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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 2026, 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 5 out of 5 stars in 2026.
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. Additionally, this plan comes with a Part B Premium reduction of $7.00. 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 Grandioso (HMO-POS) Medicare plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. Under this plan, you will pay no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 7 select care drugs at standard pharmacies or through standard mail order. This makes managing everyday maintenance medications highly affordable for members. For higher tier medications, standard pharmacy copays remain low, with Tier 3 preferred brands costing a $5 copay for a 1-month supply and Tier 4 non-preferred drugs costing a $15 copay. Specialty medications require coinsurance, specifically 25% for Tier 5 preferred specialty drugs and 33% for Tier 6 specialty drugs. Standard mail order options also provide cost-effective 3-month supplies, including a $10 copay for Tier 3 and a $30 copay for Tier 4 drugs.
Additional Benefits
The MMM Grandioso (HMO-POS) plan offers comprehensive healthcare coverage with no copay and no coinsurance for inpatient hospital stays, primary care provider visits, and telehealth services. Outpatient hospital services, specialist visits, and emergency care are highly affordable, requiring no coinsurance and low copays ranging from no copay up to $75. Additionally, routine eye exams, vision hardware up to a $1,000 yearly limit, and routine hearing exams are covered with no copays or deductibles. For specialized care, the plan provides preventive dental, home health, and skilled nursing facility services with no copay and no coinsurance. Durable medical equipment, prosthetics, and dialysis services are covered with no copay and a 20% coinsurance, while Part B insulin is available for a $35 copay. To maximize these benefits, keep in mind that many services, including diagnostic tests and unlimited plan-approved transportation, require prior authorization.
Inpatient Hospital See details
MMM Grandioso (HMO-POS) covers inpatient acute hospital stays with no copay and no coinsurance, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric care is covered with a $75 copay per admission and no coinsurance, but additional days are not covered, and prior authorization is required for both benefits.
Outpatient Services See details
MMM Grandioso (HMO-POS) covers outpatient services with no coinsurance, including a $75 copay for outpatient hospital services, a $0 to $50 copay per stay for observation services, and a $5 copay for outpatient substance abuse sessions. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, though prior authorization is required for most of these services.
Partial Hospitalization See details
Partial hospitalization is covered by MMM Grandioso (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 Grandioso (HMO-POS), featuring unlimited one-way trips to plan-approved locations with no copay and no coinsurance, subject to prior authorization. Some ambulance services are covered with no copay or coinsurance, but ground and air ambulance services, as well as transportation to any health-related locations, are not covered.
Emergency Services See details
MMM Grandioso (HMO-POS) covers emergency services with a $75 copay (waived if admitted within 24 hours) and no coinsurance, and urgently needed services with no copay or coinsurance. Worldwide emergency and urgent services are partially covered up to a $500 maximum with a $100 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Primary care benefits under MMM Grandioso (HMO-POS) feature no copay and no coinsurance for primary care provider visits and telehealth, while specialist, mental health, therapy, and podiatry services generally require a copay of $0 to $10 and no coinsurance. Chiropractic care is partially covered, offering routine care with a $5 copay but excluding other chiropractic services. Most specialty and therapy services require prior authorization, and opioid treatment services require a 10% coinsurance with no copay.
Preventive Services See details
Preventive services are partially covered under MMM Grandioso (HMO-POS) with no copay and no coinsurance, although prior authorization is required for some services. Covered options include health education and alternative therapies, while annual physical exams, in-home safety assessments, medical nutrition therapy, and weight management programs are not covered.
Hearing Services See details
Hearing services under MMM Grandioso (HMO-POS) include one routine hearing exam every year with no copay and no coinsurance, though prior authorization is required. Hearing aid fittings, evaluations, prescription hearing aids, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
MMM Grandioso (HMO-POS) covers routine eye exams and eyewear with no copay, no coinsurance, and no deductible, subject to prior authorization. This benefit is partially covered, offering one routine exam annually and a $1,000 yearly limit for eyeglasses and contact lenses, while other exam services, individual lenses or frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by MMM Grandioso (HMO-POS), with maxillofacial prosthetics and orthodontics excluded from coverage. Preventive services feature no copay and no coinsurance, while Medicare-covered and comprehensive services require no copay and 0% to 20% coinsurance up to a $1,000 annual limit.
Home Infusion bundled Services See details
MMM Grandioso (HMO-POS) covers home infusion bundled services with prior authorization, offering Medicare Part B insulin for a $35 copay and no coinsurance. Covered Part B chemotherapy and radiation drugs require a copay and up to 20% coinsurance, while other Part B drugs range from no copay to a $15 copay and up to 20% coinsurance.
Dialysis Services See details
MMM Grandioso (HMO-POS) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
MMM Grandioso (HMO-POS) covers durable medical equipment and prosthetics or medical supplies with no copay and a 20% coinsurance, subject to prior authorization. While diabetic equipment is covered with no copay and no coinsurance, 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 Grandioso (HMO-POS) with prior authorization required and no copays or coinsurance for covered lab and diagnostic radiological services. 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 Grandioso (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
MMM Grandioso (HMO-POS) covers some cardiac rehabilitation services with no copay and no coinsurance, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered. Prior authorization and a referral are required for covered rehabilitation benefits.
Skilled Nursing Facility (SNF) See details
MMM Grandioso (HMO-POS) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. While the plan allows SNF admission without a prior three-day inpatient hospital stay, additional days beyond Medicare-covered care are not covered.
Other Services See details
MMM Grandioso (HMO-POS) partially covers other services, offering acupuncture with a $10 copay and no coinsurance for up to 10 treatments per year, alongside chronic illness meals and over-the-counter (OTC) items with no copay and no coinsurance. Naloxone, certain CMS OTC list drugs, and other additional services are not covered under these benefits.
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