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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 a wide range of benefits with varying cost-sharing. Inpatient hospital stays have no copay, while emergency services have a $40 copay. The plan covers both primary care and preventive services, including hearing and vision coverage with no copays for routine exams. Additional benefits include dental services, home infusion, dialysis services, and medical equipment with varying copays and coinsurance. The plan also covers ambulance services and transportation, with specific limitations. Other services, like acupuncture and over-the-counter items, are covered, but some services, like certain mental health and dental services, are not included.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Inpatient Hospital-Acute has no copay and covers additional days with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute 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, but individual and group sessions are not covered.
Partial Hospitalization See details
Partial Hospitalization benefits are covered by the MCS Classicare Excede (HMO) plan. There is no information about the cost of services.
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 Services 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 under the MCS Classicare Excede (HMO) plan with a $40 copay, and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $75 copay, and no coinsurance, while 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, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Routine Chiropractic Care is limited to 6 visits per year. Mental Health Specialty Services, Individual Sessions for Mental Health Specialty Services, Group Sessions for Mental Health Specialty Services, Individual Sessions for Psychiatric Services, Group Sessions for Psychiatric Services, and Podiatry Services are not covered.
Preventive Services See details
The MCS Classicare Excede (HMO) plan covers preventive services, including Medicare-covered services with no copay. Additional preventive services are partially covered, with Health Education, Alternative Therapies (6 visits), Therapeutic Massage (6 sessions), Nutritional/Dietary Benefit (6 visits), Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit covered. The plan does not cover 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, or counseling services.
Hearing Services See details
The MCS Classicare Excede (HMO) plan covers hearing exams, with no copay, and routine hearing exams and fitting/evaluation for hearing aids, each covered once per year. Prescription hearing aids are covered up to $500 per year, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision services are covered, including routine eye exams with no copay for one exam per year, and eyewear with a combined maximum benefit of $500 per year. Eyeglass lens, frames, and contact lenses are covered, but upgrades are not covered.
Dental Services See details
The MCS Classicare Excede (HMO) plan covers various dental services, 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 have a maximum benefit of $1500 per year. Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and coinsurance between 0-20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the MCS Classicare Excede (HMO) plan. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no copay or coinsurance, but Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies - Non-Medicare benefit has no copay, but has coinsurance. Prosthetic Devices have between 0-20% coinsurance. Medical Supplies have 10% coinsurance. 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, with no copay. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 15%, and Lab Services have a coinsurance of at most 20%, but the minimum coinsurance is 0%. Therapeutic Radiological Services have a coinsurance of at most 15%, but the minimum coinsurance is 0%. 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, but 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, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare coverage and non-Medicare stays are not covered. Prior authorization is required for this benefit.
Other Services See details
Other Services includes acupuncture, which is limited to 6 treatments per year, and over-the-counter (OTC) items, with a maximum benefit coverage amount of $70.00 every month that carries forward if unused. 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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