A non-government entity
MCS Classicare Efectivo (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MCS Classicare Efectivo (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MCS Classicare Efectivo (HMO) in 2026, please refer to our full plan details page.
MCS Classicare Efectivo (HMO) is a HMO plan offered by MHH Healthcare, L.P. 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 MCS Classicare Efectivo (HMO) 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 MCS Classicare Efectivo (HMO).
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 MCS Classicare Efectivo (HMO), 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 $55.00. 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 Maximum Out-Of-Pocket cost of $3400.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 MCS Classicare Efectivo (HMO)
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 MCS Classicare Efectivo (HMO) plan features a $0 prescription drug deductible, meaning your coverage begins immediately without any out-of-pocket deductible costs. Under this plan, there is no copay for Tier 1 preferred generic and Tier 2 generic drugs filled at standard pharmacies, as well as no copay for three-month supplies ordered through standard mail order. This makes managing common health conditions highly affordable for members. For Tier 3 preferred brand drugs, standard pharmacy copays are $5 for a one-month, $10 for a two-month, and $15 for a three-month supply, with standard mail order costing a $10 copay for a three-month supply. Tier 4 non-preferred drugs carry copays of $15, $30, or $45 at standard pharmacies, and a $30 copay for a three-month mail-order supply. Specialty drugs in Tier 5 require a 33% coinsurance for a one-month supply at standard pharmacies or through standard mail order.
Additional Benefits
The MCS Classicare Efectivo (HMO) plan offers comprehensive medical coverage with no copay and no coinsurance for most essential services, including inpatient hospital stays, primary and specialist care, outpatient services, and home health care. Preventive care, diagnostic tests, and skilled nursing facility stays are also covered with no copay and no coinsurance. However, emergency room visits require a $40 copay, which is waived if you are admitted to the hospital within 24 hours. For additional health benefits, members enjoy no copays and no coinsurance for routine dental, vision, and hearing care, including up to $500 annually for both eyewear and hearing aids. While the plan covers transportation and medical equipment with no copay, certain services like dialysis and prosthetic devices require coinsurance up to 20%. Additionally, home infusion insulin drugs carry a $35 copay, and ambulance services are not covered under this plan.
Inpatient Hospital See details
Inpatient hospital care is covered by MCS Classicare Efectivo (HMO) with no copay and no coinsurance for both acute and psychiatric stays, though prior authorization is required. Unlimited additional days are covered for acute care, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
MCS Classicare Efectivo (HMO) outpatient services are covered with no copay and no coinsurance, including outpatient hospital, ambulatory surgical center, and blood services. Some outpatient substance abuse services are covered with no copay and no coinsurance, but individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization is covered by MCS Classicare Efectivo (HMO) with no copay and no coinsurance.
Ambulance and Transportation Services See details
MCS Classicare Efectivo (HMO) does not cover ground or air ambulance services, but provides transportation services with no copay and no coinsurance. Covered transportation is limited to 34 one-way trips per year to plan-approved health-related locations.
Emergency Services See details
MCS Classicare Efectivo (HMO) covers emergency services with a $40 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance, while urgently needed services have no copay and no coinsurance. Worldwide emergency services are partially covered with no coinsurance and a $75 copay for both emergency and urgent care, but worldwide emergency transportation is not covered.
Primary Care See details
Primary care benefits under MCS Classicare Efectivo (HMO) are covered with no copay and no coinsurance, including primary care, specialist, therapy, telehealth, and opioid treatment services. Chiropractic care is partially covered with no copay or coinsurance for up to 6 routine visits per year, while podiatry is not covered. Some psychiatric and mental health specialty services are covered, but individual and group sessions for these services are not covered.
Preventive Services See details
Preventive services under MCS Classicare Efectivo (HMO) are partially covered with no copay and no coinsurance for covered benefits, which include Medicare-covered preventive care, kidney disease education, alternative therapies, and nutritional counseling. However, several services are not covered under this plan, including annual physical exams, fitness benefits, in-home safety assessments, and weight management programs.
Hearing Services See details
MCS Classicare Efectivo (HMO) offers hearing services with no copay and no coinsurance, covering one annual routine exam, one fitting evaluation, and up to $500 yearly for prescription hearing aids. This benefit is partially covered, as OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
MCS Classicare Efectivo (HMO) offers partially covered vision services with no deductible, no copays, and no coinsurance, which includes one routine eye exam and up to $500 for eyewear every year. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
MCS Classicare Efectivo (HMO) offers partially covered dental services with no copay and no coinsurance for covered preventive and comprehensive care, though orthodontics and maxillofacial prosthetics are not covered. Covered benefits include exams, cleanings, x-rays, and implants, many of which require prior authorization.
Home Infusion bundled Services See details
Home infusion bundled services are covered by MCS Classicare Efectivo (HMO) with no copay and require prior authorization. Medicare Part B insulin drugs under this benefit have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis services are covered under the MCS Classicare Efectivo (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
MCS Classicare Efectivo (HMO) 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, carrying a coinsurance of 0% to 20% for prosthetics and 10% for medical supplies.
Diagnostic and Radiological Services See details
MCS Classicare Efectivo (HMO) partially covers diagnostic and radiological services with prior authorization, featuring no copay and no coinsurance for covered services. Diagnostic procedures, lab services, and therapeutic radiological services are covered at no cost, but outpatient X-ray services are not covered.
Home Health Services See details
Home health services are covered by MCS Classicare Efectivo (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the MCS Classicare Efectivo (HMO) plan. This exclusion applies to all related sub-services, including intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services.
Skilled Nursing Facility (SNF) See details
MCS Classicare Efectivo (HMO) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required and additional days beyond Medicare-covered limits are not covered. The plan also allows admission to a skilled nursing facility without requiring a prior three-day inpatient hospital stay.
Other Services See details
MCS Classicare Efectivo (HMO) provides partial coverage for other services, offering acupuncture and over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture is limited to 8 treatments per year, and OTC items are reimbursed up to $10 monthly, though meal benefits and other supplemental services are not covered.
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