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:
Sign up for MMM Balance (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The MMM Balance (HMO-POS) Medicare plan features a $0 drug deductible, meaning your prescription coverage begins immediately with no upfront costs. You will pay no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 7 select care drugs when using standard pharmacy or standard mail order services. This makes essential everyday medications highly accessible and affordable for plan members. For brand-name and specialty medications, the plan offers predictable copays and coinsurance rates. Tier 3 preferred brand drugs carry a $6.00 copay for a 1-month supply, while Tier 4 non-preferred drugs have an $8.00 copay. Specialty prescriptions require coinsurance, with a 25% coinsurance for Tier 5 preferred specialty drugs and a 33% coinsurance for Tier 6 specialty drugs.
Additional Benefits
The MMM Balance (HMO-POS) plan offers comprehensive medical coverage with many essential services requiring no copay and no coinsurance, including acute inpatient hospital stays, primary care visits, and home health services. Outpatient hospital services and inpatient psychiatric admissions carry a low $50 copay, while emergency care is covered with a $75 copay that is waived if you are admitted. Specialist and physical therapy visits are also highly affordable, ranging from no copay up to a $5 copay. For routine care, the plan provides dental, vision, and hearing benefits with no copay or coinsurance, featuring a $500 annual vision allowance and a $1,500 annual limit for comprehensive dental services. Additionally, members can access covered over-the-counter items and up to ten routine one-way transportation trips per year at no cost. Durable medical equipment and diagnostic lab services are also covered with no copay and no coinsurance.
Inpatient Hospital See details
MMM Balance (HMO-POS) covers inpatient acute hospital stays with no copay, no coinsurance, and unlimited additional days, though prior authorization is required and upgrades or non-Medicare-covered stays are not covered. Inpatient psychiatric hospital stays are also covered with a $50 copay per admission and no coinsurance, but additional psychiatric days and non-Medicare-covered stays are not covered.
Outpatient Services See details
MMM Balance (HMO-POS) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services with no copay. Outpatient hospital services require a $50 copay, observation services have a $0 to $50 copay per stay, and outpatient substance abuse sessions require a $5 copay.
Partial Hospitalization See details
Partial hospitalization is covered by MMM Balance (HMO-POS) with no copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services under MMM Balance (HMO-POS) do not cover ground or air ambulance services, but transportation to plan-approved locations is covered with no copay and no coinsurance. This prior-authorized transportation benefit is limited to 10 one-way trips per year via rideshare, van, medical transport, or public transit.
Emergency Services See details
MMM Balance (HMO-POS) covers emergency services with a $75 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with no copay and no coinsurance. Worldwide emergency and urgent care 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
MMM Balance (HMO-POS) covers primary care, podiatry, and telehealth services with no copay and no coinsurance, while specialist, mental health, and psychiatric visits range from no copay to a $5.00 copay with no coinsurance. Physical, occupational, and speech therapy require a $4.00 copay with no coinsurance, chiropractic care is partially covered at a $5.00 copay with no coinsurance, and opioid treatment has a 10% coinsurance with no copay.
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 several benefits. Sub-services that are not covered include the annual physical exam, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy (MNT), post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Hearing services are partially covered by MMM Balance (HMO-POS) with no copay, no coinsurance, and no deductible, though prior authorization is required. The plan covers one routine exam and one fitting evaluation yearly, plus up to $1,250 every three years for prescription hearing aids, but OTC hearing aids and inner ear, outer ear, or over-the-ear prescription aids 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, though prior authorization is required. Covered benefits include one routine eye exam and up to a $500 annual allowance 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, although prior authorization is required for most services. Comprehensive dental services like restorative care and implants are covered up to a $1,500 annual limit, while orthodontics and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by MMM Balance (HMO-POS) with prior authorization, offering Medicare Part B insulin for a $35 copay and no coinsurance. Other Medicare Part B drugs require no copay to an $8 copay and no coinsurance to 20% coinsurance. Chemotherapy and radiation drugs are also covered with a copayment and up to 20% coinsurance (or no coinsurance).
Dialysis Services See details
Dialysis Services are covered under the MMM Balance (HMO-POS) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
MMM Balance (HMO-POS) covers durable medical equipment and diabetic equipment with no copay and no coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered. Prosthetic devices and medical supplies are covered with no copay and a 5% coinsurance, with prior authorization required for most equipment.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by MMM Balance (HMO-POS) and require prior authorization. Covered lab services and diagnostic radiological services feature no copay and no coinsurance, but diagnostic procedures, 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
Cardiac Rehabilitation Services are covered by MMM Balance (HMO-POS) with no coinsurance, though in practice some services are covered while cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease are not covered. These services require a $5 copay, prior authorization, and a referral.
Skilled Nursing Facility (SNF) See details
MMM Balance (HMO-POS) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. This benefit allows for admission without a prior three-day inpatient hospital stay, but additional days beyond standard Medicare-covered limits are not covered.
Other Services See details
Other Services covered by MMM Balance (HMO-POS) include acupuncture for a $10 copay and no coinsurance, and a chronic illness meal benefit with no copay and no coinsurance. Over-the-counter (OTC) items are partially covered with no copay and no coinsurance, which includes nicotine replacement therapy but excludes naloxone and some CMS OTC list drugs.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved