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MMM Unico (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MMM Unico (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MMM Unico (HMO-POS) in 2026, please refer to our full plan details page.
MMM Unico (HMO-POS) is a HMO-POS plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Puerto Rico. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that MMM Unico (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about MMM Unico (HMO-POS).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For MMM Unico (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $15.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $3.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $3250.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $3250.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The MMM Unico (HMO-POS) Medicare plan features a $0 drug deductible, allowing your prescription drug coverage to begin immediately. You will pay no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 7 select care drugs for both 1-month and 3-month supplies at standard pharmacies and standard mail order. For brand-name and specialty medications, Tier 3 preferred brand drugs require a $3 copay for a 1-month supply and a $6 copay for a 3-month supply. Tier 4 non-preferred drugs cost a $5 copay for a 1-month supply and a $10 copay for a 3-month supply, while specialty drugs require a 25% coinsurance for Tier 5 and a 33% coinsurance for Tier 6 at standard pharmacies.
Additional Benefits
The MMM Unico (HMO-POS) Medicare plan offers robust coverage with no copays and no coinsurance for many essential services, including inpatient acute hospital stays, primary and specialist care, and home health services. Outpatient hospital services carry a low $25 copay, while emergency care features a $75 copay that is waived if you are admitted. Additionally, skilled nursing facility stays and durable medical equipment are covered with no copays or coinsurance, though prior authorization is typically required. Members also benefit from no copays and no coinsurance on routine dental, vision, and hearing exams, with generous allowances including up to $3,500 annually for comprehensive dental care and $500 for eyewear. While dialysis and Part B chemotherapy drugs require a 20% coinsurance, the plan covers up to 24 one-way transportation trips per year and over-the-counter benefits with no copay. However, it is important to note that ground and air ambulance services, as well as cardiac rehabilitation, are not covered by this plan.
Inpatient Hospital See details
MMM Unico (HMO-POS) covers inpatient acute hospital stays with no copay and no coinsurance, including unlimited additional days, while inpatient psychiatric care requires a $50 copay per admission and no coinsurance. Prior authorization is required for both benefits, and certain services such as non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
MMM Unico (HMO-POS) covers outpatient hospital services with a $25 copay and observation services with a $0 to $50 copay per stay, both with no coinsurance. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, but outpatient substance abuse services are not covered in practice because individual and group sessions are excluded.
Partial Hospitalization See details
MMM Unico (HMO-POS) covers partial hospitalization services with no copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by MMM Unico (HMO-POS), as ground and air ambulance services are not covered. The plan covers transportation to plan-approved locations with no copay and no coinsurance for up to 24 one-way trips per year, though prior authorization is required and transportation to any other health-related location is not covered.
Emergency Services See details
MMM Unico (HMO-POS) covers emergency services with a $75 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with no copay or coinsurance. Worldwide emergency and urgent services are partially covered up to a $500 maximum benefit with a $100 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
MMM Unico (HMO-POS) primary care benefits feature no copays and no coinsurance for primary care, specialist, therapy, and podiatry services, though prior authorization is required. Some chiropractic, mental health, and psychiatric services are covered, but other chiropractic services, alongside individual and group sessions for mental health and psychiatry, are not covered. Opioid treatment program services are covered with no copay and a 10% coinsurance.
Preventive Services See details
Preventive services are partially covered by MMM Unico (HMO-POS) with no copay and no coinsurance, though prior authorization is required for most services. Covered benefits include health education, nutritional training, and alternative therapies, while annual physical exams, in-home safety assessments, personal emergency response systems, therapeutic massage, and medical nutrition therapy are not covered.
Hearing Services See details
MMM Unico (HMO-POS) provides partially covered hearing services with no copay and no coinsurance for routine hearing exams, fitting evaluations, and prescription hearing aids, though prior authorization is required. Prescription hearing aids are covered up to a $1,250 maximum every three years for both ears combined, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by MMM Unico (HMO-POS) with no copay and no coinsurance, though prior authorization is required. The plan covers one routine eye exam per year and up to $500 annually for contact lenses and eyeglasses, but does not cover other eye exams, individual eyeglass lenses, eyeglass frames, or upgrades.
Dental Services See details
Dental services are partially covered by MMM Unico (HMO-POS) with no copay and no coinsurance for covered preventive and comprehensive care, such as cleanings, x-rays, and implants. Maxillofacial prosthetics and orthodontics are not covered, and there is a $3,500 annual maximum benefit for comprehensive services, which typically require prior authorization.
Home Infusion bundled Services See details
MMM Unico (HMO-POS) covers home infusion bundled services with prior authorization, offering covered insulin for a $35 copay and no coinsurance. Covered Part B chemotherapy and radiation drugs require up to 20% coinsurance, while other Part B drugs have up to a $5 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under MMM Unico (HMO-POS) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
MMM Unico (HMO-POS) covers Durable Medical Equipment (DME) with no copay and no coinsurance, requiring prior authorization. While non-Medicare prosthetics, medical supplies, and diabetic equipment feature no copay and no coinsurance, some services are covered but prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
MMM Unico (HMO-POS) provides partial coverage for diagnostic and radiological services, which require prior authorization. Covered lab services and diagnostic radiological services are available with no copay and no coinsurance, while diagnostic procedures and tests, therapeutic radiological services, and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered under MMM Unico (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the MMM Unico (HMO-POS) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
MMM Unico (HMO-POS) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance per stay, and does not require a prior three-day inpatient hospital stay. Prior authorization is required for this benefit, and additional days beyond Medicare-covered SNF days are not covered.
Other Services See details
Other services are partially covered by MMM Unico (HMO-POS), which offers acupuncture, over-the-counter items, and chronic illness meal benefits with no copay and no coinsurance. However, naloxone and certain other additional services are not covered under this plan.
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