A non-government entity
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) plan offers prescription drug coverage with a $0 drug deductible, allowing your benefits to start right away. You will pay no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 7 select care drugs filled at standard pharmacies or through standard mail order. This budget-friendly structure helps keep your everyday medication costs to a minimum. For higher-tier medications, Tier 3 preferred brands have a $6 copay for a one-month supply and a $12 copay for a three-month supply. Tier 4 non-preferred drugs cost an $8 copay for one month and a $16 copay for three months, while specialty medications require a 25% coinsurance for Tier 5 and a 33% coinsurance for Tier 6. These predictable copays and coinsurance rates make it easy to estimate your out-of-pocket prescription expenses.
Additional Benefits
MMM Balance (HMO-POS) offers comprehensive healthcare coverage with many essential services available at no cost to the member. You will pay no copay and no coinsurance for inpatient acute hospital stays, primary care visits, preventive services, and skilled nursing facility care. Specialist visits require a low copay of up to $10, while emergency room visits incur a $75 copay that is waived if you are admitted. The plan also features robust supplemental benefits including dental, vision, and hearing care with no copay, coinsurance, or deductibles. Members benefit from a $500 annual allowance for contact lenses and eyeglasses, alongside a $1,250 allowance every three years for prescription hearing aids. Additionally, the plan covers up to 10 one-way transportation trips per year and provides over-the-counter benefits at no cost.
Inpatient Hospital See details
MMM Balance (HMO-POS) partially covers inpatient hospital services, offering acute stays with no copay, no coinsurance, and unlimited additional days, alongside psychiatric stays for a $50 copay per admission with no coinsurance. Both services require prior authorization, while upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
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, though prior authorization is required for these outpatient benefits.
Partial Hospitalization See details
MMM Balance (HMO-POS) covers partial hospitalization services with no copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
MMM Balance (HMO-POS) does not cover ambulance services, but transportation services are partially covered with no copay and no coinsurance. Covered transportation is limited to 10 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
MMM Balance (HMO-POS) covers emergency services with a $75 copay (waived if admitted to the hospital 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 limit with a $100 copay and no coinsurance, 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 specialists, therapists, and mental health services require copays up to $10 and no coinsurance. Chiropractic care is partially covered, with routine services requiring a $5 copay and no coinsurance while other chiropractic services are not covered.
Preventive Services See details
MMM Balance (HMO-POS) covers Medicare-covered, kidney disease education, and select additional preventive services with no copay and no coinsurance, though prior authorization is required for most services. This benefit is partially covered because several services, including annual physical exams, in-home safety assessments, and therapeutic massages, are not covered.
Hearing Services See details
MMM Balance (HMO-POS) covers hearing services with no deductible, copay, or coinsurance, including one routine exam and one fitting evaluation annually, subject to prior authorization. Prescription hearing aids are covered with no copay or coinsurance up to a $1,250 maximum every three years for both ears combined, though OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by MMM Balance (HMO-POS) with no copay, no coinsurance, and no deductible, subject to prior authorization. Covered services include one routine eye exam per year and a $500 annual allowance for contact lenses and eyeglasses, while other eye exams, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
MMM Balance (HMO-POS) offers partially covered dental services with no copay and no coinsurance for covered preventive and comprehensive care, though prior authorization is required. While many diagnostic and restorative services are covered, maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by MMM Balance (HMO-POS) with prior authorization and step therapy. Part B insulin is covered with a $35 copay and no coinsurance, while other Part B drugs, including chemotherapy, require a 0% to 20% coinsurance and copays ranging from no copay up to $8.
Dialysis Services See details
Dialysis Services are covered under the MMM Balance (HMO-POS) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered 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, though diabetic supplies and diabetic therapeutic shoes or inserts are not covered. Prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
MMM Balance (HMO-POS) partially covers diagnostic and radiological services with prior authorization, offering covered lab and diagnostic radiological services with no copay and no coinsurance. However, diagnostic procedures and tests, therapeutic radiological services, and outpatient x-ray services are not covered.
Home Health Services See details
MMM Balance (HMO-POS) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
MMM Balance (HMO-POS) covers Cardiac Rehabilitation Services with no coinsurance, though only some services are covered in practice while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $5 copay. Prior authorization and a referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by MMM Balance (HMO-POS) with no copay and no coinsurance, though prior authorization is required. While the plan allows admission without a prior three-day inpatient hospital stay, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by MMM Balance (HMO-POS), featuring acupuncture with a $10 copay and no coinsurance, and over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Naloxone OTC items and Dual Eligible SNPs with Highly Integrated Services are not covered.
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