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MCS Classicare RxMax (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MCS Classicare RxMax (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MCS Classicare RxMax (HMO) in 2025, please refer to our full plan details page.
MCS Classicare RxMax (HMO) is a HMO plan offered by MHH Healthcare, L.P. available for enrollment in 2025 to people living in Puerto Rico. This plan received an overall rating of 5 out of 5 stars in 2025.
It's important to know that MCS Classicare RxMax (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 RxMax (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 RxMax (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 $18.00. 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 RxMax (HMO) plan has no deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions depending on the drug tier and pharmacy. For example, the copay for a standard generic drug is $15, while the copay for a preferred brand drug is $30. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The MCS Classicare RxMax (HMO) plan offers a variety of benefits with varying cost structures. It provides inpatient hospital stays with no copay for Medicare-covered services, while outpatient services and partial hospitalization are covered with no copay. Emergency services have a $40 copay, and other services like primary care, hearing, vision, and dental offer specific coverage with copays or limits. The plan also includes benefits for transportation, home infusion, dialysis, and medical equipment, with costs varying depending on the service. Additionally, it covers services like acupuncture and over-the-counter items, while excluding others such as private duty nursing and certain types of rehabilitation services.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute, with no copay for a Medicare-covered stay, and Additional Days for Inpatient Hospital-Acute with no copay per day. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as 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, with individual and group sessions not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the plan. There is no copay or coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the MCS Classicare RxMax (HMO) plan, but ground and air ambulance services are not covered. Transportation services to a plan-approved, health-related location are covered for up to 22 one-way trips per year with no copay and no coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage have a copay of $40, no copay, and $75, respectively, with no coinsurance. Worldwide Urgent Coverage also has a $75 copay and no coinsurance, while Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care benefits include coverage for 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. Chiropractic Services require prior authorization and are limited to 6 visits per year. Individual and group sessions for both Mental Health Specialty and Psychiatric Services are not covered, and Podiatry Services are not covered.
Preventive Services See details
The MCS Classicare RxMax (HMO) plan covers preventive services, including Health Education, Alternative Therapies (6 visits), Therapeutic Massage (6 sessions), Nutritional/Dietary Benefit (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, 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 are not covered.
Hearing Services See details
Hearing Services includes routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams and fitting/evaluation for hearing aids are covered for one visit per year. Prescription hearing aids are covered up to $1,000 per year, per ear, and require prior authorization. Prescription hearing aids (inner ear, outer ear, and over the ear) and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for routine eye exams with one visit per year, and a $300 combined maximum benefit for eyewear annually, including coverage for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. 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, and orthodontic services. Orthodontic services have a maximum plan benefit of $2,000 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, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%, while the coinsurance for the other drugs is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the MCS Classicare RxMax (HMO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical equipment is covered under the MCS Classicare RxMax (HMO) plan. Durable Medical Equipment (DME) has 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, and the coinsurance varies between 0% and 20% for Medicare-covered Prosthetic Devices and Medicare-covered Medical Supplies, with Medical Supplies having a 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, including diagnostic procedures, lab services, diagnostic radiological services, and therapeutic radiological services, are covered with no copay and a coinsurance of up to 20%. Outpatient X-Ray services are not covered.
Home Health Services See details
Home Health Services are covered by MCS Classicare RxMax (HMO) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered. Prior authorization is required for SNF services.
Other Services See details
The MCS Classicare RxMax (HMO) plan covers acupuncture with a limit of 6 treatments per year, and it also covers over-the-counter (OTC) items up to $60 per month, with unused amounts carried over. However, this 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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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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