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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 2026, 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 & South. This plan received an overall rating of 5 out of 5 stars in 2026.
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 $60.00. 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) prescription drug plan offers a $0 deductible, allowing your benefits to start immediately. For medications in Tier 1 through Tier 4—which includes preferred generics, generics, preferred brands, and non-preferred drugs—there is no copay for one-, two-, or three-month supplies at standard pharmacies. Furthermore, you will pay no copay for a three-month supply of these same tiers when using standard mail order. For Tier 5 specialty drugs, the plan charges a 33% coinsurance for a one-month supply at standard retail pharmacies and standard mail order. This coverage structure makes the MCS Classicare Excede (HMO) plan an exceptionally budget-friendly option for most routine prescription needs.
Additional Benefits
The MCS Classicare Excede (HMO) plan offers robust medical coverage with no copays and no coinsurance for inpatient hospital stays, outpatient services, primary care, and specialist visits. Additionally, members benefit from no copays on home health care, skilled nursing facility stays, and diagnostic services, though some of these require prior authorization. Emergency room visits carry a $40 copay, which is waived if admitted, while urgently needed services require no copay. For supplemental care, the plan features no copays for routine dental, vision, and hearing exams, including up to $500 annually for eyewear and hearing aids, and a $1,500 orthodontic limit. Members also receive up to 12 one-way transportation trips per year and a $109 monthly over-the-counter reimbursement benefit with no copays. However, certain services like ambulance transport, cardiac rehabilitation, and diabetic supplies are not covered under this plan.
Inpatient Hospital See details
MCS Classicare Excede (HMO) covers inpatient hospital acute and psychiatric services with no copay and no coinsurance, though prior authorization is required. This benefit is partially covered, as upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under MCS Classicare Excede (HMO) are covered with no copay and no coinsurance for outpatient hospital, ambulatory surgical center, and blood services. Some outpatient substance abuse services are covered with no copay or coinsurance, but individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization is covered by MCS Classicare Excede (HMO) with no copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are offered by MCS Classicare Excede (HMO), though ambulance services are not covered in practice because ground and air ambulance services are excluded. Transportation services are covered with no copay and no coinsurance for up to 12 one-way trips per year to plan-approved locations, while trips to any health-related location are not covered.
Emergency Services See details
MCS Classicare Excede (HMO) covers emergency services with a $40 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with no copay or coinsurance. Worldwide emergency services are partially covered with a $75 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
MCS Classicare Excede (HMO) covers primary care, specialist, and therapy services with no copay and no coinsurance. Chiropractic care is partially covered, but other chiropractic services are not covered, while podiatry is not covered, and some mental health and psychiatric services are covered but individual and group sessions are not covered.
Preventive Services See details
Preventive services are partially covered by MCS Classicare Excede (HMO) with no copay and no coinsurance for covered benefits like kidney disease education, diabetes self-management, and select alternative therapies. However, several services are not covered under this plan, including annual physical exams, fitness benefits, weight management programs, and in-home support services.
Hearing Services See details
Hearing services are partially covered by MCS Classicare Excede (HMO) with no copay and no coinsurance for routine exams, fitting evaluations, and prescription hearing aids. While the plan provides up to $500 annually for prescription hearing aids, OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
MCS Classicare Excede (HMO) covers vision services with no copay and no coinsurance, including one routine eye exam per year and up to $500 annually for contacts and eyeglasses. However, other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by MCS Classicare Excede (HMO) with no copay and no coinsurance for covered preventive, diagnostic, and comprehensive care, though maxillofacial prosthetics and orthodontics are not covered. Many covered services require prior authorization, and orthodontic services have a maximum plan benefit of $1,500 per year.
Home Infusion bundled Services See details
MCS Classicare Excede (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while other Part B chemotherapy, radiation, and miscellaneous drugs carry a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by MCS Classicare Excede (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits under MCS Classicare Excede (HMO) are partially covered, featuring durable medical equipment with no copay and no coinsurance, while diabetic supplies and therapeutic shoes or inserts are not covered. Prosthetics and medical supplies feature no copay, but carry a 0% to 20% coinsurance for prosthetic devices and a 10% coinsurance for medical supplies.
Diagnostic and Radiological Services See details
MCS Classicare Excede (HMO) partially covers diagnostic and radiological services with no copays and no coinsurance, although prior authorization is required. While diagnostic procedures, lab services, and both diagnostic and therapeutic radiological services are covered, 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, although prior authorization is required.
Cardiac Rehabilitation Services See details
MCS Classicare Excede (HMO) does not cover Cardiac Rehabilitation Services, which includes cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
MCS Classicare Excede (HMO) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. While the plan allows SNF admission without a prior three-day inpatient hospital stay, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services under the MCS Classicare Excede (HMO) are partially covered, featuring up to 6 acupuncture treatments per year and a $109 monthly over-the-counter (OTC) reimbursement benefit with no copay and no coinsurance for both. Meal benefits and other additional services are not covered under this plan.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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