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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 2026, 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 2026.
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 $31.00. 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 features a $0 drug deductible, meaning your prescription drug coverage begins immediately without any out-of-pocket deductible costs. Under this plan, there is no copay for Tier 1 (Preferred Generic), Tier 2 (Generic), and Tier 3 (Preferred Brand) drugs purchased at standard pharmacies or through standard mail order. This applies to 1-month, 2-month, and 3-month supplies, making essential medications highly affordable. For Tier 4 (Non-Preferred) drugs, you will pay a $10 copay for a 1-month supply, a $20 copay for a 2-month supply, and a $30 copay for a 3-month supply at standard pharmacies, or a $20 copay for a 3-month standard mail order. Tier 5 (Specialty) drugs require a 33% coinsurance for a 1-month supply at both standard pharmacies and standard mail order. This clear copayment structure helps you easily project your monthly healthcare expenses with MCS Classicare Primero.
Additional Benefits
The MCS Classicare Primero (HMO C-SNP) plan offers comprehensive medical coverage with no copays, no deductibles, and no coinsurance for many essential services, including inpatient hospital stays, primary and specialist doctor visits, and home health care. Members also enjoy coverage with no copay or coinsurance for preventive dental services, annual vision and hearing exams, and allowances of up to $500 each for eyewear and hearing aids. Emergency room visits require a $40 copay, which is waived if you are admitted to the hospital within 24 hours, while urgent care services have no copay. For specialized needs, durable medical equipment and skilled nursing facility stays are covered with no copay or coinsurance, though dialysis services require a 20% coinsurance. Medicare Part B drugs carry a 0% to 20% coinsurance, while Part B insulin has a flat $35 copay. The plan also features extra benefits with no copay, including 32 one-way transportation trips to approved health locations, up to six acupuncture visits annually, and a $52 monthly over-the-counter item reimbursement.
Inpatient Hospital See details
Inpatient Hospital care is partially covered by MCS Classicare Primero (HMO C-SNP) with no copay and no coinsurance for Medicare-covered acute and psychiatric stays, though prior authorization is required. While unlimited additional acute days are covered, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
MCS Classicare Primero (HMO C-SNP) covers outpatient hospital, ambulatory surgical center, and blood services with no copay, no coinsurance, and no deductible. Outpatient substance abuse services are also covered with no copay or coinsurance, although individual and group sessions are not covered.
Partial Hospitalization See details
MCS Classicare Primero (HMO C-SNP) covers partial hospitalization services with no copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance services are not covered under MCS Classicare Primero (HMO C-SNP), but transportation services to plan-approved health-related locations are covered with no copay and no coinsurance. This transportation benefit is limited to 32 one-way trips per year, and transportation to general health-related locations is not covered.
Emergency Services See details
MCS Classicare Primero (HMO C-SNP) covers emergency services with a $40 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, while urgently needed services have no copay or coinsurance. Worldwide emergency and urgent care are partially covered with a $75 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
MCS Classicare Primero (HMO C-SNP) covers primary care, specialist visits, 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 while other chiropractic services are not covered, and while some mental health and psychiatric services are covered, individual and group sessions for both are not covered.
Preventive Services See details
Preventive services are partially covered by MCS Classicare Primero (HMO C-SNP) with no copay and no coinsurance for covered options like Medicare-covered zero-dollar services, kidney disease education, alternative therapies, therapeutic massage, and nutritional sessions. However, annual physical exams, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation, fitness benefits, disease management, telemonitoring, home safety modifications, and counseling are not covered.
Hearing Services See details
MCS Classicare Primero (HMO C-SNP) provides hearing services with no copay and no coinsurance, covering one routine hearing exam and one fitting evaluation annually. Prescription hearing aids are covered up to a $500 annual maximum with prior authorization, though the benefit is only partially covered as OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
MCS Classicare Primero (HMO C-SNP) offers partially covered vision services with no copay, no coinsurance, and no deductible. This benefit includes one routine eye exam per year and a $500 annual allowance for contacts and eyeglasses, but other eye exam services and eyewear upgrades are not covered.
Dental Services See details
MCS Classicare Primero (HMO C-SNP) offers partially covered dental services with no copay and no coinsurance for most preventive and comprehensive care, including cleanings, exams, and implants. However, maxillofacial prosthetics and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
MCS Classicare Primero (HMO C-SNP) covers Home Infusion bundled Services with no copay and no coinsurance, subject to prior authorization and step therapy. Under this benefit, Medicare Part B chemotherapy and other Part B drugs carry a 0% to 20% coinsurance and no copay, while Part B insulin has a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered under the MCS Classicare Primero (HMO C-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
MCS Classicare Primero (HMO C-SNP) covers durable medical equipment with no copay and no coinsurance, while diabetic equipment is partially covered with no copay and no coinsurance, excluding diabetic supplies and therapeutic shoes or inserts. Prosthetics and medical supplies are covered with no copay, carrying a 0% to 20% coinsurance for prosthetic devices and a 10% coinsurance for medical supplies.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by MCS Classicare Primero (HMO C-SNP) with prior authorization, featuring no copay and no coinsurance for covered diagnostic procedures, lab services, and diagnostic or therapeutic radiological services. Outpatient X-ray services are not covered.
Home Health Services See details
MCS Classicare Primero (HMO C-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the MCS Classicare Primero (HMO C-SNP) plan, including intensive cardiac, pulmonary, and SET for PAD services.
Skilled Nursing Facility (SNF) See details
MCS Classicare Primero (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. This benefit allows admission without a prior three-day inpatient hospital stay, but additional days beyond standard Medicare-covered days are not covered.
Other Services See details
MCS Classicare Primero (HMO C-SNP) covers acupuncture with no copay and no coinsurance for up to 6 treatments per year, alongside a monthly $52 reimbursement for over-the-counter (OTC) items with no copay or coinsurance. Meal benefits and other additional services are not covered under this plan.
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