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MCS Classicare Exacto (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MCS Classicare Exacto (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MCS Classicare Exacto (HMO) in 2025, please refer to our full plan details page.
MCS Classicare Exacto (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 Exacto (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 Exacto (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 Exacto (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 $80.00. 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 Exacto (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay no copay for preferred generic and standard generic drugs at a standard pharmacy. You will also pay a $10 copay for preferred brand drugs, and 33% coinsurance for non-preferred drugs at a standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy (LIS), you may have reduced costs.
Additional Benefits
The MCS Classicare Exacto (HMO) plan offers comprehensive coverage, including inpatient hospital stays with no copay, emergency services for a $40 copay, and worldwide emergency and urgent care with a $75 copay. This plan also includes a range of services like outpatient care, hearing and vision exams, dental, and home health services with varying cost-sharing, along with additional benefits like acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute, with no copay for a Medicare-covered stay and additional days covered with no copay per day, while Non-Medicare-covered Stay and Upgrades are not covered. Inpatient Hospital Psychiatric benefits are also covered, while additional days and Non-Medicare-covered stays for this benefit are not covered.
Outpatient Services See details
Outpatient Services are covered, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services. Outpatient Substance Abuse Services are partially covered; individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization benefits are covered by the MCS Classicare Exacto (HMO) plan. The specific costs associated with this benefit are not detailed in the provided information.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by the MCS Classicare Exacto (HMO) plan. All Ambulance Services are covered with no copay or coinsurance, while Ground and Air Ambulance Services are not covered; Transportation Services to a plan-approved health-related location are covered for up to 34 one-way trips per year, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the MCS Classicare Exacto (HMO) plan, with a $40 copay for emergency services. Worldwide Emergency Coverage and Worldwide Urgent Coverage are also covered, each with a $75 copay, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The MCS Classicare Exacto (HMO) plan covers primary care physician services, chiropractic services (with prior authorization), occupational therapy services, physician specialist services, other health care professional services, physical therapy and speech-language pathology services (with prior authorization), additional telehealth benefits, and opioid treatment program services. Mental health specialty services (individual and group sessions), psychiatric services (individual and group sessions), and podiatry services are not covered.
Preventive Services See details
The MCS Classicare Exacto (HMO) plan covers a variety of preventive services, including health education, alternative therapies (8 visits per year), therapeutic massage (8 sessions per year), nutritional/dietary benefits (6 individual sessions), glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. However, annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
The MCS Classicare Exacto (HMO) plan covers hearing exams, with one routine hearing exam and one fitting/evaluation for hearing aids covered per year. Prescription hearing aids are covered up to a maximum of $500 per year, but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The MCS Classicare Exacto (HMO) plan covers vision services, including routine eye exams once per year, and eyewear with a combined maximum benefit of $500 per year. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are also covered, but upgrades are not.
Dental Services See details
Dental services are covered, 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. Orthodontic services are covered up to a maximum of $2,500 per year, while maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by MCS Classicare Exacto (HMO). For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by MCS Classicare Exacto (HMO). The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment is covered by MCS Classicare Exacto (HMO), including Durable Medical Equipment (DME) with no copay or coinsurance, and Prosthetics/Medical Supplies with a coinsurance between 0% and 20%, and 10% coinsurance for medical supplies. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by MCS Classicare Exacto (HMO). Diagnostic Procedures/Tests have a coinsurance of at most 15%, and Lab Services have a coinsurance of at most 20%, and Diagnostic and Therapeutic Radiological Services have a coinsurance of at most 15%, with no copay for any of these services. Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the MCS Classicare Exacto (HMO) plan with no copay and no 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 the specific services of 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-covered for SNF and non-Medicare-covered stays for SNF are not covered. Prior authorization is required for this benefit.
Other Services See details
The MCS Classicare Exacto (HMO) plan covers acupuncture with a limit of 8 treatments per year. This plan also provides Over-the-Counter (OTC) Items with a maximum benefit coverage amount of $15.00 per month. The plan does not cover Meal Benefits, Dual Eligible SNPs with Highly Integrated Services, and other services such as 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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