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MCS Classicare Hero (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MCS Classicare Hero (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MCS Classicare Hero (HMO) in 2025, please refer to our full plan details page.
MCS Classicare Hero (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 Hero (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 Hero (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 Hero (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 $167.00. 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 Hero (HMO) plan has an enhanced alternative drug benefit. The plan has no deductible for prescription drugs. During the initial coverage phase, you will pay a $0 copay for preferred generic drugs and specialty tier drugs at a standard pharmacy. You will pay a $5 copay for standard generic drugs, and a $15 copay for preferred brand drugs. Non-preferred drugs have a 33% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The MCS Classicare Hero (HMO) plan offers a variety of benefits with varying cost-sharing. Inpatient hospital stays have a $100 copay per stay, while emergency services have a $75 copay. The plan covers primary care with an $11 copay, specialist visits with a $20 copay, and offers additional benefits for hearing, vision, and dental services. The plan also covers a variety of other services with some requiring prior authorization and some with coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, there is a $100 copay per stay for Medicare-covered stays, and additional days have no copay; however, Non-Medicare-covered stays and upgrades are not covered. Inpatient Hospital Psychiatric has no copay, but additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services; however, individual and group sessions for outpatient substance abuse are not covered. Outpatient blood services include three (3) pints with deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered by the MCS Classicare Hero (HMO) plan.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by the MCS Classicare Hero (HMO) plan. All Ambulance Services are covered with no copay or coinsurance, but Ground Ambulance and Air Ambulance Services are not covered. Transportation Services to a plan-approved health-related location are covered for up to 78 one-way trips per year with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage all have a $75 copay, but Worldwide Emergency Transportation is not covered. There is no coinsurance for any of these services.
Primary Care See details
Primary Care Physician Services have an $11 copay, while Chiropractic Services have a $20 copay and require prior authorization. Occupational Therapy Services and Physical Therapy and Speech-Language Pathology Services are covered with no copay or coinsurance, but require authorization. Physician Specialist Services have a $20 copay. Individual and group sessions for Mental Health and Psychiatric Services, and Podiatry Services are not covered. Additional Telehealth Benefits are covered for certain services.
Preventive Services See details
The MCS Classicare Hero (HMO) plan covers preventive services including Health Education, Alternative Therapies (6 visits per year), Therapeutic Massage (6 sessions per year), Nutritional/Dietary Benefit (6 visits per year), Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Annual Physical Exams, In-Home Safety Assessment, Personal Emergency Response System (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 Benefit, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing services with the MCS Classicare Hero (HMO) plan include routine hearing exams and fitting/evaluation for hearing aids, each covered for one visit per year, and prescription hearing aids (all types) covered for two visits per year with a maximum benefit of $1,000 per year, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The MCS Classicare Hero (HMO) plan covers vision services, including routine eye exams once per year. Eyewear is covered with a combined maximum benefit of $725 per year, and 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 Hero (HMO) plan covers a variety of dental services including oral exams, dental x-rays, other diagnostic dental services, cleanings, fluoride treatments, other preventative dental services, and orthodontic services, with some services requiring prior authorization. Orthodontic services have a maximum benefit of $3,400 per year, and maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. 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 Hero (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 and no coinsurance, Prosthetics/Medical Supplies with a coinsurance for Medicare-covered items and no copay, and Diabetic Equipment. 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 are covered by the MCS Classicare Hero (HMO) plan. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, and no copay. Diagnostic and Therapeutic Radiological Services have a coinsurance of at most 20%, and no copay, however, Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the MCS Classicare Hero (HMO) plan with no copay or 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 covered, but specific services like Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered. Prior authorization is required for SNF.
Other Services See details
Under the MCS Classicare Hero (HMO) plan, acupuncture is covered with a limit of 6 treatments per year, and over-the-counter (OTC) items are covered with a maximum benefit coverage amount of $20.00 per month, and the unused amount carries forward. Other services such as meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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