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MMM Balance (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MMM Balance (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MMM Balance (HMO-POS) in 2025, please refer to our full plan details page.
MMM Balance (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 out of 5 stars in 2025.
It's important to know that MMM Balance (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 Balance (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 Balance (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 $102.70. 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 Balance (HMO-POS) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay different copays or coinsurance amounts depending on the drug tier. For example, you will pay no copay for preferred generic drugs at standard pharmacies, and a $7 copay for standard generic drugs. For preferred brand drugs, you will pay a $10 copay, while non-preferred drugs have a 25% coinsurance. Specialty tier drugs have a 33% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs.
Additional Benefits
The MMM Balance (HMO-POS) plan offers a variety of benefits with varying costs. Inpatient hospital stays have a $0 or $50 copay depending on the type of stay, while outpatient services have a $50 copay. Emergency services cost $75, and primary care visits can have copays ranging from $0-$10, depending on the service. This plan covers preventive services with no copay, as well as hearing, vision, and dental services, with specific limitations on the types of services covered. Additional benefits include ambulance services with no copay, limited transportation services, and coverage for home infusion, dialysis, medical equipment, and home health services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a $0 copay for Inpatient Hospital-Acute and a $50 copay per stay for Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services with the MMM Balance (HMO-POS) plan includes coverage for all outpatient hospital services, with a $50 copay, and observation services with a copay of $5-$50. Ambulatory Surgical Center (ASC) Services and outpatient substance abuse services are also covered, and the plan does not cover outpatient blood services. Individual and group sessions for outpatient substance abuse have a copay of $5.
Partial Hospitalization See details
Partial Hospitalization is covered by the MMM Balance (HMO-POS) plan, but requires prior authorization. There is no information about the cost of this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no copay or coinsurance for all ambulance services. Transportation Services are partially covered; specifically, Transportation Services to a plan-approved health-related location are covered for 10 one-way trips per year.
Emergency Services See details
Emergency Services are covered by the MMM Balance (HMO-POS) plan, with a $75 copay and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $100 copay, and Worldwide Emergency Transportation is not covered.
Primary Care See details
The MMM Balance (HMO-POS) plan covers primary care physician services, chiropractic services with a $5 copay, occupational therapy services with a $4 copay, physician specialist services with a $0-$5 copay, mental health specialty services with a $0-$5 copay for individual and group sessions, podiatry services, other health care professional services with a $0-$10 copay, psychiatric services with a $0-$5 copay for individual and group sessions, physical therapy and speech-language pathology services with a $4 copay, additional telehealth benefits, and opioid treatment program services with 10% coinsurance.
Preventive Services See details
The MMM Balance (HMO-POS) plan covers preventive services, including Medicare-covered services with no copay, and other preventive services like health education, smoking cessation counseling, and fitness benefits. This plan does not cover 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, 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.
Hearing Services See details
Hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids (all types) are covered, with prior authorization required for exams and hearing aids. Routine hearing exams and fitting/evaluation for hearing aids are each limited to one visit per year. Prescription hearing aids have a maximum plan benefit of $1250 every three years. Prescription hearing aids - inner ear, outer ear, and over the ear, as well as OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for routine eye exams, contact lenses, and eyeglasses (lenses and frames). Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The MMM Balance (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), oral and maxillofacial surgery, and implant services. Orthodontic services have a maximum plan benefit of $1,500 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 0-20% coinsurance and a $0-$10 copay. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the MMM Balance (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the MMM Balance (HMO-POS) plan, including Durable Medical Equipment and Prosthetics/Medical Supplies, with no copay for DME, and a 5% coinsurance for Prosthetic Devices and Medical Supplies. Durable Medical Equipment for use outside the home, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
The MMM Balance (HMO-POS) plan covers lab services with a coinsurance of up to 20%, and diagnostic radiological services with a copay of up to $40.00, while diagnostic procedures/tests, therapeutic radiological services, and outpatient X-ray services are not covered. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the MMM Balance (HMO-POS) plan with no copay or 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 Balance (HMO-POS) plan. This includes Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. This plan does not cover additional days beyond Medicare-covered for SNF, nor does it cover non-Medicare-covered stays for SNF.
Other Services See details
The MMM Balance (HMO-POS) plan covers acupuncture with a $10 copay, and up to 10 treatments per year, as well as over-the-counter (OTC) items with a maximum benefit of $25 every three months; the plan also covers a meal benefit for chronic illness. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), and others are not covered.
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