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MCS Classicare Excede (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MCS Classicare Excede (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MCS Classicare Excede (HMO) in 2025, please refer to our full plan details page.
MCS Classicare Excede (HMO) is a HMO plan offered by MHH Healthcare, L.P. available for enrollment in 2025 to people living in Puerto Rico West. This plan received an overall rating of 5 out of 5 stars in 2025.
It's important to know that MCS Classicare Excede (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 Excede (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 Excede (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 Excede (HMO) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. During 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, you will pay 33% coinsurance. Once your total drug costs reach $2,000, you enter the next coverage phase.
Additional Benefits
The MCS Classicare Excede (HMO) plan offers comprehensive coverage, including no copay for inpatient hospital stays, ambulance services, and home health services. The plan provides coverage for a range of services such as outpatient services, emergency services, primary care, preventive services, hearing, vision, dental, and home infusion bundled services. The plan also includes coverage for durable medical equipment, diagnostic and radiological services, and skilled nursing facilities. This plan also offers additional benefits like coverage for acupuncture, and an over-the-counter (OTC) allowance of $115.00 per month. It's important to note that while the plan covers many services, some are not covered, such as specific hearing aids, annual physical exams, and certain dental and vision services.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute with no copay and Inpatient Hospital Psychiatric coverage. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and 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 (ASC) services, and outpatient blood services. Outpatient substance abuse services are partially covered, excluding individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the plan.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by the MCS Classicare Excede (HMO) plan. All Ambulance Services are covered with no copay and no coinsurance, but Ground Ambulance and Air Ambulance Services are not covered. Transportation Services to a plan-approved health-related location are covered for 12 one-way trips per year.
Emergency Services See details
Emergency Services are covered by the MCS Classicare Excede (HMO) plan, with a $40 copay for emergency services, and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $75 copay, and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Other Health Care Professional, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Mental Health Specialty Services and Psychiatric Services are partially covered, but individual and group sessions are not. Podiatry Services are not covered.
Preventive Services See details
Preventive services are covered, including Medicare-covered services with no copay. Additional preventive services include 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. The plan does not cover Annual Physical Exams, In-Home Safety Assessment, Personal Emergency Response System, 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 Benefit, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services.
Hearing Services See details
Hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, are covered; routine hearing exams and fitting/evaluation for hearing aids are each limited to one visit per year. Prescription hearing aids (all types) are covered with a plan-specified amount up to $500 per year, but prescription hearing aids for the 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 Excede (HMO) plan covers vision services, including routine eye exams once per year. The plan also covers eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $500 per year. However, 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, and Orthodontic Services. Coverage includes a maximum benefit of $1500 per year for Orthodontic Services, and other services are limited to one visit every six months or once per tooth per life. Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by MCS Classicare Excede (HMO), including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and other Medicare Part B drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the MCS Classicare Excede (HMO) plan. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered under the MCS Classicare Excede (HMO) plan. Durable Medical Equipment (DME) has no copay or coinsurance, but Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a coinsurance between 0% and 20%, and Medical Supplies have a 10% coinsurance; neither has a copay. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by MCS Classicare Excede (HMO), with no copay. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 15%, while Lab Services have a coinsurance of at most 20%; Therapeutic Radiological Services also have a coinsurance of at most 15%. Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by MCS Classicare Excede (HMO) with no copay and no coinsurance, though additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered by the MCS Classicare Excede (HMO) plan, 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 coverage, and non-Medicare covered stays, are not covered. Prior authorization is required.
Other Services See details
The MCS Classicare Excede (HMO) plan covers acupuncture with a limit of 6 treatments per year. This plan also covers over-the-counter (OTC) items up to $115.00 per month, and any unused amount carries forward to the next period. However, the plan does not cover meal benefits, Dual Eligible SNPs with Highly Integrated Services, 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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