A non-government entity
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 2026, 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 2026.
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 $148.00. 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 features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generics and Tier 2 generics, there is no copay for one-, two-, or three-month supplies at standard pharmacies, as well as no copay for three-month supplies through standard mail order. This ensures that essential generic medications remain highly accessible and affordable. For Tier 3 preferred brands, you will pay a standard pharmacy copay ranging from $20 for a one-month supply up to $60 for a three-month supply, with a $40 copay for a three-month mail order. Tier 4 non-preferred drugs carry standard pharmacy copays between $40 and $120, or an $80 copay for a three-month mail order. Tier 5 specialty drugs require a 33% coinsurance for a one-month supply at both standard pharmacies and through standard mail order.
Additional Benefits
The MCS Classicare Hero (HMO) plan offers robust coverage with low out-of-pocket costs for essential medical services. Inpatient hospital stays require a $100 copay per admission with no coinsurance, while outpatient services, urgent care, and home health care are available with no copay. For routine care, members pay an $11 copay for primary care visits and a $20 copay for specialist visits, both with no coinsurance. This plan also features strong supplemental benefits, including comprehensive dental coverage up to $3,400 annually and vision care up to $500 annually, both with no copay or coinsurance. Prescription hearing aids are covered up to $1,000 per ear each year, and members can access up to 78 one-way transportation trips annually at no copay. Additionally, most diagnostic services and medical equipment require no copay, though certain specialized services like dialysis and select Part B drugs carry coinsurance.
Inpatient Hospital See details
MCS Classicare Hero (HMO) covers inpatient hospital services with a $100 copay per admission and no coinsurance for acute care, plus unlimited additional days at no copay. Inpatient psychiatric care is also covered with no copay and no coinsurance, though prior authorization is required and upgrades or non-Medicare-covered stays are not covered.
Outpatient Services See details
MCS Classicare Hero (HMO) provides outpatient services, including outpatient hospital, ambulatory surgical center, and outpatient blood services, with no copay and no coinsurance. For outpatient substance abuse, some services are covered with no copay and no coinsurance, but individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization is covered by MCS Classicare Hero (HMO) with no copay and no coinsurance.
Ambulance and Transportation Services See details
MCS Classicare Hero (HMO) offers partially covered transportation services with no copay and no coinsurance for up to 78 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered. For ambulance services, some services are covered but ground and air ambulance services are not covered.
Emergency Services See details
MCS Classicare Hero (HMO) covers emergency services with a $75 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no copay and no coinsurance, while worldwide emergency services are partially covered with a $75 copay and no coinsurance, excluding worldwide emergency transportation which is not covered.
Primary Care See details
MCS Classicare Hero (HMO) covers primary care with an $11.00 copay and specialist visits with a $20.00 copay, both with no coinsurance. Therapy, telehealth, and opioid treatments feature no copay and no coinsurance, whereas chiropractic services are partially covered with routine care limited to 6 visits per year for a $20.00 copay and no coinsurance, while other chiropractic services and podiatry are not covered. For mental health and psychiatric specialty services, some services are covered with no copay and no coinsurance, but individual and group sessions are not covered.
Preventive Services See details
Preventive services are partially covered by MCS Classicare Hero (HMO) with no copay and no coinsurance for covered benefits such as kidney disease education, alternative therapies, and diabetes self-management training. However, several sub-services are not covered, including annual physical exams, fitness benefits, weight management programs, and in-home safety assessments.
Hearing Services See details
Hearing services are covered by MCS Classicare Hero (HMO) with no copay and no coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,000 maximum per ear every year, but OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
MCS Classicare Hero (HMO) covers routine eye exams and eyewear with no copay, no coinsurance, and no deductible, providing up to a $500 annual maximum for contacts and eyeglasses. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
MCS Classicare Hero (HMO) partially covers dental services with no copay and no coinsurance for covered preventive and comprehensive care, up to an annual maximum benefit of $3,400. While most services are covered, maxillofacial prosthetics and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
MCS Classicare Hero (HMO) covers home infusion bundled services with no copay, requiring prior authorization and step therapy. Covered Medicare Part B insulin drugs carry a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by MCS Classicare Hero (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
MCS Classicare Hero (HMO) covers medical equipment with no copay and no coinsurance for durable medical equipment and diabetic equipment, though prior authorization is required. Prosthetics and medical supplies are partially covered with no copay, featuring a 10% coinsurance for medical supplies and up to 20% coinsurance for prosthetic devices, while diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
MCS Classicare Hero (HMO) partially covers diagnostic and radiological services with no copay and no coinsurance, although prior authorization is required. While diagnostic procedures, lab services, and therapeutic radiological services are covered, outpatient X-ray services are not covered.
Home Health Services See details
MCS Classicare Hero (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
MCS Classicare Hero (HMO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, though prior authorization is required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
MCS Classicare Hero (HMO) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, and does not require a prior three-day inpatient hospital stay. This benefit is partially covered because prior authorization is required and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
MCS Classicare Hero (HMO) provides partial coverage for other services, which includes acupuncture with no copay and no coinsurance for up to 6 treatments per year. Over-the-counter (OTC) items and meal benefits are not covered under this plan.
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* 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.
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