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PMC Max (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PMC Max (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on PMC Max (HMO-POS) in 2026, please refer to our full plan details page.
PMC Max (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 PMC Max (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 PMC Max (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 PMC Max (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 PMC Max (HMO-POS) Medicare plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. Beneficiaries enjoy no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 7 select care drugs when using standard retail pharmacies or standard mail order services. This makes managing everyday medications highly affordable under this plan. For brand-name and specialty medications, the plan requires low copays or coinsurance depending on the tier. Tier 3 preferred brand drugs carry a $6 copay for a one-month supply, while Tier 4 non-preferred drugs cost an $8 copay. Specialty medications require a coinsurance of 25% for Tier 5 preferred specialty drugs and 33% for Tier 6 specialty drugs.
Additional Benefits
The PMC Max (HMO-POS) Medicare plan features robust coverage with no copays or coinsurance for many essential medical services. Members pay no copay and no coinsurance for primary care visits, telehealth, preventive care, and Medicare-covered acute inpatient hospital stays. For outpatient care, there is a $25 copay for hospital services and a $75 copay for emergency services, which is waived if you are admitted. This plan also provides valuable supplemental benefits, offering dental, routine vision, and routine hearing services with no copay and no coinsurance. Additionally, members can access up to 12 one-way transportation trips per year and select over-the-counter items with no copay. While most services require no coinsurance, specialized treatments like dialysis require a 20% coinsurance, and durable medical equipment has a 0% to 10% coinsurance.
Inpatient Hospital See details
PMC Max (HMO-POS) offers partial coverage for inpatient hospital services with prior authorization required and no coinsurance for all stays. Medicare-covered acute stays require no copay and include unlimited additional days, while psychiatric stays have a $50 copay per admission. Non-Medicare-covered stays, acute room upgrades, and additional psychiatric hospital days are not covered.
Outpatient Services See details
Outpatient services are covered by PMC Max (HMO-POS) with no coinsurance, featuring a $25 copay for outpatient hospital services, a $0 to $50 copay per stay for observation services, and a $5 copay for substance abuse sessions. Ambulatory surgical center and blood services are covered with no copay and no coinsurance, with prior authorization required for most services.
Partial Hospitalization See details
Partial hospitalization is covered by PMC Max (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
PMC Max (HMO-POS) does not cover ambulance services, but transportation services are partially covered with no copay and no coinsurance. Eligible members receive up to 12 one-way trips per year to plan-approved health-related locations, though transportation to any health-related location is not covered.
Emergency Services See details
PMC Max (HMO-POS) emergency services are covered with a $75 copay (waived if admitted to the hospital within 24 hours) and no coinsurance, while urgently needed services have no copay and no coinsurance. Worldwide emergency services are partially covered up to a $500 maximum limit with a $100 copay and no coinsurance for emergency and urgent care, but worldwide emergency transportation is not covered.
Primary Care See details
PMC Max (HMO-POS) primary care benefits feature no copay and no coinsurance for primary care visits and telehealth, while specialty, therapy, and mental health services require copays ranging from $0 to $5 and no coinsurance. Chiropractic services are partially covered, offering routine care for a $5 copay and no coinsurance while other chiropractic services are not covered, and opioid treatment requires a 10% coinsurance with no copay.
Preventive Services See details
PMC Max (HMO-POS) offers partially covered preventive services with no copay and no coinsurance, though prior authorization is required for some services. Covered benefits include health education and glaucoma screenings, but annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, and counseling services are not covered.
Hearing Services See details
Hearing Services are partially covered by PMC Max (HMO-POS), providing one annual routine hearing exam and one fitting evaluation with no copay and no coinsurance. Prescription hearing aids are covered with no copay and no coinsurance up to a $1,000 maximum every three years, though OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are partially covered by PMC Max (HMO-POS), featuring no copay, no coinsurance, and no deductible for one annual routine eye exam and up to $450 yearly for eyeglasses and contact lenses. Other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered under this plan.
Dental Services See details
PMC Max (HMO-POS) provides partially covered dental services with no copay and no coinsurance, although prior authorization is required for most services. Covered benefits include preventive and comprehensive care such as cleanings, x-rays, and implants, while maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
PMC Max (HMO-POS) covers home infusion bundled services with prior authorization required, offering Medicare Part B insulin drugs for a $35 copay and no coinsurance. Other covered Part B drugs, including chemotherapy and radiation drugs, carry a coinsurance ranging from 0% (no coinsurance) to 20% and copayments ranging from no copay up to $8.
Dialysis Services See details
Dialysis services are covered under the PMC Max (HMO-POS) plan with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Medical Equipment See details
PMC Max (HMO-POS) covers Durable Medical Equipment (DME) with no copay and 0% to 10% coinsurance, requiring prior authorization. Prosthetic devices, medical supplies, and diabetic equipment and supplies are not covered under this plan.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by PMC Max (HMO-POS) and require prior authorization, offering no copay and no coinsurance for covered lab services and diagnostic radiological services. Outpatient diagnostic procedures and tests, therapeutic radiological services, and outpatient X-ray services are not covered.
Home Health Services See details
PMC Max (HMO-POS) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the PMC Max (HMO-POS) plan, which excludes coverage for intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
PMC Max (HMO-POS) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. The plan allows for SNF admission without requiring a prior three-day inpatient hospital stay, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
PMC Max (HMO-POS) partially covers other services, offering over-the-counter (OTC) items and meal benefits for chronic illnesses with no copay and no coinsurance, while acupuncture is not covered. Prior authorization and a referral are required for the meal benefit, and some limitations apply to the OTC drug list.
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