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 2025, 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 2025.
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 $69.00. 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 has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay varying copays based on the drug tier. For example, there is no copay for preferred generic drugs and specialty tier drugs, a $4 copay for standard generic drugs, and a $14 copay for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for covered Part D drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The MCS Classicare Efectivo (HMO) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have no copay for Medicare-covered services, and emergency services have a $40 copay. The plan also covers outpatient services, partial hospitalization, ambulance services, and a variety of primary care services with no copay for many services. Additional benefits include coverage for preventive services, hearing, vision, and dental services. The plan covers routine hearing exams and hearing aids up to $800 annually, routine eye exams, and eyewear. Dental coverage includes exams, X-rays, and other services, including orthodontics up to $3,000 per year. Other covered services include home infusion, dialysis, medical equipment, and home health services.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute with no copay for Medicare-covered stays and additional days. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Inpatient Hospital Psychiatric benefits are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services. Outpatient substance abuse services are partially covered, but individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization is covered by the MCS Classicare Efectivo (HMO) plan.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the MCS Classicare Efectivo (HMO) plan. All ambulance services are covered with no copay or coinsurance, but ground and air ambulance services are not covered. Transportation Services to a plan-approved health-related location are covered for up to 26 one-way trips per year, with no copay or coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage have a $40, no copay, a $75 copay, and no coinsurance, respectively. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services, Chiropractic Services (with prior authorization), Occupational Therapy Services (with prior authorization, no copay and no coinsurance), Physician Specialist Services, Mental Health Specialty Services (with prior authorization), Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services (with prior authorization, no copay and no coinsurance), Additional Telehealth Benefits, and Opioid Treatment Program Services. Individual and group sessions for Mental Health and Psychiatric Services are not covered, and Podiatry Services are not covered.
Preventive Services See details
The MCS Classicare Efectivo (HMO) plan covers Medicare-covered preventive services with no copay, as well as additional preventive services like Health Education, Alternative Therapies (8 visits), Therapeutic Massage (8 sessions), Nutritional/Dietary Benefit (6 visits), Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, EKG following Welcome Visit, and Remote Access Technologies. The plan does not cover the Annual Physical Exam, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services.
Hearing Services See details
Hearing Services include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids, with prior authorization required for hearing aids. This plan covers one routine hearing exam and one fitting/evaluation per year, and two prescription hearing aids of any type annually, with a maximum benefit of $800 per year for hearing aids. Prescription hearing aids for the inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for routine eye exams with no deductible, as well as eyewear. Eyewear has a combined maximum benefit of $800 every year, while contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are unlimited. Upgrades are not covered.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery. Orthodontic services are covered up to a maximum of $3,000 per year, and maxillofacial prosthetics and orthodontics 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 and 0-20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the MCS Classicare Efectivo (HMO) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered by MCS Classicare Efectivo (HMO), including Durable Medical Equipment (DME) with no copay or coinsurance, but Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a coinsurance between 0% and 20%, and Medical Supplies have a 10% coinsurance, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the MCS Classicare Efectivo (HMO) plan. Diagnostic Procedures/Tests have a coinsurance of at most 15%, and Lab Services have a coinsurance of at most 20%, while Diagnostic Radiological Services and Therapeutic Radiological Services have a coinsurance of at most 15%; there is no copay for any of these services. Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the MCS Classicare Efectivo (HMO) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered by the MCS Classicare Efectivo (HMO) plan, but none of the sub-services are covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare coverage and non-Medicare-covered stays are not covered. Prior authorization is required.
Other Services See details
Other Services includes acupuncture and over-the-counter (OTC) items. Acupuncture is covered with a limit of 8 treatments per year. OTC items are covered up to $20.00 per month. Other services such as meal benefits, and several others 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