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MMM Plenitud (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MMM Plenitud (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MMM Plenitud (HMO-POS) in 2025, please refer to our full plan details page.
MMM Plenitud (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 Plenitud (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 Plenitud (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 Plenitud (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 $40.00. 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 Plenitud (HMO-POS) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. In the initial coverage phase, you will pay $0 for preferred generic drugs at standard pharmacies, $5 for standard generic drugs, $7 for preferred brand drugs, 25% coinsurance for non-preferred drugs, and 33% coinsurance for specialty tier drugs. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The MMM Plenitud (HMO-POS) plan offers a wide range of benefits, including no copay for inpatient hospital stays, and a $75 copay for emergency services. The plan also covers outpatient services, and offers transportation to health-related locations with no copay for up to 20 one-way trips per year. This plan provides coverage for primary care, preventive services, hearing, vision, and dental services. It also includes benefits like home health services with no copay, and additional services such as acupuncture and over-the-counter items.
Inpatient Hospital See details
The MMM Plenitud (HMO-POS) plan covers Inpatient Hospital-Acute with no copay, and Inpatient Hospital Psychiatric with a $50 copay per stay. Additional days for Inpatient Hospital-Acute are covered with no copay, while non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a $25 copay, and observation services with a copay between $0 and $50. Ambulatory Surgical Center (ASC) Services are covered, but individual and group sessions for outpatient substance abuse, and outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered with prior authorization required. There is no information about the cost of this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by MMM Plenitud (HMO-POS), but ground and air ambulance services are not covered. Transportation services to a plan-approved health-related location are covered for up to 20 one-way trips per year with no copay and no coinsurance, using rideshare services, bus/subway, van, or medical transport.
Emergency Services See details
Emergency Services are covered by MMM Plenitud (HMO-POS), with a $75 copay and no coinsurance, and the copay is waived if admitted to the hospital within one day. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $100 copay and no coinsurance, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The MMM Plenitud (HMO-POS) plan covers primary care physician services, chiropractic services (with a $1,000 annual maximum and prior authorization), occupational therapy services (with a $4 copay), physician specialist services (with prior authorization), 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), physical therapy and speech-language pathology services (with a $4 copay), additional telehealth benefits, and opioid treatment program services (with 10% coinsurance). Psychiatric Services individual and group sessions are not covered.
Preventive Services See details
The MMM Plenitud (HMO-POS) plan covers preventive services, including Medicare-covered zero dollar services, and additional preventive services, though 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. The plan also covers health education, alternative therapies, nutritional/dietary benefits, additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, home and bathroom safety devices and modifications, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit.
Hearing Services See details
The MMM Plenitud (HMO-POS) plan covers hearing exams, routine hearing exams (1 per year), and fitting/evaluation for hearing aids (1 per year). The plan also covers prescription hearing aids up to a maximum of $1250 every three years, but prescription hearing aids for the inner, outer, and over the ear are not covered.
Vision Services See details
The MMM Plenitud (HMO-POS) plan covers vision services, including routine eye exams once per year, and eyewear with a combined maximum benefit of $500 per year. This plan also covers contact lenses and eyeglasses (lenses and frames), however, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The MMM Plenitud (HMO-POS) plan covers a variety of dental services, including oral exams, dental x-rays, and other diagnostic and preventive services, with a maximum benefit of $2,000 per year for orthodontic services. Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. For Medicare Part B Insulin Drugs, the plan has a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the plan has a coinsurance between 0% and 20%, and the Other Medicare Part B Drugs have a copay between $0 and $7.
Dialysis Services See details
Dialysis Services are covered under the MMM Plenitud (HMO-POS) plan, but require prior authorization. The coinsurance for this service is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no copay or coinsurance, Prosthetic Devices and Medical Supplies with 5% coinsurance, and Diabetic Equipment. However, 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
Diagnostic and Radiological Services are covered by MMM Plenitud (HMO-POS), with Lab Services having a coinsurance of at most 20%, and Diagnostic Radiological Services having a copay of at most $40.00; however, 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 Plenitud (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 covered by the MMM Plenitud (HMO-POS) plan, but none of the sub-services are covered. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered. Prior authorization is required.
Other Services See details
The MMM Plenitud (HMO-POS) plan covers acupuncture with a $10 copay, up to 10 treatments per year, and over-the-counter items with a $40 maximum benefit every three months. The plan also provides a meal benefit for chronic illness, but other services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and Private Duty Nursing Services are not covered.
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