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MMM Elite (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MMM Elite (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MMM Elite (HMO-POS) in 2025, please refer to our full plan details page.
MMM Elite (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 Elite (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 Elite (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 Elite (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 Elite (HMO-POS) plan has an "Enhanced Alternative" drug benefit. The plan has no deductible. In the initial coverage phase, you will pay no copay for preferred generic, standard generic, and preferred brand drugs at a standard pharmacy. Non-preferred drugs have a 25% coinsurance, and specialty tier drugs have a 33% coinsurance. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The MMM Elite (HMO-POS) plan offers comprehensive coverage, including inpatient hospital stays with no copay for Medicare-covered stays and $50 copay for psychiatric stays. Outpatient services have a $25 copay, and emergency services have a $50 copay, with worldwide emergency coverage available for a $100 copay. The plan also covers a variety of services with varying cost-sharing, such as primary care, hearing, vision, and dental, with specific copays, coinsurance, and annual maximums. Additional benefits include ambulance and transportation services, home health services, and durable medical equipment with no copay. The plan also provides coverage for home infusion, diagnostic and radiological services, and skilled nursing facilities. However, some services like cardiac rehabilitation, additional home health hours, and certain dental and vision upgrades are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute with no copay for Medicare-covered stays, and Inpatient Hospital Psychiatric with a $50 copay. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services with the MMM Elite (HMO-POS) plan cover all outpatient hospital services, with a $25 copay for outpatient hospital services and a copay of $0-$50 for observation services. Ambulatory Surgical Center (ASC) Services are covered, and Outpatient Substance Abuse Services are partially covered, but individual and group sessions for outpatient substance abuse are not covered, and outpatient blood services are not covered.
Partial Hospitalization See details
Partial hospitalization is covered by the MMM Elite (HMO-POS) plan, but requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the MMM Elite (HMO-POS) plan. All ambulance services are covered with no copay or coinsurance, while 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 with no copay or coinsurance, and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the MMM Elite (HMO-POS) plan with a $50 copay, and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage are covered with a $100 copay, and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The MMM Elite (HMO-POS) plan covers primary care physician services, chiropractic services (with a $1,000 annual maximum and 12 visits per year), occupational therapy services (no copay and no coinsurance), physician specialist services, podiatry services (6 visits per year), other health care professional services (with a copay between $0 and $10), physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services (with 10% coinsurance). Mental health specialty services (individual and group sessions) and psychiatric services (individual and group sessions) are not covered.
Preventive Services See details
The MMM Elite (HMO-POS) plan covers preventive services, including Medicare-covered preventive services with prior authorization. Annual physical exams, in-home safety assessments, Personal Emergency Response Systems (PERS), medical nutrition therapy, 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, and support for caregivers of enrollees are not covered.
Hearing Services See details
Hearing Services include routine hearing exams and fitting/evaluation for hearing aids, each covered once per year, and prescription hearing aids with a combined maximum benefit of $2,000 every three years; however, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered. Prior authorization is required for hearing exams and prescription hearing aids.
Vision Services See details
Vision services are covered, including routine eye exams, contact lenses, and eyeglasses (lenses and frames). Eyewear has a combined maximum plan benefit coverage of $500 per year, and eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The MMM Elite (HMO-POS) plan covers a range of dental services, including oral exams, dental x-rays, and other diagnostic, preventive, and restorative services. Orthodontic services are covered up to a maximum of $2500 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 and Other Medicare Part B Drugs are also covered with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the MMM Elite (HMO-POS) plan and require prior authorization. The coinsurance is 20%.
Medical Equipment See details
Medical Equipment benefits for MMM Elite (HMO-POS) include Durable Medical Equipment (DME) with no copay or coinsurance, though authorization is required, as well as Prosthetics/Medical Supplies with no copay and 5% coinsurance for Medicare-covered items. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
The MMM Elite (HMO-POS) plan covers diagnostic and radiological services, with lab services having a coinsurance of at most 20% and diagnostic radiological services having a copay of at most $25.00. 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 Elite (HMO-POS) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered but not covered in practice, as Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization and a doctor's referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but prior authorization is required. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture with a $10 copay, over-the-counter items with a $90 maximum benefit every three months, and a meal benefit for chronic illness. Additionally, services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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