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MMM Combo Platino (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MMM Combo Platino (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MMM Combo Platino (HMO D-SNP) in 2025, please refer to our full plan details page.
MMM Combo Platino (HMO D-SNP) is a HMO D-SNP 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 Combo Platino (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
MMM Combo Platino (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about MMM Combo Platino (HMO D-SNP).
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 Combo Platino (HMO D-SNP), 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 $100.00. 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 a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 Combo Platino (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you'll pay the costs for drugs in each tier until your total drug costs reach $2,000. If you qualify for the low-income subsidy, you will have no copay for Part D drugs. Once your yearly out-of-pocket drug costs reach $2,000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The MMM Combo Platino (HMO D-SNP) plan offers a range of healthcare benefits, including coverage for inpatient and outpatient services, emergency services, and primary care with no copay. This plan also includes coverage for vision and dental services, along with home health and dialysis services. Additional benefits of this plan include coverage for ambulance and transportation services with no copay, and offers coverage for services like acupuncture, over-the-counter items, and meal benefits for chronic illnesses. However, it's important to note that some services, like hearing exams and specific types of equipment, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. However, additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered under the MMM Combo Platino (HMO D-SNP) plan, including Outpatient Hospital Services, Observation Services, and Ambulatory Surgical Center (ASC) Services, all of which require prior authorization. Outpatient Substance Abuse Services are covered with prior authorization and a doctor referral, however, Individual and Group Sessions for Outpatient Substance Abuse are not covered, and Outpatient Blood Services are also not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
The MMM Combo Platino (HMO D-SNP) plan covers all ambulance services with no copay or coinsurance, and transportation services to plan-approved health-related locations with no copay or coinsurance. Ground and air ambulance services, and transportation services to any health-related location, are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered with no copay and no coinsurance. Worldwide Urgent Coverage has a $75 copay, and Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care includes coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic Services are covered with a maximum benefit coverage amount of $750 per year, and Routine Chiropractic Care is limited to 6 visits per year. Occupational Therapy Services and Physical Therapy and Speech-Language Pathology Services have no copay or coinsurance, but require authorization. Mental Health Specialty Services and Psychiatric Services do not cover individual or group sessions.
Preventive Services See details
Preventive services are covered by MMM Combo Platino (HMO D-SNP), however, 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. Additional preventive services are covered, including health education, alternative therapies (12 visits every three months, up to a $45 maximum), nutritional/dietary benefits (6 visits), additional sessions of smoking and tobacco cessation counseling (9 visits), fitness benefits (memory fitness, up to a $45 maximum every three months), remote access technologies, home and bathroom safety devices and modifications (up to a $45 maximum every three months), glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following welcome visits.
Hearing Services See details
Hearing services are not covered by the MMM Combo Platino (HMO D-SNP), as routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids of all types, and OTC hearing aids are not covered. Prior authorization is required for hearing exams.
Vision Services See details
Vision services are covered, including eye exams and eyewear, such as contact lenses and eyeglasses. Routine eye exams are not covered, and eyeglasses lenses, frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, including Medicare dental services, orthodontic services, restorative services, implant services, prosthodontics (removable and fixed). Adjunctive general services, endodontics, periodontics, maxillofacial prosthetics, oral and maxillofacial surgery, and orthodontics are not covered; coinsurance ranges from 0% to 20% for covered services. The plan has a maximum benefit of $1000 per year for orthodontic services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the MMM Combo Platino (HMO D-SNP) plan, including Medicare Part B Insulin Drugs. Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis services are covered, but require prior authorization. There is no copay or coinsurance for this benefit.
Medical Equipment See details
The MMM Combo Platino (HMO D-SNP) plan covers Durable Medical Equipment (DME) with 20% coinsurance and requires prior authorization, but does not cover DME for use outside the home. Prosthetics/Medical Supplies and Diabetic Equipment are covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered. There is no copay for covered services.
Home Health Services See details
Home Health Services are covered by the MMM Combo Platino (HMO D-SNP) plan with no copay or coinsurance, but authorization is required. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered. Prior authorization is required.
Other Services See details
The MMM Combo Platino (HMO D-SNP) plan covers acupuncture with a maximum benefit of $500 per year, and requires prior authorization and a doctor's referral. This plan also covers over-the-counter (OTC) items with a maximum benefit of $45 every three months, including nicotine replacement therapy, while other services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, are not covered. Meal benefits are covered for a chronic illness.
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