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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 2025, 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 2025.
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:
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Drug Coverage
The MCS Classicare Firme (HMO) 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, and 33% coinsurance for non-preferred drugs at standard pharmacies. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase, where you will pay nothing for covered Part D drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The MCS Classicare Firme (HMO) plan offers comprehensive coverage, including no copay for inpatient hospital stays and ambulance services. It also provides coverage for outpatient services, vision, dental, and hearing services. Additional benefits include coverage for emergency services, preventive services, home health services, and durable medical equipment. The plan includes a $40 copay for emergency services, a $75 copay for worldwide urgent coverage, and offers up to $950 per year for hearing aids and eyewear.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, but Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, and Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. For Inpatient Hospital-Acute, there is no copay for a Medicare-covered stay.
Outpatient Services See details
Outpatient Services are covered, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services. Outpatient Substance Abuse Services are partially covered, excluding individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the MCS Classicare Firme (HMO) plan. There is no cost information provided for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no copay and no coinsurance for all ambulance services. Transportation Services to a plan-approved health-related location are covered for 42 one-way trips per year. Ground and air ambulance services, and transportation services to any health-related location, are not covered.
Emergency Services See details
Emergency Services are covered by MCS Classicare Firme (HMO), with a $40 copay and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $75 copay and no coinsurance, while Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic Services require prior authorization and are limited to 6 visits per year, while Mental Health Specialty Services and Podiatry Services are not covered.
Preventive Services See details
The MCS Classicare Firme (HMO) plan covers preventive services, including Medicare-covered zero-dollar preventive services, 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, EKG following Welcome Visit, and remote access technologies. Annual physical exams, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy (MNT), 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, and fitting/evaluation for hearing aids, with one visit allowed per year. Prescription hearing aids are covered up to a maximum of $950 per year, with two visits covered per year for all types of hearing aids. Inner ear, outer ear, and over the ear prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams with no copay, and eyewear with a combined maximum benefit of $950 every year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are also covered. Upgrades are not covered.
Dental Services See details
The MCS Classicare Firme (HMO) plan covers a variety of dental services, including oral exams, dental x-rays, and other diagnostic services, all with a limited number of visits and prior authorization required for some services. Orthodontic services are covered up to a maximum of $3000 per year, while maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the MCS Classicare Firme (HMO) plan, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, with coinsurance between 0% and 20%, and other Medicare Part B drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis services are covered under the MCS Classicare Firme (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no copay or coinsurance, Prosthetics/Medical Supplies with no copay and a coinsurance between 0% and 20%, and Diabetic Equipment, though Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the MCS Classicare Firme (HMO) plan. Diagnostic Procedures/Tests have a coinsurance of at most 15%, and Lab Services have a coinsurance of at most 20%, while Diagnostic and Therapeutic Radiological Services have a coinsurance of at most 15%; outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by MCS Classicare Firme (HMO) with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. This benefit requires authorization.
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 for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered and require prior authorization. However, additional days beyond Medicare coverage and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The MCS Classicare Firme (HMO) plan covers acupuncture with a limit of 6 treatments every year, and it does not require a copay or coinsurance. Over-the-Counter (OTC) Items are covered up to $120.00 every month, and unused amounts carry forward. Other services such as 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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