A non-government entity
MCS Classicare Del Caribe (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MCS Classicare Del Caribe (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MCS Classicare Del Caribe (HMO) in 2025, please refer to our full plan details page.
MCS Classicare Del Caribe (HMO) is a HMO plan offered by MHH Healthcare, L.P. available for enrollment in 2025 to people living in Puerto Rico South 8. This plan received an overall rating of 5 out of 5 stars in 2025.
It's important to know that MCS Classicare Del Caribe (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 Del Caribe (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 Del Caribe (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 Del Caribe (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. Non-preferred drugs have a 33% coinsurance. Once your total drug costs reach $2,000, you enter the next coverage phase.
Additional Benefits
The MCS Classicare Del Caribe (HMO) plan offers comprehensive coverage, including no copay for inpatient hospital stays, ambulance services, and many primary care services like occupational therapy, physical therapy, and speech-language pathology. This plan also provides coverage for dental, vision, and hearing services, with specific benefits for exams, eyewear, and hearing aids. This plan includes a $40 copay for emergency services and covers outpatient services, partial hospitalization, and home health services with no copay. Diagnostic and radiological services, along with dialysis services, are covered with coinsurance. Additional benefits include coverage for acupuncture, over-the-counter items, and transportation to health-related locations.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute with no copay, and Additional Days for Inpatient Hospital-Acute with no copay, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Inpatient Hospital Psychiatric benefits are covered, but Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services, are covered by MCS Classicare Del Caribe (HMO). Outpatient Substance Abuse Services are partially covered, but Individual Sessions and Group Sessions are not covered.
Partial Hospitalization See details
Partial hospitalization is covered by this plan.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered; All Ambulance Services are covered with no copay or coinsurance, while 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, with no copay or coinsurance, and Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by MCS Classicare Del Caribe (HMO). Emergency Services have a $40 copay and no coinsurance, while Urgently Needed Services have no copay and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $75 copay and no coinsurance, and Worldwide Emergency Transportation is not covered.
Primary Care See details
The MCS Classicare Del Caribe (HMO) plan covers Primary Care Physician Services, Chiropractic Services (with prior authorization for 6 visits per year), Occupational Therapy Services with no copay or coinsurance, Physician Specialist Services, Other Health Care Professional, Physical Therapy, Speech-Language Pathology Services with no copay or coinsurance, Additional Telehealth Benefits, and Opioid Treatment Program Services. Mental Health Specialty Services and Psychiatric Services do not cover individual or group sessions, and Podiatry Services are not covered.
Preventive Services See details
The MCS Classicare Del Caribe (HMO) plan covers preventive services, including health education, alternative therapies (6 visits), therapeutic massage (6 sessions), nutritional/dietary benefits (6 visits), glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. Annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing Services include routine hearing exams and fitting/evaluation for hearing aids, each covered once per year, as well as prescription hearing aids with a maximum benefit of $500 every year, though prescription hearing aids - inner ear, outer ear, and over the ear, are not covered. OTC hearing aids are not covered.
Vision Services See details
The MCS Classicare Del Caribe (HMO) plan covers vision services including routine eye exams once per year, as well as contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames, all of which have no copay. This plan also provides a combined maximum benefit of $500 per year for eyewear. However, upgrades are not covered.
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, orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), implant services, prosthodontics (fixed), and oral and maxillofacial surgery. However, 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%, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0-20%. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the MCS Classicare Del Caribe (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no copay or coinsurance, and Prosthetics/Medical Supplies - Non-Medicare benefit with no copay and a coinsurance for Medicare-covered services. 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 under MCS Classicare Del Caribe (HMO), with no copay for diagnostic services, but a coinsurance of up to 15% for Diagnostic Procedures/Tests and up to 20% for Lab Services. Radiological services have no copay, with a coinsurance of up to 15% for both Diagnostic and Therapeutic Radiological Services, while Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the MCS Classicare Del Caribe (HMO) plan 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 technically covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required for this benefit.
Other Services See details
The MCS Classicare Del Caribe (HMO) plan covers acupuncture with a limit of 6 treatments per year. This plan also covers over-the-counter (OTC) items, with a maximum benefit coverage amount of $48.00 every month. However, the plan does not cover meal benefits, dual eligible SNPs with highly integrated services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several other additional services.
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