Managing Chronic (Long Term) Conditions ☆☆☆☆☆
Member Experience with Health Plan ☆☆☆☆☆
Complaints and Changes in Plans Performance ☆☆☆☆☆
Health Plan Customer Service ☆☆☆☆☆
Drug Plan Customer Service ☆☆☆☆☆
Complaints and Changes in the Drug Plan ☆☆☆☆☆
Member Experience with the Drug Plan ☆☆☆☆☆
Drug Safety and Accuracy of Drug Pricing ☆☆☆☆☆

Contact Information for Prominence Health Plan

Website
Prominence Health Plan Plan Page
Providers
Prominence Health Plan Providers Page
Formulary
Prominence Health Plan Formulary Page
Pharmacy
Prominence Health Plan Pharmacy Page
New Member Health Plan Help
(855)969-5882
New Member Health Plan TTY
711
New Member Part D Help
(855)969-5882
New Member Part D TTY Users
711

Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.

Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
Data Source Publisher Last Accessed
Landscape Source Files Centers for Medicare & Medicaid Services October 5, 2026
Medicare Part C & D Performance Centers for Medicare & Medicaid Services October 5, 2026
Plan Benefits Package Centers for Medicare & Medicaid Services October 5, 2026
Monthly Enrollment by Contract/Plan/State/County Centers for Medicare & Medicaid Services October 5, 2026

Data sources and methodology documentation.

Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
Prominence Health Plan (official source) http://www.prominencemedicare.com October 4, 2026
CMS.gov Chronic Condition Special Needs Plans (C-SNPs) April 28, 2026
Medicare.gov Understanding Medicare Advantage Plans April 28, 2026
NCOA.org 5 Steps to Choosing the Right Medicare Plan for You April 28, 2026

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Data provenance documentation is maintained in alignment with the U.S. Core Data for Interoperability (USCDI) Provenance standard.