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MMM Deluxe (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MMM Deluxe (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MMM Deluxe (HMO-POS) in 2025, please refer to our full plan details page.
MMM Deluxe (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 Deluxe (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 Deluxe (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 Deluxe (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. Additionally, this plan comes with a Part B Premium reduction of $171.50. 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 Deluxe (HMO-POS) plan has an enhanced alternative drug benefit, and a $0 deductible. During the initial coverage phase, you will pay a copay for your prescriptions. For example, you'll pay $4 for preferred generic drugs, $10 for standard generic drugs, and $15 for preferred brand drugs. For non-preferred drugs, you'll pay 25% coinsurance, and for specialty tier drugs, you'll pay 33% coinsurance. After your yearly out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase, where you pay nothing for your prescriptions.
Additional Benefits
The MMM Deluxe (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have no copay for Medicare-covered services, and emergency services cost a $75 copay. Primary care, vision, and home health services have no copay. Preventive services include some alternative therapies and fitness benefits, while dental services cover a variety of procedures. The plan also covers ambulance, home infusion, and dialysis services. However, some services like certain outpatient services, cardiac rehabilitation, and additional days in a skilled nursing facility may not be covered or require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits for MMM Deluxe (HMO-POS) include Inpatient Hospital-Acute with no copay for Medicare-covered stays, and Inpatient Hospital Psychiatric with a $50 copay per admission or stay. Additional Days for Inpatient Hospital-Acute is covered with no copay, but other services such as Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services with the MMM Deluxe (HMO-POS) plan cover outpatient hospital services with a $25 copay, and observation services with a $10-$50 copay. Ambulatory Surgical Center (ASC) Services and outpatient substance abuse services are also covered, with individual and group sessions for outpatient substance abuse each having a $5 copay. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the MMM Deluxe (HMO-POS) plan. All ambulance services are covered with no copay and no coinsurance, but ground and air ambulance services are not covered. Transportation Services to plan-approved health-related locations are covered for up to 6 one-way trips per year using rideshare services, bus/subway, van, or medical transport, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by MMM Deluxe (HMO-POS). Emergency Services have a $75 copay, while Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $100 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
The MMM Deluxe (HMO-POS) plan covers primary care, chiropractic services with a $5 copay, occupational therapy services with a $5 copay, physician specialist services with a $0-$5 copay, mental health specialty services with a $0-$5 copay, podiatry services with a $0-$5 copay, other health care professional services with a $0-$10 copay, psychiatric services with a $0-$5 copay, physical therapy and speech-language pathology services with a $5 copay, additional telehealth benefits, and opioid treatment program services with a 10% coinsurance. Routine foot care is covered.
Preventive Services See details
Preventive services are covered, but annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, and weight management programs are not covered. This plan covers additional preventive services, including health education, alternative therapies (12 visits every three months, with a maximum plan benefit coverage amount of $25), nutritional/dietary benefits (6 visits), additional sessions of smoking and tobacco cessation counseling (9 visits), fitness benefits (Memory Fitness, with a maximum plan benefit coverage amount of $25 every three months), remote access technologies, home and bathroom safety devices and modifications (maximum plan benefit coverage amount of $25 every three months), and kidney disease education services.
Hearing Services See details
Hearing services include coverage for routine hearing exams and fitting/evaluation for hearing aids, each limited to one visit per year. Prescription hearing aids are covered with a maximum benefit of $1250 every three years, while inner ear, outer ear, and over-the-ear prescription hearing aids, as well as OTC hearing aids, are not covered.
Vision Services See details
The MMM Deluxe (HMO-POS) plan covers eye exams, including routine eye exams once per year, with no copay and no deductible. Eyewear is covered with a combined maximum of $200 per year, and contact lenses and eyeglasses (lenses and frames) are also covered. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The MMM Deluxe (HMO-POS) plan covers a variety of dental services, including oral exams, dental x-rays, other diagnostic dental services, cleanings, fluoride treatments, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery, but does not cover maxillofacial prosthetics or orthodontics. Orthodontic services have a maximum benefit of $1000 per year.
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 $4-15 copay and 0-20% coinsurance; prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the MMM Deluxe (HMO-POS) plan, but require prior authorization. The coinsurance for Dialysis Services is between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, Prosthetic Devices with a 5% coinsurance, and Medical Supplies with a 5% coinsurance, but Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for lab services with a coinsurance of up to 20% and diagnostic radiological services with a copay of up to $40.00, but 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 Deluxe (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the MMM Deluxe (HMO-POS) plan. Prior authorization and a doctor's referral are required for coverage, but the plan does not cover the services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the MMM Deluxe (HMO-POS) plan, 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
Under the MMM Deluxe (HMO-POS) plan, acupuncture has a $10 copay and is limited to 10 treatments per year with prior authorization required. Over-the-counter items are covered with a maximum benefit of $25 every three months, and a meal benefit is available for a chronic illness with a doctor referral and prior authorization. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others, are not covered.
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