A non-government entity
MCS Classicare Firme (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MCS Classicare Firme (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MCS Classicare Firme (HMO) in 2026, please refer to our full plan details page.
MCS Classicare Firme (HMO) is a HMO plan offered by MHH Healthcare, L.P. available for enrollment in 2025 to people living in Puerto Rico West 39. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that MCS Classicare Firme (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 Firme (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 Firme (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 $5.00. 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 Firme (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 Firme (HMO) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generics, Tier 2 generics, Tier 3 preferred brands, and Tier 4 non-preferred drugs, there is no copay for 1-month, 2-month, or 3-month supplies at standard pharmacies. You also pay no copay for 3-month supplies of these medications when using standard mail order services. For Tier 5 specialty drugs, you will pay a 33% coinsurance for a 1-month supply at both standard pharmacies and standard mail order. This plan offers exceptionally low out-of-pocket costs for most drug tiers, helping you save on your regular prescription needs.
Additional Benefits
The MCS Classicare Firme (HMO) plan offers comprehensive medical coverage with no copay and no coinsurance for most essential services. You will pay nothing for inpatient and outpatient hospital stays, primary and specialist office visits, preventive care, and skilled nursing facility stays. This plan also features excellent dental, vision, and hearing benefits with no copays, including a $950 annual allowance for both eyewear and hearing aids. While many benefits are fully covered, some services do require a copay or coinsurance. Emergency room visits have a $40 copay, while worldwide emergency care requires a $75 copay. Additionally, you will pay a 20% coinsurance for dialysis services, a $35 copay for Part B insulin, and up to a 20% coinsurance for chemotherapy and other Part B drugs.
Inpatient Hospital See details
MCS Classicare Firme (HMO) covers inpatient hospital services with no copay and no coinsurance for Medicare-covered acute and psychiatric stays, though prior authorization is required. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional days for psychiatric stays are not covered.
Outpatient Services See details
Outpatient services are covered by MCS Classicare Firme (HMO) with no copay and no coinsurance for outpatient hospital, ambulatory surgical center, and blood services. Outpatient substance abuse services are not covered under this plan.
Partial Hospitalization See details
Partial hospitalization is covered by MCS Classicare Firme (HMO) with no copay and no coinsurance. This means you will pay nothing for these services under this plan.
Ambulance and Transportation Services See details
MCS Classicare Firme (HMO) does not cover ambulance services, but transportation services are partially covered with no copay and no coinsurance. This benefit allows up to 42 one-way trips per year to plan-approved health-related locations, while transportation to general, non-approved health-related locations is not covered.
Emergency Services See details
Emergency services are covered by MCS Classicare Firme (HMO) with a $40 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no copay or coinsurance, and worldwide emergency and urgent care are partially covered with a $75 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
MCS Classicare Firme (HMO) provides primary care, specialist, therapy, and telehealth services with no copay and no coinsurance, while podiatry is not covered. Chiropractic care is partially covered with no copay or coinsurance for up to six routine visits, but other chiropractic services are not covered. Additionally, some mental health and psychiatric services are covered with no copay or coinsurance, but individual and group sessions are not covered.
Preventive Services See details
Preventive services are partially covered by MCS Classicare Firme (HMO) with no copay and no coinsurance for covered services like Medicare-covered preventive care, kidney disease education, nutritional therapy, alternative therapies, and therapeutic massage. However, the plan does not cover an annual physical exam, fitness benefits, weight management, counseling, medical nutrition therapy, in-home safety assessments, PERS, post-discharge medication reconciliation, readmission prevention, wigs, adult day health, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, or home safety modifications.
Hearing Services See details
MCS Classicare Firme (HMO) provides partially covered hearing services with no copay and no coinsurance, including one routine exam and fitting yearly and up to $950 annually for prescription hearing aids. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision Services under MCS Classicare Firme (HMO) are partially covered with no copay, no coinsurance, and no deductible for covered services. The plan covers one routine eye exam per year and provides up to a $950 annual allowance for contact lenses and eyeglasses, though other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by MCS Classicare Firme (HMO) with no copay and no coinsurance for covered preventive and comprehensive care. Maxillofacial prosthetics and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
MCS Classicare Firme (HMO) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy are required. Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by MCS Classicare Firme (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
MCS Classicare Firme (HMO) covers durable medical equipment with no copay and no coinsurance, and prosthetics and medical supplies with no copay and coinsurance ranging from 0% to 20%. Diabetic equipment is partially covered under the plan with no copay and no coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
MCS Classicare Firme (HMO) partially covers diagnostic and radiological services with no copay and no coinsurance, though prior authorization is required. Covered services include diagnostic procedures, lab services, and diagnostic or therapeutic radiological services, but outpatient X-ray services are not covered.
Home Health Services See details
MCS Classicare Firme (HMO) covers home health services with no copay and no coinsurance, although prior authorization is required for these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by MCS Classicare Firme (HMO) with no copay and no coinsurance, subject to prior authorization. While some services are covered, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
MCS Classicare Firme (HMO) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, requiring prior authorization but allowing admission without a prior three-day inpatient hospital stay. While standard Medicare-covered days are included, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by MCS Classicare Firme (HMO), offering acupuncture limited to 6 treatments per year and over-the-counter items up to $120 monthly via reimbursement with no copay and no coinsurance. Meal benefits, nicotine replacement therapy, and naloxone 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