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MCS Classicare InteliCare (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MCS Classicare InteliCare (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MCS Classicare InteliCare (HMO) in 2025, please refer to our full plan details page.
MCS Classicare InteliCare (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 InteliCare (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 InteliCare (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 InteliCare (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 $49.00. 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 InteliCare (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay no copay for preferred generic, standard generic, preferred brand, and specialty tier drugs at standard pharmacies. For non-preferred drugs at standard pharmacies, you will pay 33% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The MCS Classicare InteliCare (HMO) plan offers a variety of benefits with varying costs. Inpatient hospital stays have no copay, and emergency services have a $40 copay. The plan also covers outpatient services, ambulance services with no copay, and offers coverage for primary care, hearing, vision, and dental services. Other key benefits include coverage for home infusion, dialysis, medical equipment, and diagnostic services, with varying coinsurance amounts. The plan also includes coverage for skilled nursing facilities and other services such as acupuncture and over-the-counter items. Notably, some services such as cardiac rehabilitation and additional days in certain facilities are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits for MCS Classicare InteliCare (HMO) include Inpatient Hospital-Acute, with no copay for a Medicare-covered stay and additional days with no copay, but Non-Medicare-covered Stay and Upgrades are not covered. Inpatient Hospital Psychiatric is covered, but Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric 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. Outpatient substance abuse services are partially covered, with individual and group sessions not covered.
Partial Hospitalization See details
Partial Hospitalization benefits are covered by the MCS Classicare InteliCare (HMO) plan. There is no additional information about the cost of this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by MCS Classicare InteliCare (HMO). All Ambulance Services are covered with no copay and no coinsurance, but Ground and Air Ambulance Services are not covered. Transportation Services to a plan-approved health-related location are covered for 50 one-way trips per year, and other transportation services are not covered.
Emergency Services See details
Emergency Services are covered under the MCS Classicare InteliCare (HMO) plan with a $40 copay, and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $75 copay, with no coinsurance, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The MCS Classicare InteliCare (HMO) plan covers primary care physician services, chiropractic services (6 visits per year, with prior authorization and a doctor referral), occupational therapy services (with no copay or coinsurance, but requires authorization), physician specialist services (with a doctor referral), and physical therapy and speech-language pathology services (with no copay or coinsurance, but requires authorization). Mental health specialty services and psychiatric services do not cover individual or group sessions, and podiatry services are not covered.
Preventive Services See details
The MCS Classicare InteliCare (HMO) plan covers various preventive services, but does not cover annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post discharge in-home medication reconciliation, readmission 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 benefits, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services. The plan covers 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, kidney disease education services, and remote access technologies.
Hearing Services See details
Hearing Services includes coverage for routine hearing exams, and fitting/evaluation for hearing aids, with each covered once per year. The plan also covers prescription hearing aids (all types), with a maximum benefit of $500 per year, but does not cover prescription hearing aids for the inner ear, outer ear, or over the ear, and does not cover OTC hearing aids.
Vision Services See details
The MCS Classicare InteliCare (HMO) plan covers vision services including routine eye exams once per year, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames with no deductible. Eyewear has a combined maximum benefit of $500 per year, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with coverage for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the MCS Classicare InteliCare (HMO) plan. For Medicare Part B Insulin Drugs, you will pay a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you will pay a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the MCS Classicare InteliCare (HMO) plan. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no copay or coinsurance, and Prosthetics/Medical Supplies with no copay and coinsurance for Medicare-covered items. Diabetic Equipment benefits are partially covered, as Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the MCS Classicare InteliCare (HMO) plan. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 15%, while Lab Services and Therapeutic Radiological Services have a coinsurance of at most 20%; there is no copay for these services. Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the MCS Classicare InteliCare (HMO) plan with no copay and no coinsurance, but require authorization and a referral. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the MCS Classicare InteliCare (HMO) plan. Specifically, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered SNF and non-Medicare-covered stays are not covered. Prior authorization and a doctor referral are required.
Other Services See details
Other Services include acupuncture and over-the-counter (OTC) items. Acupuncture is covered up to 6 treatments per year. OTC items are covered with a maximum plan benefit coverage amount of $90.00 every month.
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