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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 2025, 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 4.5 out of 5 stars in 2025.
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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying copays or coinsurance depending on the drug tier and pharmacy. For example, standard generic drugs have a $3 copay, and non-preferred drugs have 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. This plan may also reduce your premium if you qualify for the low-income subsidy.
Additional Benefits
The MMM Unico (HMO-POS) plan offers a range of benefits with varying cost-sharing. This plan provides no copay for inpatient hospital stays, and also covers outpatient services with a $25 copay, and emergency services with a $25 copay. Additional benefits include coverage for hearing, vision, and dental services. Hearing services include hearing exams and hearing aids, vision services include routine eye exams and eyewear, and dental services cover a wide range of procedures. The plan also offers transportation services, various therapy services, and covers services like home health and medical equipment.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute with no copay for a Medicare-covered stay and Additional Days for Inpatient Hospital-Acute with no copay, but do not include Non-Medicare-covered Stay for Inpatient Hospital-Acute or Upgrades for Inpatient Hospital-Acute. Inpatient Hospital Psychiatric benefits are covered with a $50 copay per admission or stay, but Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by the MMM Unico (HMO-POS) plan, including outpatient hospital services with a $25 copay, and observation services with a copay between $0 and $50. The plan does not cover individual or group sessions for outpatient substance abuse, or outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered by the MMM Unico (HMO-POS) plan, but requires prior authorization. There is no information about cost-sharing, such as copay or coinsurance, for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no copay or coinsurance for ambulance services; however, ground and air ambulance services are not covered. Transportation services to a plan-approved health-related location are covered for up to 24 one-way trips per year, using rideshare services, bus/subway, van, or medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the MMM Unico (HMO-POS) plan. Emergency Services have a $25 copay, while Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $100 copay, and Worldwide Emergency Transportation is not covered.
Primary Care See details
The MMM Unico (HMO-POS) plan covers Primary Care Physician Services, Chiropractic Services with a maximum of $1000 per year, Occupational Therapy Services with no copay or coinsurance, Physician Specialist Services, Podiatry Services up to 6 visits per year, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services with no copay or coinsurance, Additional Telehealth Benefits, and Opioid Treatment Program Services with 10% coinsurance. Mental Health Specialty Services offers no coverage for individual and group sessions.
Preventive Services See details
The MMM Unico (HMO-POS) plan covers preventive services, including Medicare-covered services with prior authorization, and additional preventive services. Some services are covered, including Health Education, Alternative Therapies (up to 12 visits every three months with a maximum plan benefit coverage amount of $40), Nutritional/Dietary Benefit (up to 6 visits), Additional Sessions of Smoking and Tobacco Cessation Counseling (up to 9 visits), Fitness Benefit (Memory Fitness, with a maximum plan benefit coverage amount of $40 every three months), Remote Access Technologies, Home and Bathroom Safety Devices and Modifications (maximum plan benefit coverage amount of $40 every three months), Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit; however, Annual Physical Exam, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams and fitting/evaluation for hearing aids are each limited to one visit per year. Prescription hearing aids are covered up to a maximum of $1250 every three years. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and neither are OTC hearing aids.
Vision Services See details
The MMM Unico (HMO-POS) plan covers routine eye exams once per year, and eyewear, including contact lenses and eyeglasses (lenses and frames), with a combined maximum of $500 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The MMM Unico (HMO-POS) plan covers Dental Services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery. Orthodontic services have a maximum benefit of $3,500 per year, while maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with a $0-$5 copay and 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the MMM Unico (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits under the MMM Unico (HMO-POS) plan include Durable Medical Equipment (DME) with no copay or coinsurance, but does not cover Durable Medical Equipment for use outside the home. Prosthetics/Medical Supplies - Non-Medicare benefit is covered with no copay or coinsurance, but does not cover Prosthetic Devices or Medical Supplies. Diabetic Equipment benefits do not cover Diabetic Supplies or Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services includes coverage for lab services with a coinsurance of at most 20%, and diagnostic radiological services with a copay of at most $5.00; however, diagnostic procedures/tests, therapeutic radiological services, and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered by the MMM Unico (HMO-POS) plan with no copay and no coinsurance, but authorization is required. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor referral are required for coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required for this benefit.
Other Services See details
The MMM Unico (HMO-POS) plan covers acupuncture with prior authorization, up to 12 treatments per year, and Over-the-Counter (OTC) items with a maximum benefit of $40 every three months, including nicotine replacement therapy. The plan also covers meal benefits for chronic illness with prior authorization and a doctor referral. However, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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