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MCS Classicare Metro (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MCS Classicare Metro (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MCS Classicare Metro (HMO) in 2025, please refer to our full plan details page.
MCS Classicare Metro (HMO) is a HMO plan offered by MHH Healthcare, L.P. available for enrollment in 2025 to people living in Puerto Rico Metro 8. This plan received an overall rating of 5 out of 5 stars in 2025.
It's important to know that MCS Classicare Metro (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 Metro (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 Metro (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 $51.00. 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 Metro (HMO) plan has an enhanced alternative drug benefit. This plan has no deductible. In the initial coverage phase, you will pay varying copays and coinsurance amounts depending on the drug tier and pharmacy used. For example, the copay for a standard generic drug is $5.00, while the copay for a preferred brand drug is $15.00. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The MCS Classicare Metro (HMO) plan offers comprehensive coverage, including no copay for inpatient hospital stays and ambulance services. It also provides coverage for outpatient services, partial hospitalization, and a range of services like primary care with a $5 copay, specialist visits with a $10 copay, and preventive services. This plan includes vision and dental benefits, covering routine exams, eyewear, and a variety of dental procedures. Additionally, it covers hearing services with hearing exams and hearing aid benefits, and offers home infusion, dialysis, and medical equipment coverage.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with no copay for a Medicare-covered stay for Inpatient Hospital-Acute. Additional Days for Inpatient Hospital-Acute are covered with no copay per day. Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered under the MCS Classicare Metro (HMO) plan, with coverage including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services. Individual and group sessions for Outpatient Substance Abuse are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the MCS Classicare Metro (HMO) plan.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by MCS Classicare Metro (HMO). All ambulance services are covered with no copay or coinsurance. Transportation Services to a Plan Approved Health-related Location are covered with no copay or coinsurance, with a maximum plan benefit coverage amount of $600 per year.
Emergency Services See details
Emergency Services are covered, including emergency services, urgently needed services, and worldwide emergency services. Emergency Services have a $40 copay, and worldwide emergency coverage and worldwide urgent coverage have a $75 copay, and there is no coinsurance for any of these services. Worldwide emergency transportation is not covered.
Primary Care See details
Primary Care Physician Services have a $5 copay, while Chiropractic Services and Occupational Therapy Services are also covered. Physician Specialist Services have a $10 copay, and Physical Therapy and Speech-Language Pathology Services are covered with no copay or coinsurance. Mental Health Specialty Services and Psychiatric Services do not cover individual or group sessions, and Podiatry Services are not covered. Additional Telehealth Benefits are also covered.
Preventive Services See details
The MCS Classicare Metro (HMO) plan covers preventive services, with specific services like Health Education, Alternative Therapies (6 visits per year), Therapeutic Massage (6 sessions per year), Nutritional/Dietary Benefit (6 visits per year), In-Home Support Services, Support for Caregivers of Enrollees, 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, 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 include routine hearing exams and fitting/evaluation for hearing aids, each covered for one visit per year, as well as prescription hearing aids with a maximum plan benefit of $500 every year, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and over-the-counter hearing aids are not covered.
Vision Services See details
The MCS Classicare Metro (HMO) plan covers vision services, including routine eye exams, with one exam covered every year. Eyewear is covered with a combined maximum benefit of $500 per year, and the plan also covers contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames.
Dental Services See details
The MCS Classicare Metro (HMO) plan covers a range of dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery, with prior authorization required for some services. Maxillofacial prosthetics and orthodontics are not covered. Orthodontic services have a maximum benefit of $1600 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the MCS Classicare Metro (HMO) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no copay or coinsurance, and Prosthetics/Medical Supplies with coinsurance for Medicare-covered services. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
The MCS Classicare Metro (HMO) plan covers Diagnostic and Radiological Services, including Diagnostic Procedures/Tests with a coinsurance of at most 15%, Lab Services with a coinsurance of at most 20%, Diagnostic Radiological Services and Therapeutic Radiological Services with a coinsurance of at most 15%, and does not have a copay for any of these services. Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by MCS Classicare Metro (HMO) with no copay and no coinsurance, but prior authorization is required. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered. Prior authorization is required.
Other Services See details
The MCS Classicare Metro (HMO) plan covers acupuncture with a limit of 6 treatments per year, and over-the-counter (OTC) items up to $69.00 per month. Meal benefits, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and various other services are not covered.
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