A non-government entity
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 2026, 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 2026.
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 $20.00. 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:
Sign up for MCS Classicare RxMax (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The MCS Classicare RxMax (HMO) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generic drugs, there is no copay for one-month, two-month, or three-month supplies at standard pharmacies, or for a three-month standard mail order. Tier 2 generic medications cost $5 for a one-month supply at a standard pharmacy and offer a $10 copay for a three-month standard mail order supply. Tier 3 preferred brand drugs require a $15 copay for a one-month supply at a standard pharmacy, while Tier 4 non-preferred drugs carry a $30 copay for a one-month supply. For Tier 5 specialty drugs, you will pay a 33% coinsurance for a one-month supply at both standard pharmacies and through standard mail order. These clearly defined tiers help you easily estimate your monthly prescription expenses under this plan.
Additional Benefits
The MCS Classicare RxMax (HMO) plan offers extensive coverage with no copay and no coinsurance for many essential medical services, including inpatient hospital stays, outpatient care, primary and specialist visits, and home health services. While emergency room visits require a $40 copay which is waived if admitted within 24 hours, urgent care is available with no copay. Additionally, specialized services like dialysis and chemotherapy require no copay but carry coinsurance rates up to 20 percent. This plan also features robust supplemental benefits, offering covered dental, vision, and hearing services with no copay and no coinsurance. Members can take advantage of allowances such as up to $1,000 per ear annually for prescription hearing aids, up to $500 yearly for eyewear, and a $64 monthly reimbursement for eligible over-the-counter items. Routine transportation is also covered with no copay for up to 22 one-way trips per year to plan-approved health locations, though ambulance services are fully excluded.
Inpatient Hospital See details
MCS Classicare RxMax (HMO) covers inpatient hospital services, including acute and psychiatric stays, with no copay and no coinsurance, although prior authorization is required. While unlimited additional days for acute stays are included, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by MCS Classicare RxMax (HMO) with no copay and no coinsurance for outpatient hospital, ambulatory surgical center, and blood services. While some outpatient substance abuse services are covered, individual and group sessions are not.
Partial Hospitalization See details
Partial hospitalization is covered by MCS Classicare RxMax (HMO) with no copay and no coinsurance.
Ambulance and Transportation Services See details
MCS Classicare RxMax (HMO) does not cover ambulance services, as both ground and air ambulance services are excluded. Transportation services are partially covered with no copay and no coinsurance for up to 22 one-way trips per year to plan-approved health-related locations, though transportation to any health-related location is not covered.
Emergency Services See details
MCS Classicare RxMax (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, while worldwide emergency transportation is not covered.
Primary Care See details
MCS Classicare RxMax (HMO) covers primary care, specialist, therapy, and telehealth services with no copay and no coinsurance. While routine chiropractic care is covered for up to 6 visits per year, podiatry is not covered, and individual or group sessions for mental health and psychiatric services are excluded.
Preventive Services See details
Preventive services are partially covered by MCS Classicare RxMax (HMO) with no copay and no coinsurance for covered services such as kidney disease education, alternative therapies, and nutritional benefits. However, the plan does not cover annual physical exams, fitness benefits, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, adult day health, home-based palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing services under MCS Classicare RxMax (HMO) are covered with no copay and no coinsurance, including one routine exam and one fitting evaluation annually. Prescription hearing aids are partially covered up to $1,000 per ear yearly with prior authorization, but OTC hearing aids and inner, outer, and over-the-ear prescription models are not covered.
Vision Services See details
MCS Classicare RxMax (HMO) vision services are partially covered with no copay and no coinsurance, though other eye exam services and eyewear upgrades are not covered. The plan includes one routine eye exam per year and provides up to $500 annually for covered eyewear like contact lenses and eyeglasses.
Dental Services See details
MCS Classicare RxMax (HMO) provides partially covered dental services with no copay and no coinsurance for covered preventive and comprehensive care. However, maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by MCS Classicare RxMax (HMO) with no copay and require prior authorization. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Dialysis Services are covered under the MCS Classicare RxMax (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
MCS Classicare RxMax (HMO) covers durable medical equipment with no copay and no coinsurance, while prosthetic devices and medical supplies feature no copay and coinsurance ranging from 0% to 20% (10% for medical supplies). Diabetic equipment is partially covered with no copay and no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
MCS Classicare RxMax (HMO) partially covers diagnostic and radiological services with prior authorization required, offering no copay and no coinsurance for diagnostic procedures, lab services, and diagnostic or therapeutic radiological services. Outpatient X-ray services are not covered under this plan.
Home Health Services See details
Home health services are covered by MCS Classicare RxMax (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
MCS Classicare RxMax (HMO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, though prior authorization is required. While some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by MCS Classicare RxMax (HMO) with no copay and no coinsurance, and the plan does not require a three-day inpatient hospital stay prior to admission. Prior authorization is required for these services, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
MCS Classicare RxMax (HMO) covers 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 the OTC benefit provides up to $64 monthly via reimbursement, excluding nicotine replacement therapy and naloxone.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved