Compare Utuado County Puerto Rico
Medicare Advantage Plans

A Medicare Advantage Plan in Utuado County, PR can provide additional benefits above and beyond Original Medicare. There are 38 Medicare Advantage Plans (Part-C) available in Utuado County from 6 different health insurance providers to compare in 2023. 29 of these Medicare Advantage Plans offer additional gap coverage to help avoid the “donut hole”. The plan with the lowest out-of-pocket expense is $3250 and the highest out-of-pocket is $6700. Utuado County Puerto Rico qualifying beneficiaries can also pick from 30 Medicare Special Needs Plans. The highest rated Medicare Advantage Plan in Utuado County Puerto Rico received a 4.5 overall star rating from CMS.



Most Popular Plans by Enrollment in Utuado County, Puerto Rico

Plan Name Plan ID Marketing Name Monthly
Premium
Enrollment
MMM Elite (HMO-POS)
H4003-034
Medicare y Mucho Mas $0 58319
MMM Plenitud (HMO-POS)
H4004-065
PMC Medicare Choice $0 22587
MCS Classicare Efectivo (HMO)
H5577-005
MCS Classicare $0 22262
MCS Classicare Essential (HMO-POS)
H5577-008
MCS Classicare $0 20449
MCS Classicare Activo (HMO)
H5577-031
MCS Classicare $0 14098


2023 Medicare Advantage Plans in Utuado County, PR

(Click the Plan Name for More Details)
(⇅ Click the Header to Sort)


Name ⇅ Monthly
Premium
Deductible MOOP Gap 2023 Plan
Stars
Rating
Real (HMO)
(H5774-005)

$0 $0 $3,650 Yes
PMC Max (HMO-POS)
(H4004-056)

$0 $0 $3,250 Yes
Optimo Xtra (PPO)
(H4005-007)

$40.00 $0 $6,700 Yes
Optimo Plus (PPO)
(H4005-004)

$0 $0 $6,700 Yes
MMM Unico (HMO-POS)
(H4003-019)

$15.00 $0 $3,250 Yes
MMM Plenitud (HMO-POS)
(H4004-065)

$0 $0 $3,250 Yes
MMM Flexi Max (HMO-POS)
(H4003-057)

$0 $0 $3,250 Yes
MMM Encanto (HMO-POS)
(H4003-054)

$0 $0 $3,250 Yes
MMM Elite (HMO-POS)
(H4003-034)

$0 $0 $3,250 Yes
MMM Dinamico (HMO-POS)
(H4003-051)

$0 $0 $3,250 Yes
MMM Deluxe (HMO-POS)
(H4003-055)

$0 $0 $3,250 Yes
MMM Balance (HMO-POS)
(H4004-063)

$0 $0 $3,250 Yes
MCS Classicare SuperRx (HMO)
(H5577-039)

$0 $0 $3,400 Yes
MCS Classicare InteliCare (HMO)
(H5577-052)

$0 $0 $3,400 Yes
MCS Classicare Hero (HMO)
(H5577-044)

$0 $0 $3,400 Yes
MCS Classicare Freedom (HMO)
(H5577-014)

$0 $0 $6,700 Yes
MCS Classicare Firme (HMO)
(H5577-042)

$0 $0 $3,400 Yes
MCS Classicare Exacto (HMO)
(H5577-053)

$0 $0 $3,400 Yes
MCS Classicare Essential (HMO-POS)
(H5577-008)

$0 $0 $3,400 Yes
MCS Classicare En Tu Hogar (HMO)
(H5577-043)

$0 $0 $3,400 Yes
MCS Classicare En Tu Casa (HMO)
(H5577-047)

$0 $0 $3,400 Yes
MCS Classicare Electrico (HMO)
(H5577-049)

$0 $0 $3,400 Yes
MCS Classicare Efectivo (HMO)
(H5577-005)

$0 $0 $3,400 Yes
MCS Classicare Activo (HMO)
(H5577-031)

$0 $0 $3,400 Yes
MCS Classicare Acceso (HMO-POS)
(H5577-050)

$0 $0 $3,400 Yes
Magno (HMO-POS)
(H5774-027)

$0 $0 $3,650 Yes
HumanaChoice Value H2029-001 (PPO)

$38.00 $0 $6,700 NoNA
Humana Gold Plus H4007-025 (HMO)

$0 $0 $5,000 No
Humana Gold Plus H4007-024 (HMO)

$0 $0 $5,000 No
Humana Gold Plus H4007-021 (HMO)

$0 $0 $5,000 No
Humana Gold Plus H4007-020 (HMO)

$0 $0 $5,000 No
Humana Gold Plus H4007-012 (HMO)

$0 $0 $5,000 No
Enlace Plus (HMO)
(H5774-038)

$0 $0 $3,650 Yes
Brillante (HMO-POS)
(H5774-031)

$0 $0 $3,650 Yes
AhorroMax (HMO)
(H5774-037)

$0 $0 $3,650 Yes






Puerto Rico Part-C Plans Without Drug Coverage

Plan Name ⇅ Premium Type MOOP 2023 Plan
Stars
Rating
Optimo (PPO)
(H4005-001)

$0 LocalPPO* $6,700
MCS Classicare Patriot (HMO)
(H5577-016)

$0 LocalHMO* $3,400
Basic (HMO)
(H5774-003)

$0 LocalHMO* $3,650





Medicare Special Needs Plans in Utuado County Puerto Rico

Plan Name ⇅ Monthly
Premium
Part D
Deductible
 Gap  Special
Needs
Type
2023 Plan
Stars
Rating
PMC Premier Platino (HMO D-SNP)
(H4004-048)
   $0 $505.00  No Dual-Eligible
Platino Ultra (HMO D-SNP)
(H5774-025)
   $0 $505.00  No Dual-Eligible
Platino Titan (HMO D-SNP)
(H5774-036)
   $0 $505.00  No Dual-Eligible
Platino Plus (HMO D-SNP)
(H5774-024)
   $0 $505.00  No Dual-Eligible
Platino Blindao (HMO D-SNP)
(H5774-028)
   $0 $505.00  No Dual-Eligible
Platino Alcance (HMO D-SNP)
(H5774-035)
   $0 $505.00  No Dual-Eligible
Platino Advance (HMO D-SNP)
(H5774-026)
   $0 $505.00  No Dual-Eligible
MMM Vibrante (HMO C-SNP)
(H4003-053)
   $0 $0  Yes Chronic or Disabling Condition
MMM Valor Platino (HMO D-SNP)
(H4003-047)
   $0 $505.00  No Dual-Eligible
MMM Supremo (HMO C-SNP)
(H4003-009)
   $0 $0  Yes Chronic or Disabling Condition
MMM Relax Platino (HMO D-SNP)
(H4004-062)
   $0 $505.00  No Dual-Eligible
MMM Integral (HMO C-SNP)
(H4003-052)
   $0 $0  Yes Chronic or Disabling Condition
MMM Grande Platino (HMO D-SNP)
(H4003-049)
   $0 $505.00  No Dual-Eligible
MMM Dorado Platino (HMO D-SNP)
(H4003-058)
   $0 $505.00  No Dual-Eligible
MMM Diamante Platino (HMO D-SNP)
(H4003-017)
   $0 $505.00  No Dual-Eligible
MCS Classicare Primero (HMO C-SNP)
(H5577-038)
   $0 $0  Yes Chronic or Disabling Condition
MCS Classicare Platino Total (HMO D-SNP)
(H5577-046)
   $0 $505.00  No Dual-Eligible
MCS Classicare Platino Solido (HMO D-SNP)
(H5577-041)
   $0 $505.00  No Dual-Eligible
MCS Classicare Platino Progreso (HMO D-SNP)
(H5577-017)
   $0 $505.00  No Dual-Eligible
MCS Classicare Platino MasCash (HMO D-SNP)
(H5577-029)
   $0 $505.00  No Dual-Eligible
MCS Classicare Platino Ideal (HMO D-SNP)
(H5577-002)
   $0 $505.00  No Dual-Eligible
MCS Classicare Platino Home (HMO D-SNP)
(H5577-037)
   $0 $505.00  No Dual-Eligible
MCS Classicare CeroCeroCero (HMO C-SNP)
(H5577-045)
   $0 $0  Yes Chronic or Disabling Condition
Humana Gold Plus SNP-DE H4007-027 (HMO D-SNP)
(H4007-027)
   $0 $505.00  No Dual-Eligible
Humana Gold Plus SNP-DE H4007-026 (HMO D-SNP)
(H4007-026)
   $0 $505.00  No Dual-Eligible
Humana Gold Plus SNP-DE H4007-022 (HMO D-SNP)
(H4007-022)
   $0 $505.00  No Dual-Eligible
Humana Gold Plus SNP-DE H4007-019 (HMO D-SNP)
(H4007-019)
   $0 $505.00  No Dual-Eligible
Humana Gold Plus SNP-DE H4007-018 (HMO D-SNP)
(H4007-018)
   $0 $505.00  No Dual-Eligible
Humana Gold Plus SNP-DE H4007-016 (HMO D-SNP)
(H4007-016)
   $0 $505.00  No Dual-Eligible
Contigo Plus (HMO C-SNP)
(H5774-022)
   $0 $0  Yes Chronic or Disabling Condition



Types of MA Plan in PR


HMO - Health Maintenance Organization. A Health Maintenance Organization manages your Part A and Part B health insurance benefits. In most cases you need to choose a primary care doctor. Health Maintenance Organization's offers services through a network of contracted hospitals, doctors and other providers, and the plan pays the providers directly. You generally must receive all Healthcare from the plan providers or through referrals from the plan provider. Emergency care, and out-of-area urgent care is still covered. An HMO-POS plan allows you to get some services out-of-network.

PPO - Preferred Provider Organization. A Preferred Provider Organization offers a network of doctors, hospitals, and other providers you can choose from. Because providers are preferred, you can save money by using in network providers or usually pay a higher cost to use out-of-network providers. A primary care doctor is not required.

PFFS - Private Fee For Service. A Private Fee For Service plan allows you greater flexibility in choosing a Puerto Rico provider. You may obtain covered services from any Medicare eligible provider who is willing to accept the plan's terms. The Healthcare provider must agree to accept the plan's terms before each visit. Some of these plans have a network of approved providers that have agreed to treat plan members.

SNP - Special Needs Plan. A Special Needs Plan is for individuals who receive Medicare and Medicaid, have specific severe or disabling chronic conditions or reside in a licensed nursing home or skilled facility. SNP plans must provide prescription drug coverage to Utuado County Puerto Rico residents.

Cost - Cost Plan. A cost plan doesn't replace your Original Medicare. It offers additional benefits to Original Medicare. If the cost plan doesn't include prescription drug coverage, you can enroll in a Part-D plan separately.





Can I get help in the coverage gap in Utuado County, PR?


Yes. 29 Medicare Advantage Plans in Utuado County offer additional gap coverage. Once in the coverage gap, you’ll pay no more than 25% of the cost for brand-name and generic prescription drugs. If you choose a drug plan that includes coverage in the gap, you may get a discount applied to the drug's price.

Are there Medicare Advantage Plans in Utuado County, PR?


There are 38 Medicare Advantage Plans available in Utuado County, Puerto Rico from 6 different health insurance providers. These plans offer additional benefits that aren't available through Original Medicare. Medicare beneficiaries who are interested in a Part-C policy may choose among many plans to compare versus Vega Alta County Medicare Advantage Plans.



How much is a Medicare Plan in Utuado County, PR?


Individuals who are interested in a Medicare Advantage Plan in Puerto Rico may choose among many cost options depending on your necessary benefits. The lowest plan premium is $0 and the highest premium is $40. The deductibles in Utuado County range from $0-$1. The plan with the lowest out-of-pocket (MOOP) expense is $3250 and the highest out-of-pocket is $6700.



Things to consider when choosing a MA Plan in Utuado


  • Are you eligible for a Medicare Advantage Plan?

  • How much are the premiums, deductibles, and other costs?

  • Is there a yearly limit on what you could pay out-of-pocket?

  • Does the plan cover your prescription drugs?

  • Will you hit the prescription drug coverage gap?

  • Is your pharmacy in the plan’s network?

  • Will your prescription drugs require prior authorization?

  • How well does the plan cover the services you need like vision, hearing, or dental?

  • Are your doctors in-network?

  • Will you need to be referred to see a specialist?

  • Does the plan cover services from out-of-network providers?

  • How does the plan compare to your current coverage?

  • Do you want to juggle multiple Medicare plans?


Special Needs Plan in Utuado County Explained


C-SNP - Chronic Condition SNP. These plans help individuals receive customized care to fit their unique health care needs. You may qualify for C-SNP if you have one or more specific severe or disabling chronic conditions like:

  • Stroke
  • Certain neurologic disorders
  • Certain chronic and disabling mental health conditions
  • HIV/AIDS
  • Certain chronic lung disorders
  • Diabetes mellitus
  • End-Stage Renal Disease (ESRD)
  • End-stage liver disease
  • Certain severe hematologic disorders
  • Chronic alcohol and other drug dependence
  • Certain cardiovascular disorders
  • Cancer
  • Chronic heart failure
  • Certain autoimmune disorders
  • Dementia

I-SNP - Institutional SNP. These plans require 90 days or longer stay in a facility, or are expected to need the level of services provided in a long-term care (LTC) skilled nursing facility (SNF), a LTC nursing facility (NF), an intermediate care facility for individuals with intellectual disabilities, or an inpatient psychiatric facility.

D-SNP - Dual Eligible SNP. Puerto Rico Medicare and Medicaid enrollees who have limited income and resources may get help paying for their premiums and out-of-pocket medical expenses from Medicaid. Eligibility is based on a percentage of Federal Poverty Levels.


When to sign up for a Puerto Rico Medicare Advantage Plan?


Below mentioned are the types of the enrollment period, along with the instructions on what to do during this period:

Initial Enrollment Period (IEP). This period starts 3 months prior to the month you will turn 65. It ends after 3 months you have turned 65. At this stage, you can sign up for a Puerto Rico Medicare Advantage Plan.

Annual Enrollment Period (AEP). Also known as the Open Enrollment Period, it starts on the 15th of October and ends on the 7th of December. At this stage, you can either sign up for the plan, switch or leave your current plan.

Special Enrollment Period (SEP). This enrollment period depends on the personal circumstances of the beneficiaries, like if you move or lose insurance coverage. Check to determine if you qualify to modify your plan.

Open Enrollment Period. Jan 1 – Mar 31. If you’re enrolled in a Puerto Rico Medicare Advantage Plan, you can switch to a different Medicare Part-C Plan in Utuado County, PR or switch to Original Medicare once during this time.

5-star Special Enrollment Period. Dec 8 - Nov 30. If a Centers for Medicare and Medicaid Services (CMS) 5-star plan is available in your area you can switch to the 5-star plan once during this period.



Check for CMS Star Ratings

Centers for Medicare & Medicaid Service (CMS) assesses the quality of medical services of Medicare Advantage Plan using a 5-star rating system. A report is released yearly for the public to assess the quality of healthcare services. Thus, if you are searching for the highest Medicare Advantage Plan in your state, research the CMS ratings and costs of the plans report for further information.


Can I get a Medicare Advantage Plans in Utuado County, PR?

Yes. There are 38 Medicare Advantage Plans available in Utuado County, Puerto Rico from 6 different health insurance providers. These plans offer additional benefits that aren't available through Original Medicare.

How much is a Medicare Plan in Utuado County, Puerto Rico?

Puerto Rico residents who are interested in a Medicare Advantage Plan may choose among many cost options depending on your necessary benefits. The lowest plan premium is $0 and the highest premium is $40. The deductibles in Utuado County range from $0-$1

Can I get help in the coverage gap in Utuado County, PR?

Yes. 29 Medicare Advantage Plans in Utuado County offer additional gap coverage. Once in the coverage gap, you’ll pay no more than 25% of the cost for brand-name and generic prescription drugs. If you choose a drug plan that includes coverage in the gap, you may get a discount applied to the drug's price.

What is the most popular plan in Utuado, PR?

The most popular plan by enrollment in Utuado is the MMM Elite (HMO-POS) with 58319 enrollment.



Source: CMS. Data as of Oct 1, 2022.
Plans are subject to change as contracts are finalized.
Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded. For 2023, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit.


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Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. Enrollment depends on the plan’s contract renewal.

Every year, Medicare evaluates plans based on a 5-star rating system.