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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 2025, 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 4 out of 5 stars in 2025.
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 $17.60. 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) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay different copays or coinsurance amounts depending on the drug tier and pharmacy. For example, you will pay a $2.00 copay for preferred generic drugs at a standard pharmacy. Once your total drug costs reach $2,000.00, you enter the catastrophic coverage phase where you will pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, you may have reduced premiums.
Additional Benefits
The MMM Mega Flex (HMO-POS) plan offers a variety of benefits with varying costs. You can expect no copay for inpatient hospital-acute, ambulance services, and home health services. You'll also have access to a variety of other services such as outpatient services, primary care, hearing, vision, and dental services. This plan covers emergency services, and offers coverage for home infusion bundled services, dialysis services, medical equipment, diagnostic and radiological services, cardiac rehabilitation, and skilled nursing facility services. Copays and coinsurance vary depending on the service, so be sure to review the details to understand potential out-of-pocket costs.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Inpatient Hospital-Acute has no copay, and Inpatient Hospital Psychiatric has a $50 copay.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services with a $75 copay, observation services with a copay between $25 and $75, ambulatory surgical center services, and outpatient substance abuse services with a copay of $7 for both individual and group sessions. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. There is no information about the cost of this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the MMM Mega Flex (HMO-POS) plan. All ambulance services are covered with no copay and no coinsurance, while ground and air ambulance services are not covered. Transportation Services to a plan-approved health-related location are covered with no copay and no coinsurance, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered, with a $75 copay for Emergency Services and a $100 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The MMM Mega Flex (HMO-POS) plan covers primary care physician services, chiropractic services with a $7 copay, occupational therapy services with a $7 copay, physician specialist services with a $0-$7 copay, mental health specialty services with a $0-$7 copay for individual and group sessions, podiatry services with a $0-$7 copay, other health care professional services with a $0-$10 copay, psychiatric services with a $0-$7 copay for individual and group sessions, physical therapy and speech-language pathology services with a $7 copay, additional telehealth benefits, and opioid treatment program services with 10% coinsurance. Prior authorization is required for many of these services.
Preventive Services See details
The MMM Mega Flex (HMO-POS) plan covers various preventive services, including Medicare-covered services with prior authorization, and additional preventive services like health education, alternative therapies (12 visits), nutritional/dietary benefits (6 visits), additional sessions of smoking and tobacco cessation counseling (9 visits), and remote access technologies. This plan does not cover annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers of enrollees, fitness benefits, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, or counseling services.
Hearing Services See details
Hearing services with the MMM Mega Flex (HMO-POS) plan include hearing exams with no deductible and no coinsurance, and routine hearing exams once per year. Fitting/Evaluation for Hearing Aid, Prescription Hearing Aids, and OTC Hearing Aids are not covered.
Vision Services See details
The MMM Mega Flex (HMO-POS) plan covers vision services, including routine eye exams with no deductible. Routine eye exams are covered once per year. Eyewear is also covered, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The MMM Mega Flex (HMO-POS) plan offers dental services, including oral exams, dental x-rays, and other diagnostic and preventive services. Medicare Dental Services may have a coinsurance of 0% to 20%, while other services such as orthodontics, restorative services, and others are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with a copay between $2-15 and 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the MMM Mega Flex (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, are covered. DME and Prosthetic Devices have a 20% coinsurance, while Medical Supplies and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Lab Services have a coinsurance of at most 20%, while Diagnostic Procedures/Tests and Outpatient X-Ray Services are not covered. Diagnostic Radiological Services have a copay of at most $50.00, while Therapeutic Radiological Services are not covered.
Home Health Services See details
Home Health Services are covered by the MMM Mega Flex (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the MMM Mega Flex (HMO-POS) plan, but the plan does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered by the MMM Mega Flex (HMO-POS) plan.
Other Services See details
Other Services include acupuncture, which has a $10 copay, and meal benefits, which require prior authorization and a doctor referral. Over-the-counter items, 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, and Self-Directed Personal Assistance Services are not covered.
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