A non-government entity
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 2026, 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 5 out of 5 stars in 2026.
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:
Sign up for MMM Elite (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The MMM Elite (HMO-POS) plan offers highly cost-effective prescription drug coverage featuring a $0 drug deductible, allowing your benefits to begin immediately. You will pay no copay for Tier 1 preferred generic, Tier 2 generic, Tier 3 preferred brand, Tier 4 non-preferred, and Tier 7 select care drugs. This no-copay rate applies to both 1-month and 3-month supplies at standard pharmacies, as well as 3-month standard mail orders. For specialty medications, the plan utilizes coinsurance rather than flat copayments. Tier 5 preferred specialty drugs require a 25% coinsurance for a 1-month supply at standard pharmacies, while Tier 6 specialty drugs have a 33% coinsurance. This structure ensures exceptionally low costs for most common prescriptions while detailing clear cost-sharing for specialized medical needs.
Additional Benefits
MMM Elite (HMO-POS) offers comprehensive medical coverage with no copays and no coinsurance for inpatient hospital stays, skilled nursing facility care, primary care visits, and specialist services. Outpatient hospital services require a low $25 copay, while emergency care has a $75 copay that is waived if you are admitted to the hospital. Additionally, routine preventive care, home health services, and up to 24 one-way health-related transportation trips are available with no copays or coinsurance. The plan also provides strong supplemental benefits, including dental, vision, and hearing services with no copays or coinsurance, featuring generous allowances like a $2,500 annual dental limit and a $2,000 hearing aid benefit. Durable medical equipment is covered with no copay, though dialysis services require a 20% coinsurance and Medicare Part B drugs can carry a coinsurance up to 20%. Eligible members can also access chronic illness meals and select over-the-counter items with no copays.
Inpatient Hospital See details
MMM Elite (HMO-POS) covers inpatient acute hospital stays with no copay, no coinsurance, and unlimited additional days, though prior authorization is required. Inpatient psychiatric hospital stays require prior authorization, a $50 copay per stay, and no coinsurance, while non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
MMM Elite (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, and while some outpatient substance abuse services are covered, individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization is covered by MMM Elite (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
MMM Elite (HMO-POS) covers transportation services with no copay and no coinsurance for up to 24 one-way trips per year to plan-approved health-related locations. Ambulance services, including both ground and air transport, are not covered by this plan in practice.
Emergency Services See details
Emergency services are covered by MMM Elite (HMO-POS) with a $75 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance, while urgently needed services have no copay or coinsurance. Worldwide emergency and urgent care are partially covered up to a $500 maximum with a $100 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Primary Care services under MMM Elite (HMO-POS) are widely covered with no copay and no coinsurance, including primary care doctor visits, specialist services, and physical therapy. The benefit is partially covered as other chiropractic services, alongside individual and group sessions for both mental health and psychiatric services, are not covered. Opioid treatment requires a 10% coinsurance with no copay, while visits to other health care professionals may require a copay up to $10 with no coinsurance.
Preventive Services See details
Preventive services are partially covered by MMM Elite (HMO-POS) with no copay and no coinsurance, though prior authorization is required for many options. While benefits like glaucoma screenings and diabetes training are included, annual physical exams, in-home safety assessments, and personal emergency response systems are not covered.
Hearing Services See details
MMM Elite (HMO-POS) covers hearing services with no copay and no coinsurance, subject to prior authorization. One routine hearing exam and one fitting evaluation are covered annually, and prescription hearing aids are partially covered with a $2,000 maximum benefit every three years. OTC hearing aids, along with inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
MMM Elite (HMO-POS) provides partially covered vision services with no copay, no coinsurance, and no deductible, although prior authorization is required. The plan covers one routine eye exam per year and offers a $500 annual maximum for contact lenses and eyeglasses, while other eye exams, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by MMM Elite (HMO-POS) with no copay and no coinsurance for all covered preventive and comprehensive services, though prior authorization is required. Maxillofacial prosthetics and orthodontics are not covered under this plan, and covered comprehensive services are subject to a $2,500 annual maximum limit.
Home Infusion bundled Services See details
MMM Elite (HMO-POS) covers Home Infusion bundled Services with no copay and no coinsurance, although prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and 0% to 20% coinsurance.
Dialysis Services See details
MMM Elite (HMO-POS) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered by MMM Elite (HMO-POS), which offers durable medical equipment with no copay and no coinsurance, and prosthetic devices and medical supplies with no copay and 5% coinsurance. Diabetic equipment is partially covered with no copay and no coinsurance, but diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
MMM Elite (HMO-POS) partially covers diagnostic and radiological services, requiring prior authorization for covered services. Covered lab services and diagnostic radiological services feature no copays 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 the MMM Elite (HMO-POS) plan 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 Elite (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 Elite (HMO-POS) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance per stay, although prior authorization is required. This benefit allows for admission without a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
MMM Elite (HMO-POS) provides coverage for other services, including acupuncture for a $10 copay and no coinsurance for up to 10 treatments per year, as well as chronic illness meal benefits and select over-the-counter items with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, and some sub-services, such as Naloxone OTC coverage and Dual Eligible SNPs, are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved