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MMM Balance (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MMM Balance (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MMM Balance (HMO-POS) in 2026, please refer to our full plan details page.
MMM Balance (HMO-POS) is a HMO-POS plan offered by Elevance Health, Inc. available for enrollment in 2026 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 Balance (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 Balance (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 Balance (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 $51.00. 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 Balance (HMO-POS) Medicare plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 (Preferred Generic), Tier 2 (Generic), and Tier 7 (Select Care) drugs, there is no copay for 1-month and 3-month supplies at standard pharmacies, as well as for 3-month standard mail orders. Tier 3 (Preferred Brand) drugs require a $6 copay for a 1-month supply and $12 for a 3-month supply at standard pharmacies or standard mail order. Tier 4 (Non-Preferred) drugs have copays of $8 for a 1-month supply and $16 for a 3-month supply. Specialty medications require coinsurance, with Tier 5 (Preferred Specialty) costing 25% and Tier 6 (Specialty) costing 33% for a 1-month supply at standard pharmacies.
Additional Benefits
The MMM Balance (HMO-POS) Medicare plan offers robust coverage with exceptionally low out-of-pocket costs, featuring no copays and no coinsurance for many essential healthcare services. Members can benefit from no copay and no coinsurance for inpatient acute hospital stays, primary care visits, preventive care, and skilled nursing facility services. Outpatient hospital services and emergency visits are also highly affordable, requiring low copays of $50 and $75 respectively with no coinsurance. This plan also provides valuable supplemental benefits to support your daily health, including dental, vision, and hearing care with no copays or coinsurance for covered services. You will receive allowances for prescription eyewear and hearing aids, alongside covered local transportation and durable medical equipment. Most diagnostic lab services, home health visits, and over-the-counter items are also covered with no copay, making this plan a cost-effective choice for comprehensive healthcare.
Inpatient Hospital See details
MMM Balance (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 hospital stays are covered with a $50 copay per stay and no coinsurance, but additional days and non-Medicare-covered stays are excluded. Prior authorization is required for both of these inpatient services.
Outpatient Services See details
MMM Balance (HMO-POS) covers outpatient services with no coinsurance, featuring a $50 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, with prior authorization required for most services.
Partial Hospitalization See details
Partial hospitalization services are covered under the MMM Balance (HMO-POS) plan with no copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by MMM Balance (HMO-POS) with no copay and no coinsurance, although ground and air ambulance services are not covered. Transportation benefits are limited to 10 one-way trips per year to plan-approved locations, while trips to any other health-related locations are not covered.
Emergency Services See details
MMM Balance (HMO-POS) covers emergency services with a $75 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance, while urgently needed services have no copay or coinsurance. Worldwide emergency and urgent care are partially covered with a $100 copay and no coinsurance up to a $500 maximum benefit, but worldwide emergency transportation is not covered.
Primary Care See details
MMM Balance (HMO-POS) covers primary care, telehealth, and podiatry services with no copay and no coinsurance, while specialist, psychiatric, and mental health services range from no copay up to a $5 copay with no coinsurance. Physical and occupational therapy require a $4 copay with no coinsurance, opioid treatment has no copay and a 10% coinsurance, and chiropractic services are partially covered with a $5 copay and no coinsurance, as other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered under MMM Balance (HMO-POS) with no copay and no coinsurance, though prior authorization is required for most services. Covered benefits include alternative therapies and nutritional sessions, while annual physical exams, medical nutrition therapy, weight management programs, and therapeutic massages are not covered.
Hearing Services See details
Hearing services are partially covered by MMM Balance (HMO-POS) with no copay and no coinsurance, though prior authorization is required. While the plan covers one routine exam and fitting annually and up to $1,250 every three years for prescription hearing aids, OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
MMM Balance (HMO-POS) partially covers vision services with no copay, no coinsurance, and no deductible, though prior authorization is required. Covered benefits include one routine eye exam per year and up to $500 annually for contact lenses and eyeglasses, while other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by MMM Balance (HMO-POS) with no copay and no coinsurance for covered preventive and comprehensive care, though prior authorization is required for most services. While many diagnostic, restorative, and surgical procedures are covered, maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
MMM Balance (HMO-POS) covers home infusion bundled services with prior authorization, featuring a $35 copay and no coinsurance for Medicare Part B insulin. Other covered Part B chemotherapy and radiation drugs require 0% to 20% coinsurance, while other Part B drugs have a 0% to 20% coinsurance and copays ranging from no copay up to $8.
Dialysis Services See details
Dialysis Services are covered by MMM Balance (HMO-POS) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
MMM Balance (HMO-POS) covers durable medical equipment with no copay and no coinsurance, and prosthetics and medical supplies with no copay and a 5% coinsurance. Diabetic equipment is partially covered with no copay and no coinsurance, but diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
MMM Balance (HMO-POS) diagnostic and radiological services are partially covered and require prior authorization. Covered lab services and diagnostic radiological services feature no copay and no coinsurance, while diagnostic procedures, therapeutic radiological services, and outpatient x-ray services are not covered.
Home Health Services See details
Home health services are covered under the MMM Balance (HMO-POS) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by MMM Balance (HMO-POS) with no coinsurance, but require prior authorization and a referral. While some services are covered, standard Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered and carry a $5 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by MMM Balance (HMO-POS) with no copay and no coinsurance, and do not require a prior three-day inpatient hospital stay. Prior authorization is required, and additional days beyond Medicare-covered SNF days are not covered.
Other Services See details
MMM Balance (HMO-POS) covers other services including acupuncture for a $10 copay and no coinsurance, up to 10 treatments per year, as well as chronic illness meals and over-the-counter items with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, and certain items such as Naloxone are not covered.
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