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MCS Classicare Essential (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MCS Classicare Essential (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MCS Classicare Essential (HMO-POS) in 2026, please refer to our full plan details page.
MCS Classicare Essential (HMO-POS) is a HMO-POS 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 Essential (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 MCS Classicare Essential (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 MCS Classicare Essential (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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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:
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Drug Coverage
The MCS Classicare Essential (HMO-POS) plan offers highly affordable prescription drug coverage with a $0 drug deductible, allowing your benefits to start immediately. Members will pay no copay for Tier 1 preferred generics, Tier 2 generics, Tier 3 preferred brands, and Tier 4 non-preferred drugs filled at standard pharmacies or through standard mail order. For Tier 5 specialty drugs, there is a 33% coinsurance for a 1-month supply at both standard pharmacies and standard mail order. This plan provides excellent cost savings and highly predictable drug expenses on a wide variety of daily medications.
Additional Benefits
The MCS Classicare Essential (HMO-POS) plan offers comprehensive medical coverage with no copays or coinsurance for many core services, including inpatient hospital stays, doctor visits, and outpatient care. Emergency room visits require a $40 copay, which is waived if you are admitted, while urgently needed care is available with no copay. Although ambulance services are not covered, the plan provides up to 34 one-way trips for plan-approved transportation at no cost. For specialized care, members receive routine dental, vision, and hearing benefits with no copays or coinsurance, up to specified annual limits. While durable medical equipment is covered at no cost, dialysis and prosthetic devices require up to a 20% coinsurance. Part B insulin is available with a $35 copay, while other Part B drugs like chemotherapy carry a coinsurance ranging from 0% to 20%.
Inpatient Hospital See details
MCS Classicare Essential (HMO-POS) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization is required. While unlimited additional days are covered for acute care, upgrades, psychiatric additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
MCS Classicare Essential (HMO-POS) covers outpatient services, including outpatient hospital, ambulatory surgical center, and blood services, with no copay and no coinsurance. Outpatient substance abuse services are not covered in practice, as both individual and group sessions are excluded.
Partial Hospitalization See details
Partial hospitalization is covered by MCS Classicare Essential (HMO-POS) with no copay and no coinsurance required for these services.
Ambulance and Transportation Services See details
MCS Classicare Essential (HMO-POS) does not cover ambulance services, as both ground and air ambulance services are not covered. Transportation services are partially covered with no copay and no coinsurance for up to 34 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
MCS Classicare Essential (HMO-POS) covers emergency services with a $40 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with no copay and no coinsurance. Worldwide emergency and urgent services are partially covered with a $75 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
MCS Classicare Essential (HMO-POS) offers primary care, specialist, occupational therapy, physical therapy, and telehealth services with no copay and no coinsurance. Chiropractic care is partially covered with no copay or coinsurance for up to 6 routine visits per year, but podiatry and other chiropractic services are not covered. Additionally, some mental health and psychiatric services are covered, but individual and group sessions for these services are not covered.
Preventive Services See details
MCS Classicare Essential (HMO-POS) covers preventive services with no copay and no coinsurance for covered benefits, which include Medicare-covered zero-dollar services, alternative therapies, and kidney disease education. However, several services are not covered under this plan, including annual physical exams, fitness benefits, medical nutrition therapy, and in-home safety assessments.
Hearing Services See details
MCS Classicare Essential (HMO-POS) provides partially covered hearing services with no copay and no coinsurance for annual routine exams, fitting evaluations, and prescription hearing aids up to a $750 maximum per ear every year. Prior authorization is required for prescription hearing aids, and 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 Essential (HMO-POS) offers partially covered vision services with no copay and no coinsurance for routine eye exams and eyewear, up to a $1,100 yearly limit. Routine eye exams are limited to one per year, while other eye exam services and eyewear upgrades are not covered.
Dental Services See details
MCS Classicare Essential (HMO-POS) offers partially covered dental services with no copay and no coinsurance for covered preventive, diagnostic, and restorative treatments. Maxillofacial prosthetics and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
MCS Classicare Essential (HMO-POS) covers home infusion bundled services with no copay and no coinsurance, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by MCS Classicare Essential (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by MCS Classicare Essential (HMO-POS) with no copay and no coinsurance for durable medical equipment. Prosthetics and medical supplies have no copay, but carry a 0% to 20% coinsurance for prosthetic devices and a 10% coinsurance for medical supplies. Diabetic equipment is partially covered with no copay or coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
MCS Classicare Essential (HMO-POS) partially covers diagnostic and radiological services with prior authorization, offering covered services with no copay and no coinsurance. While diagnostic procedures, lab services, and diagnostic and therapeutic radiological services are covered, outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered by MCS Classicare Essential (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
MCS Classicare Essential (HMO-POS) covers some cardiac rehabilitation services with no copay and no coinsurance, though prior authorization is required. However, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by MCS Classicare Essential (HMO-POS) with no copay and no coinsurance, though prior authorization is required and additional days beyond the Medicare-covered limit are not covered. This plan also waives the standard three-day prior inpatient hospital stay requirement for admission.
Other Services See details
MCS Classicare Essential (HMO-POS) provides partial coverage for other services, offering acupuncture and over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture is limited to 6 treatments per year, and the OTC benefit provides up to $47 monthly via reimbursement, though meal benefits, nicotine replacement therapy, and naloxone are not covered.
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