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MCS Classicare Primero (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MCS Classicare Primero (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MCS Classicare Primero (HMO C-SNP) in 2025, please refer to our full plan details page.
MCS Classicare Primero (HMO C-SNP) is a HMO C-SNP 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 Primero (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
MCS Classicare Primero (HMO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about MCS Classicare Primero (HMO C-SNP).
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 Primero (HMO C-SNP), 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 $40.00. 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:
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Drug Coverage
The MCS Classicare Primero (HMO C-SNP) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay no copay for preferred generic, standard generic, preferred brand, and specialty tier drugs at standard pharmacies. For non-preferred drugs, you will pay 33% coinsurance. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase and pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, you will pay $0.00 for Part D covered drugs.
Additional Benefits
The MCS Classicare Primero (HMO C-SNP) plan offers a variety of benefits with varying costs. Inpatient hospital stays have no copay for Medicare-covered days, while outpatient services, partial hospitalization, and ambulance services (excluding air and ground) are covered with no copay. Emergency services have a $40 copay, and worldwide emergency and urgent care have a $75 copay. This plan provides coverage for primary care, preventive services, hearing (exams and hearing aids up to $700 annually), vision (routine exams and eyewear up to $700 annually), and dental services (with prior authorization). Additional benefits include home infusion, dialysis (20% coinsurance), medical equipment, diagnostic and radiological services, home health services, and skilled nursing facility services. The plan also covers acupuncture (up to 6 treatments per year) and over-the-counter items (up to $89.00 per month).
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute, which has no copay for a Medicare-covered stay and additional days for Inpatient Hospital-Acute with no copay per day. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and all Inpatient Hospital Psychiatric services are not covered.
Outpatient Services See details
Outpatient Services are covered by MCS Classicare Primero (HMO C-SNP), including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services. Outpatient Substance Abuse Services are partially covered, as Individual and Group Sessions for Outpatient Substance Abuse are not covered.
Partial Hospitalization See details
Partial Hospitalization benefits are covered. There is no copay or coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered; Air and Ground Ambulance Services are not covered, but all other Ambulance Services are covered with no copay or coinsurance. Transportation Services to a plan-approved health-related location are covered for 32 one-way trips per year, with no copay or coinsurance, but transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services are covered under the MCS Classicare Primero (HMO C-SNP) plan. Emergency Services have a $40 copay and no coinsurance, while Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $75 copay and no coinsurance.
Primary Care See details
The MCS Classicare Primero (HMO C-SNP) plan covers Primary Care Physician Services, Chiropractic Services (with prior authorization), Occupational Therapy Services (with authorization), Physician Specialist Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services (with authorization), Additional Telehealth Benefits, and Opioid Treatment Program Services. Individual and group sessions for Mental Health Specialty Services and Psychiatric Services are not covered.
Preventive Services See details
The MCS Classicare Primero (HMO C-SNP) plan covers preventive services, including health education, alternative therapies (6 visits), therapeutic massage (6 sessions), nutritional/dietary benefits (6 visits), glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. Annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing Services include coverage for routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams and fitting/evaluation for hearing aids are covered once per year, and prescription hearing aids are covered up to $700 every year. Prescription hearing aids - Inner Ear, Outer Ear, and Over the Ear, and OTC hearing aids are not covered.
Vision Services See details
The MCS Classicare Primero (HMO C-SNP) plan covers vision services, including routine eye exams with one visit per year and eyewear with a combined maximum benefit of $700 every year. Contact lenses, eyeglass lenses, and eyeglass frames are also covered, while upgrades are not covered.
Dental Services See details
The MCS Classicare Primero (HMO C-SNP) plan covers a variety of dental services, including oral exams, dental x-rays, and other diagnostic services, with the need for prior authorization for some services, and the number of visits and periodicity varying by service. Orthodontic services have a maximum plan benefit of $3000 per year, while 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 Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by MCS Classicare Primero (HMO C-SNP). You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by MCS Classicare Primero (HMO C-SNP), including Durable Medical Equipment (DME) with no copay and no coinsurance, and Prosthetics/Medical Supplies with coinsurance between 0% and 20%, and Medical Supplies with 10% coinsurance. Diabetic Equipment is covered, however, Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by MCS Classicare Primero (HMO C-SNP), with no copay for all services. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 15%, and Lab Services have a coinsurance of at most 20%, while Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by MCS Classicare Primero (HMO C-SNP) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. 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 include acupuncture, covered for up to 6 treatments per year, and over-the-counter (OTC) items, with a maximum benefit of $89.00 per month; however, meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and many other services are not covered.
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