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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 features a $0 drug deductible, allowing your coverage to start immediately with no upfront costs. For medications in Tiers 1 through 4, which cover preferred generic, generic, preferred brand, and non-preferred drugs, there is no copay for one-month, two-month, and three-month supplies at standard pharmacies. You will also enjoy no copay for a three-month supply of these medications when using standard mail order services. For Tier 5 specialty drugs, the plan requires a 33% coinsurance for a one-month supply at standard pharmacies and through standard mail order. This straightforward pricing structure helps keep healthcare expenses predictable, particularly for those relying on common generic and brand-name prescriptions.
Additional Benefits
The MCS Classicare Excede (HMO) plan offers extensive coverage with no deductible, no copays, and no coinsurance for many of its primary benefits. This includes inpatient and outpatient hospital care, primary and specialist doctor visits, home health services, and diagnostic testing. You also receive routine dental, vision, and hearing care with no copay, which includes a $500 annual allowance for eyewear, a $500 allowance for hearing aids, and up to $64 monthly for over-the-counter items. While many services feature no copay, emergency room visits require a $40 copay, which is waived upon hospital admission, and dialysis services carry a 20% coinsurance. Additionally, Medicare Part B insulin is subject to a $35 copay, and other Part B drugs require a coinsurance ranging from 0% to 20%. It is important to note that this plan does not cover ambulance services, cardiac rehabilitation, or routine podiatry.
Inpatient Hospital See details
MCS Classicare Excede (HMO) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, subject to prior authorization. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered under the MCS Classicare Excede (HMO) with no copay and no coinsurance for outpatient hospital, ambulatory surgical center, and blood services. For outpatient substance abuse, only some services are covered because individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization is covered under the MCS Classicare Excede (HMO) plan with no copay and no coinsurance required for these services.
Ambulance and Transportation Services See details
MCS Classicare Excede (HMO) provides transportation services with no copay and no coinsurance for up to 12 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered. Ambulance services are not covered under this plan, as both ground and air ambulance services are excluded.
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 and urgent care are partially covered with a $75 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
MCS Classicare Excede (HMO) covers primary care, specialist visits, therapies, telehealth, and opioid treatment with no copay and no coinsurance. Chiropractic care is partially covered with no copay or coinsurance for up to 6 routine visits per year, but other chiropractic services and podiatry are not covered. For mental health specialty and psychiatric services, some services are covered with no copay or coinsurance, 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 such as kidney disease education, alternative therapies, and diabetes self-management. Non-covered services include annual physical exams, fitness benefits, counseling, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, adult day health, palliative care, in-home support, caregiver support, additional tobacco cessation, enhanced disease management, telemonitoring, and home safety modifications.
Hearing Services See details
Hearing services are covered by MCS Classicare Excede (HMO), which offers one routine hearing exam and one fitting evaluation annually with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $500 annual maximum, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by MCS Classicare Excede (HMO) with no copay, no coinsurance, and no deductible. Covered benefits include one routine eye exam per year and up to $500 annually for eyewear like contacts and eyeglasses, while 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 and comprehensive services, though maxillofacial prosthetics and orthodontics are not covered. Most covered services, including cleanings, fillings, and implants, have no copay and no coinsurance, but many require prior authorization and orthodontic services are subject to a $1,500 annual maximum.
Home Infusion bundled Services See details
Home infusion bundled services are covered by MCS Classicare Excede (HMO) with no copay, subject to prior authorization and step therapy requirements. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the MCS Classicare Excede (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by MCS Classicare Excede (HMO), offering durable medical equipment with no copay and no coinsurance, and prosthetics and medical supplies with no copay and coinsurance ranging from 0% to 20% and 10% respectively. Diabetic equipment is partially covered with no copay or coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by MCS Classicare Excede (HMO) with no copays and no coinsurance for covered services, though prior authorization is required. While diagnostic procedures, lab services, and diagnostic and therapeutic radiological services are covered at no cost, 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, including intensive cardiac, pulmonary, and SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by MCS Classicare Excede (HMO) with no copay and no coinsurance, although prior authorization is required. Under this plan, you can be admitted without a prior three-day hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services under MCS Classicare Excede (HMO) are partially covered, offering acupuncture and over-the-counter (OTC) items with no copay and no coinsurance, while meal benefits are not covered. Acupuncture is limited to 6 treatments per year, and OTC items are reimbursed up to $64 monthly, though Nicotine Replacement Therapy and Naloxone are excluded.
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