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MMM Grandioso (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MMM Grandioso (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MMM Grandioso (HMO-POS) in 2025, please refer to our full plan details page.
MMM Grandioso (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 Grandioso (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 Grandioso (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 Grandioso (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 MMM Grandioso (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay different copays or coinsurance amounts depending on the drug tier and pharmacy you use. For example, you'll pay no copay for Preferred Generic drugs at a Standard Pharmacy, and a $10 copay for Standard Generic drugs at a Standard Pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you will pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The MMM Grandioso (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have either no copay or a $75 copay, while outpatient services can have copays between $5 and $75. Emergency services have a $75 copay, but urgent services have no copay. This plan covers primary care, preventive, hearing, vision, and dental services, with copays and coinsurance depending on the specific service. Additional benefits include ambulance services with no copay, home health with no copay, and coverage for durable medical equipment with 20% coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute, with no copay for a Medicare-covered stay, and Inpatient Hospital Psychiatric, with a $75 copay per admission or stay; however, Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days for Inpatient Hospital Psychiatric are not covered. Prior authorization is required for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services. Outpatient hospital services have a $75 copay, and observation services have a copay between $25 and $75. Individual and group sessions for outpatient substance abuse have a copay of $5. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the MMM Grandioso (HMO-POS) plan. All ambulance services are covered with no copay and no coinsurance, but ground and air ambulance services are not covered; transportation services to plan-approved health-related locations are covered.
Emergency Services See details
Emergency Services under the MMM Grandioso (HMO-POS) plan include a $75 copay, with no coinsurance, and the copay is waived if admitted to the hospital within 1 day. Urgently Needed Services have no copay and no coinsurance. Worldwide Emergency Services are covered, with a $100 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, but Worldwide Emergency Transportation is not covered.
Primary Care See details
The MMM Grandioso (HMO-POS) plan covers primary care physician services, chiropractic services with a $5 copay, occupational therapy services with a $5 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 with a $0-$5 copay, 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 $5 copay, additional telehealth benefits, and opioid treatment program services with a 10% coinsurance. Routine Chiropractic Care has a maximum of 8 visits per year.
Preventive Services See details
The MMM Grandioso (HMO-POS) plan covers preventive services, including Medicare-covered services with no copay, and additional preventive services with prior authorization, but does not cover annual physical exams. Additional services like health education, alternative therapies (up to $30 every three months), nutritional/dietary benefits (6 visits), additional smoking cessation counseling (9 visits), fitness benefits (Memory Fitness, up to $30 every three months), remote access technologies, and home and bathroom safety devices (up to $30 every three months) are covered.
Hearing Services See details
Hearing Services for MMM Grandioso (HMO-POS) include coverage for routine hearing exams once per year, and no deductible applies. Fitting/Evaluation for Hearing Aid, Prescription Hearing Aids of all types, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services are covered, including routine eye exams and eyewear. Eyeglasses (lenses and frames) and contact lenses are covered, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, with a coinsurance of 0% - 20% for Medicare dental services and other dental services. Orthodontic services are covered with a maximum benefit of $1,000 per year, and a coinsurance of 0% - 20% for restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%, and Other Medicare Part B Drugs have a copay between $0 and $15.
Dialysis Services See details
Dialysis Services are covered under the MMM Grandioso (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 Grandioso (HMO-POS) plan, including durable medical equipment (DME) with 20% coinsurance and no copay, and Medicare-covered prosthetic devices and medical supplies with 20% coinsurance and no copay. Diabetic equipment is covered, but diabetic supplies and therapeutic shoes/inserts are not covered, and durable medical equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Lab Services with a coinsurance of at most 20% and Diagnostic Radiological Services with a copay of up to $50.00. 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 Grandioso (HMO-POS) plan with no copay and no 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 covered, but the specific services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization and a doctor referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the MMM Grandioso (HMO-POS) plan, 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 "Other Services" benefit includes acupuncture with a $10 copay, up to 10 treatments per year, and over-the-counter (OTC) items with a $30 benefit every three months. The plan also covers a meal benefit for chronic illnesses, requiring prior authorization and a doctor's referral. The plan does not cover Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, or Self-Directed Personal Assistance Services.
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