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MMM Mega Flex (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MMM Mega Flex (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MMM Mega Flex (HMO-POS) in 2026, please refer to our full plan details page.
MMM Mega Flex (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 Mega Flex (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 Mega Flex (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 Mega Flex (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 $4.00. 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 Mega Flex (HMO-POS) Medicare plan offers a $0 drug deductible, allowing your prescription coverage to begin immediately without any upfront out-of-pocket costs. You will enjoy no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 7 select care drugs at standard pharmacies or through standard mail order. This no-copay benefit applies to both one-month and three-month supplies of these essential medications. For other drug tiers, the plan provides clear and predictable copays and coinsurance rates. Tier 3 preferred brand drugs have a $10 copay for a one-month supply and a $20 copay for a three-month supply, while Tier 4 non-preferred drugs require a $15 copay for one month and a $30 copay for three months. Specialty medications require coinsurance, with Tier 5 preferred specialty drugs carrying a 25% coinsurance and Tier 6 specialty drugs requiring a 33% coinsurance.
Additional Benefits
The MMM Mega Flex (HMO-POS) Medicare plan offers robust medical coverage with many essential services featuring no copay and no coinsurance. Beneficiaries enjoy no copays for primary care visits, telehealth services, acute inpatient hospital stays, and routine preventive care. For specialized medical needs, the plan keeps out-of-pocket costs low with copays up to ten dollars for specialist visits and a seventy-five dollar copay for emergency and outpatient hospital services. Routine dental, vision, and hearing exams are covered with no copay and no coinsurance, though comprehensive dental and standard eyewear are not covered. Additionally, the plan provides unlimited, cost-free transportation to plan-approved locations and fully covered skilled nursing facility services. While durable medical equipment and dialysis services require a twenty percent coinsurance, home health care and diagnostic lab services are available with no copay.
Inpatient Hospital See details
Inpatient hospital services are partially covered by MMM Mega Flex (HMO-POS), with prior authorization required for stays. Acute care stays feature no copay and no coinsurance, while psychiatric stays require a $50 copay and no coinsurance. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
MMM Mega Flex (HMO-POS) covers outpatient services with no coinsurance, featuring a $75 copay for outpatient hospital services, a $0 to $50 copay per stay for observation services, and a $7 copay for outpatient substance abuse sessions. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, with prior authorization required for most services.
Partial Hospitalization See details
Partial hospitalization is covered under the MMM Mega Flex (HMO-POS) plan with no copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
MMM Mega Flex (HMO-POS) transportation services are partially covered with no copay and no coinsurance for unlimited one-way rides to plan-approved locations, though trips to any health-related location are not covered. Ambulance services are not covered by this plan, and prior authorization is required for the covered transportation benefits.
Emergency Services See details
MMM Mega Flex (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 and no coinsurance. Worldwide emergency services are partially covered up to a $500 maximum with a $100 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
MMM Mega Flex (HMO-POS) provides primary care physician and telehealth services with no copay and no coinsurance, while specialist visits, mental health, and physical therapy feature copays up to $10 and no coinsurance. Chiropractic services are partially covered under this plan, offering routine care for a $7 copay and no coinsurance, while other chiropractic services are not covered.
Preventive Services See details
MMM Mega Flex (HMO-POS) partially covers preventive services with no copay and no coinsurance, though prior authorization is required for several benefits. Covered services include Medicare-covered zero-dollar preventive care, kidney disease education, alternative therapies, and nutritional counseling, while annual physical exams, fitness benefits, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services covered by MMM Mega Flex (HMO-POS) include one routine hearing exam per year with no copay, no coinsurance, and no deductible, though prior authorization is required. Fitting evaluations and OTC hearing aids are not covered, and while some prescription hearing aid services are covered, sub-services including inner ear, outer ear, and over-the-ear hearing aids are not covered in practice.
Vision Services See details
MMM Mega Flex (HMO-POS) features partially covered vision services, offering one routine eye exam annually with no copay and no coinsurance, though other eye exam services are not covered. For eyewear, some services are covered with no copay and no coinsurance, but contact lenses, eyeglasses, lenses, frames, and upgrades are not covered.
Dental Services See details
MMM Mega Flex (HMO-POS) partially covers dental services, offering preventive care like cleanings, exams, and x-rays with no copay and no coinsurance, while Medicare-covered dental services have no copay and 0% to 20% coinsurance. However, comprehensive dental services such as restorative care, endodontics, periodontics, prosthodontics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
MMM Mega Flex (HMO-POS) covers home infusion bundled services with prior authorization, featuring 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 have a copay of up to $15 and up to 20% coinsurance, with minimums starting at no copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the MMM Mega Flex (HMO-POS) plan with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
MMM Mega Flex (HMO-POS) covers durable medical equipment and prosthetics with no copay and 20% coinsurance. Diabetic equipment is partially covered with no copay and no coinsurance, but 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 Mega Flex (HMO-POS), with prior authorization required for all covered services. Covered lab services and diagnostic radiological services have no copay and no coinsurance, while diagnostic procedures and tests, therapeutic radiological services, and outpatient X-ray services are not covered.
Home Health Services See details
MMM Mega Flex (HMO-POS) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the MMM Mega Flex (HMO-POS) plan, as sub-services like intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered in practice. For these services, the plan lists no coinsurance and a $7 copay, and both referrals and prior authorizations are required.
Skilled Nursing Facility (SNF) See details
MMM Mega Flex (HMO-POS) covers skilled nursing facility (SNF) services with no copay and no coinsurance, although prior authorization is required. This benefit allows for admission without a prior three-day inpatient hospital stay, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
MMM Mega Flex (HMO-POS) covers acupuncture with a $10 copay and no coinsurance for up to 10 treatments yearly, and chronic illness meal benefits with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this plan.
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