A non-government entity
MMM Valioso (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MMM Valioso (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MMM Valioso (HMO-POS) in 2026, please refer to our full plan details page.
MMM Valioso (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 Valioso (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 Valioso (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 Valioso (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 $115.00. 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 Valioso (HMO-POS) Medicare plan features no drug deductible, allowing your prescription coverage to begin immediately. For Tier 1 preferred generics, Tier 2 generics, and Tier 7 select care drugs, you will pay no copay for a 1-month or 3-month supply at a standard pharmacy, or for a 3-month standard mail order. This ensures that many common maintenance medications are available to members at zero cost. For other drug tiers, the plan offers competitive copays and coinsurance rates at standard pharmacies. Tier 3 preferred brand drugs require an $8.00 copay for a 1-month supply or a $16.00 copay for a 3-month supply, while Tier 4 non-preferred drugs carry an $18.00 copay for 1 month and a $36.00 copay for 3 months. High-cost specialty medications require a 25% coinsurance for Tier 5 preferred specialty drugs and a 33% coinsurance for Tier 6 specialty drugs for a 1-month supply.
Additional Benefits
The MMM Valioso (HMO-POS) plan offers comprehensive coverage with no copays or coinsurance for many essential services, including inpatient acute care, primary care visits, preventive care, and home health services. For outpatient care, specialists, and urgent needs, members can expect low out-of-pocket costs, such as a $10 copay for specialist visits and no copay for urgent care. Emergency services require a $75 copay, which is waived if you are admitted to the hospital within 24 hours. This plan also features robust supplemental benefits, providing routine dental, vision, and hearing services with no copays or coinsurance, alongside allowances for glasses and hearing aids. Members also benefit from unlimited one-way transportation trips to plan-approved locations with no copay. For medical equipment and dialysis services, there is no copay, though a standard 20% coinsurance applies.
Inpatient Hospital See details
Inpatient hospital services are partially covered by MMM Valioso (HMO-POS), featuring acute care stays with no copay, no coinsurance, and unlimited additional days, while excluding upgrades and non-Medicare-covered stays. Psychiatric hospital stays require a $100 copay per admission and no coinsurance, with prior authorization required for both benefits and additional psychiatric days not covered.
Outpatient Services See details
Outpatient services are covered by MMM Valioso (HMO-POS) with no coinsurance, although prior authorization is required for most care. There is a $100 copay for outpatient hospital and ambulatory surgical center services, a $10 copay for substance abuse sessions, a $0 to $50 copay per stay for observation services, and no copay for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered by MMM Valioso (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by MMM Valioso (HMO-POS), which offers unlimited one-way trips to plan-approved locations with no copay and no coinsurance, though prior authorization is required. Ambulance services and transportation to any health-related location are not covered.
Emergency Services See details
MMM Valioso (HMO-POS) covers emergency services with a $75 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with no copay or 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, though worldwide emergency transportation is not covered.
Primary Care See details
MMM Valioso (HMO-POS) covers primary care doctor visits and telehealth with no copay and no coinsurance, while specialist, therapy, and mental health services require a copay of up to $10 and no coinsurance. Chiropractic services are partially covered, offering routine care with a $10 copay and no coinsurance but excluding other chiropractic services, and opioid treatment has a 10% coinsurance with no copay.
Preventive Services See details
Preventive services are partially covered by MMM Valioso (HMO-POS) with no copay and no coinsurance, although prior authorization is required for most services. Covered benefits include Medicare-covered preventive care, health education, and nutrition counseling, while the annual physical exam, fitness benefits, and in-home support are not covered.
Hearing Services See details
MMM Valioso (HMO-POS) hearing services are partially covered with no copay and no coinsurance, although prior authorization is required. Annual routine exams and fitting evaluations are covered, as well as prescription hearing aids up to $500 every three years, but OTC hearing aids and prescription inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services under MMM Valioso (HMO-POS) are partially covered with no deductible, no copay, and no coinsurance, although prior authorization is required. The plan covers one routine eye exam and up to $250 annually for contact lenses and eyeglasses, while other eye exams, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by MMM Valioso (HMO-POS) with no copay and no coinsurance for most diagnostic, preventive, restorative, and implant services. Maxillofacial prosthetics and orthodontics are not covered, and there is a $500 annual maximum limit on covered orthodontic services.
Home Infusion bundled Services See details
MMM Valioso (HMO-POS) covers home infusion Part B drugs, featuring a $35 copay and no coinsurance for insulin, and coinsurance ranging from no coinsurance to 20% for chemotherapy and radiation drugs. Other Part B drugs are covered with a copay ranging from no copay to $18 and coinsurance ranging from no coinsurance to 20%, with prior authorization and step therapy required.
Dialysis Services See details
Dialysis Services are covered by MMM Valioso (HMO-POS) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical Equipment is covered by MMM Valioso (HMO-POS) with no copay and requires prior authorization. Durable medical equipment, prosthetic devices, and medical supplies have a 20% coinsurance, while diabetic equipment is partially covered with no coinsurance, as diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by MMM Valioso (HMO-POS), offering covered lab services and diagnostic radiological services with no copay and no coinsurance, though prior authorization is required. 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 by MMM Valioso (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under MMM Valioso (HMO-POS) with no coinsurance, though in practice only some services are covered. Cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $10 copay, with prior authorization and referrals required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by MMM Valioso (HMO-POS) with no copay and no coinsurance, though prior authorization is required. Admission does not require a prior three-day inpatient hospital stay, but additional days beyond standard Medicare-covered days are not covered.
Other Services See details
MMM Valioso (HMO-POS) partially covers other services, offering acupuncture with a $10.00 copay and no coinsurance for up to 10 treatments per year, and chronic illness meal benefits with no copay and no coinsurance. Over-the-counter (OTC) items and other miscellaneous services under this benefit are not covered.
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