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MCS Classicare En Tu Hogar (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MCS Classicare En Tu Hogar (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MCS Classicare En Tu Hogar (HMO) in 2025, please refer to our full plan details page.
MCS Classicare En Tu Hogar (HMO) is a HMO 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 En Tu Hogar (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 En Tu Hogar (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 En Tu Hogar (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 $21.00. 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 En Tu Hogar (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay different copays depending on the drug tier. For example, you will pay no copay for preferred generic drugs at a standard pharmacy, and a $5 copay for standard generic drugs. For preferred brand drugs, you will pay a $15 copay, and for non-preferred drugs, you will pay 33% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for covered drugs.
Additional Benefits
The MCS Classicare En Tu Hogar (HMO) plan offers coverage for a wide range of services. This plan includes no copay for inpatient hospital stays covered by Medicare, and covers emergency services with a $40 copay. The plan also includes benefits for primary care, hearing, vision, and dental services, with specific limits and copays. Additionally, the plan covers home infusion, dialysis, medical equipment, and diagnostic services, with varying coinsurance amounts.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization required. For Inpatient Hospital-Acute, there is no copay for a Medicare-covered stay and additional days are covered with no copay; however, non-Medicare-covered stays and upgrades are not covered. Inpatient Hospital Psychiatric has no additional days or non-Medicare-covered stays covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services, are covered by MCS Classicare En Tu Hogar (HMO). Outpatient Substance Abuse Services are partially covered, with individual and group sessions not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the plan. There is no information about the cost of this service.
Ambulance and Transportation Services See details
The MCS Classicare En Tu Hogar (HMO) plan covers all ambulance services with no copay or coinsurance, but ground and air ambulance services are not covered. Transportation services to a plan-approved health-related location are covered for up to 16 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered, with a $40 copay and no coinsurance, and if admitted to the hospital within 24 hours the copay is waived. Worldwide Emergency Coverage and Worldwide Urgent Coverage are covered with a $75 copay and no coinsurance, while Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care for MCS Classicare En Tu Hogar (HMO) covers primary care physician services, chiropractic services (with prior authorization), occupational therapy services (with authorization), physician specialist services, podiatry services, other health care professional services, physical therapy, speech-language pathology services (with authorization), additional telehealth benefits, and opioid treatment program services. Mental health specialty services are partially covered, but individual and group sessions are not covered, while psychiatric services are partially covered, but individual and group sessions are not covered.
Preventive Services See details
Preventive Services are covered, but the annual physical exam, in-home safety assessment, personal emergency response system, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, fitness benefit, enhanced disease management, and telemonitoring services are not covered. This plan covers health education, alternative therapies (6 visits per year), therapeutic massage (6 sessions per year), nutritional/dietary benefit (6 visits per year), remote access technologies, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visit.
Hearing Services See details
Hearing services include routine hearing exams and fitting/evaluation for hearing aids, each covered for one visit per year, and prescription hearing aids with a maximum benefit of $500 every year. Prescription hearing aids are covered for two visits per year for all types, but not covered for inner ear, outer ear, or over the ear hearing aids. OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams covered once per year, and eyewear with a combined maximum plan benefit of $500 per year. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are also covered, while upgrades are not covered.
Dental Services See details
The MCS Classicare En Tu Hogar (HMO) plan covers various dental services, including oral exams, dental x-rays, other diagnostic services, cleaning, and fluoride treatments. Orthodontic services are covered up to a maximum of $2,500 per year. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered under the MCS Classicare En Tu Hogar (HMO) plan. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the MCS Classicare En Tu Hogar (HMO) 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, Prosthetic Devices with 0-20% coinsurance, and Medical Supplies with a 10% coinsurance. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services includes coverage for all diagnostic services, with no copay and coinsurance that may vary. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20% and no copay. Diagnostic Radiological Services and Therapeutic Radiological Services have a coinsurance of at most 20% and no copay, while Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the MCS Classicare En Tu Hogar (HMO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. 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
Under the "Other Services" benefit, MCS Classicare En Tu Hogar (HMO) covers acupuncture with a limit of 6 treatments per year, and over-the-counter (OTC) items with a maximum benefit coverage amount of $35.00 every month. The plan does not cover meal benefits, 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.
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