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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 2025, 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 2025.
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 has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a $0 copay for preferred generic, standard generic, preferred brand, and specialty tier drugs at a standard pharmacy. For non-preferred drugs, you will pay 33% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The MCS Classicare Essential (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays and many outpatient services have no copay. Emergency services have a $40 copay, while worldwide emergency and urgent care have a $75 copay. The plan covers primary care, preventive services, hearing, vision, and dental services, each with specific limits and cost-sharing. It also includes coverage for home infusion, dialysis, medical equipment, diagnostic and radiological services, and home health services. However, it does not cover cardiac rehabilitation services or many other services, such as private duty nursing or personal care services.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute with no copay for a Medicare-covered stay, and Additional Days for Inpatient Hospital-Acute with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric, 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. Individual and group sessions for outpatient substance abuse are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the plan. There is no information available about the cost of this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the MCS Classicare Essential (HMO-POS) plan, but Ground and Air Ambulance Services are not covered. Transportation Services to a Plan Approved Health-related Location are covered for up to 34 one-way trips every year, with no copay and no coinsurance.
Emergency Services See details
Emergency Services are covered by the MCS Classicare Essential (HMO-POS) plan, with a $40 copay, and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $75 copay, and no coinsurance, but Worldwide Emergency Transportation is not covered.
Primary Care See details
The MCS Classicare Essential (HMO-POS) plan covers primary care physician services, chiropractic services (with prior authorization), occupational therapy services (with authorization, no copay or coinsurance), physician specialist services, other health care professional, physical therapy, speech-language pathology services (with authorization, no copay or coinsurance), additional telehealth benefits, and opioid treatment program services. The plan does not cover individual or group sessions for mental health specialty services or psychiatric services, and podiatry services.
Preventive Services See details
The MCS Classicare Essential (HMO-POS) plan covers preventive services, including health education, alternative therapies (6 visits), therapeutic massage (6 sessions), nutritional/dietary benefits (6 visits), glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. Annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams and fitting/evaluation for hearing aids are covered for one visit per year, and prescription hearing aids are covered for two visits per year with a maximum benefit of $750 per year. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including routine eye exams and eyewear. Routine eye exams are covered once per year, and eyewear has a combined maximum benefit of $1100 per year.
Dental Services See details
The MCS Classicare Essential (HMO-POS) plan covers a range of dental services, 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), oral and maxillofacial surgery, and implant services, with prior authorization often required. Orthodontic services are covered up to a maximum of $3,500 per year, while maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. The plan covers Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and also covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the MCS Classicare Essential (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with no copay or coinsurance, and Prosthetics/Medical Supplies with a coinsurance for Medicare-covered supplies, and Diabetic Equipment, although Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered. Durable Medical Equipment for use outside the home is also not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the MCS Classicare Essential (HMO-POS) plan. For Diagnostic Procedures/Tests, and Lab Services, you may pay up to 20% coinsurance, and for Diagnostic Radiological Services and Therapeutic Radiological Services, you may also pay up to 20% coinsurance. Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the MCS Classicare Essential (HMO-POS) plan with no copay or coinsurance, but prior authorization is required. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are not covered by the MCS Classicare Essential (HMO-POS) plan. This includes Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
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 for SNF services.
Other Services See details
Other Services include acupuncture and over-the-counter (OTC) items. Acupuncture is covered with a limit of 6 treatments per year, while OTC items are covered with a maximum plan benefit coverage amount of $35.00 per month that carries forward if unused. Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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