2019 MMM Cero (HMO-POS) H4003-045 By Medicare y Mucho

2019 Medicare Advantage Plan Services for
MMM Cero (HMO-POS)


MMM Cero (HMO-POS) H4003-045 is a 2019 Medicare Advantage or Medicare Part-C plan by Medicare y Mucho available to residents in Puerto Rico. This plan includes additional Medicare prescription drug (Part-D) coverage. The MMM Cero (HMO-POS) has a monthly premium of $- and has an in-network Maximum Out-of-Pocket limit of $3,250 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $3,250 out of pocket. This can be a extremely nice safety net.

MMM Cero (HMO-POS) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.

Medicare y Mucho works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for MMM Cero (HMO-POS) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Medicare y Mucho and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Medicare y Mucho except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.



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2019 Medicare y Mucho Medicare Advantage Plan Details

Name:
MMM Cero (HMO-POS)
ID:
H4003-045
Provider:Medicare y Mucho
Year:2019
Type: Local HMO
Monthly Premium C+D: $-
Part C Premium:$0.00
MOOP: $3,250
Part D (Drug) Premium:$0.00
Part D Supplemental Premium$0.00
Total Part D Premium:$0.00
Drug Deductible:$0.00
Tiers with No Deductible:0
Gap Coverage:Yes
Initial Coverage Limit:$3820
Benchmark:not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced






Part-C Premium

Medicare y Mucho plan charges a $0.00 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.



Part-D Deductible and Premium

MMM Cero (HMO-POS) has a monthly drug premium of $0.00 and a $0.00 drug deductible. This Medicare y Mucho plan offers a $0.00 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by Medicare y Mucho above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0.00. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.



Premium Assistance

Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The MMM Cero (HMO-POS) medicare insurance offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $0.00 for 75% low income subsidy $0.00 for 50% and $0.00 for 25%.



Full LIS Premium:$0.00
75% LIS Premium:$0.00
50% LIS Premium:$0.00
25% LIS Premium:$0.00


Gap Coverage

In 2019 once you and your plan provider have spent $3820 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for brand-name drugs and 37% on generic drugs unless your plan offers additional coverage. This Medicare y Mucho plan does offer additional coverage through the gap.





Plan Services




Health plan deductible


$0



Emergency care/Urgent care


Emergency $0 copay
Urgent care $0 copay



Diagnostic procedures/lab services/imaging


Diagnostic tests and procedures In-Network $0 copay
Diagnostic tests and procedures Out-of-Network 20%
Lab services In-Network 0-20%
Lab services Out-of-Network 20%
Diagnostic radiology services (e.g., MRI) In-Network $0-10
Diagnostic radiology services (e.g., MRI) Out-of-Network 20%
Outpatient x-rays In-Network $0 copay
Outpatient x-rays Out-of-Network 20%



Hearing


Hearing exam In-Network $0 copay
Hearing exam Out-of-Network 20%
Fitting/evaluation In-Network $0 copay
Fitting/evaluation Out-of-Network 20%
Hearing aids In-Network $0 copay
Hearing aids Out-of-Network 20%



Preventive dental


Oral exam In-Network $0 copay
Oral exam Out-of-Network 20%
Cleaning In-Network $0 copay
Cleaning Out-of-Network 20%
Fluoride treatment In-Network $0 copay
Fluoride treatment Out-of-Network 20%
Dental x-ray(s) In-Network $0 copay
Dental x-ray(s) Out-of-Network 20%



Comprehensive dental


Non-routine services Not covered
Diagnostic services In-Network $0 copay
Diagnostic services Out-of-Network 50%
Restorative services In-Network $0 copay
Restorative services Out-of-Network 50%
Endodontics In-Network $0 copay
Endodontics Out-of-Network 50%
Periodontics In-Network $0 copay
Periodontics Out-of-Network 50%
Extractions In-Network $0 copay
Extractions Out-of-Network 50%
Prosthodontics, other oral/maxillofacial surgery, other services In-Network $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services Out-of-Network 50%



Vision


Routine eye exam In-Network $0 copay
Routine eye exam Out-of-Network 20%
Other Not covered
Contact lenses In-Network $0 copay
Contact lenses Out-of-Network 20%
Eyeglasses (frames and lenses) In-Network $0 copay
Eyeglasses (frames and lenses) Out-of-Network 20%
Eyeglass frames Not covered
Eyeglass lenses Not covered
Upgrades Not covered



Mental health services


Inpatient hospital - psychiatric In-Network $0 copay
Inpatient hospital - psychiatric Out-of-Network 20% per stay
Outpatient group therapy visit with a psychiatrist In-Network $0 copay
Outpatient group therapy visit with a psychiatrist Out-of-Network 20%
Outpatient individual therapy visit with a psychiatrist In-Network $0 copay
Outpatient individual therapy visit with a psychiatrist Out-of-Network 20%
Outpatient group therapy visit In-Network $0 copay
Outpatient group therapy visit Out-of-Network 20%
Outpatient individual therapy visit In-Network $0 copay
Outpatient individual therapy visit Out-of-Network 20%



Skilled Nursing Facility


In-Network $0 copay
Out-of-Network 20% per stay



Rehabilitation services


Occupational therapy visit In-Network $0 copay
Occupational therapy visit Out-of-Network 20%
Physical therapy and speech and language therapy visit In-Network $0 copay
Physical therapy and speech and language therapy visit Out-of-Network 20%



Ground ambulance


In-Network $0 copay
Out-of-Network 20%



Other health plan deductibles?


In-Network No



Transportation


In-Network $0 copay



Foot care (podiatry services)


Foot exams and treatment In-Network $0 copay
Foot exams and treatment Out-of-Network 20%
Routine foot care In-Network $0 copay
Routine foot care Out-of-Network 20%



Medical equipment/supplies


Durable medical equipment (e.g., wheelchairs, oxygen) In-Network $0 copay
Durable medical equipment (e.g., wheelchairs, oxygen) Out-of-Network 20% per item
Prosthetics (e.g., braces, artificial limbs) In-Network $0 copay
Prosthetics (e.g., braces, artificial limbs) Out-of-Network 20% per item
Diabetes supplies In-Network $0 copay
Diabetes supplies Out-of-Network 20% per item



Wellness programs (e.g., fitness, nursing hotline)


Covered



Medicare Part B drugs


Chemotherapy In-Network $0 copay
Chemotherapy Out-of-Network 20%
Other Part B drugs In-Network $0 copay
Other Part B drugs Out-of-Network 20%



Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)


$3,250 In and Out-of-network
$3,250 In-network
$3,250 Out-of-network



Optional supplemental benefits


No



Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?


In-Network Yes, contact plan for further details



Inpatient hospital coverage


In-Network Tier 1
$0 copay per stay
Tier 2
$100 per stay
Out-of-Network 20% per stay



Outpatient hospital coverage


In-Network $0 copay
Out-of-Network 20% per visit



Doctor visits


Primary In-Network $0 copay
Primary Out-of-Network 20% per visit
Specialist In-Network $0-5 per visit
Specialist Out-of-Network 20% per visit



Preventive care


In-Network $0 copay
Out-of-Network 20%




Ratings for MMM Cero (HMO-POS) H4003

2018 Overall Rating
Part C Summary Rating
Part D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing


Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment


Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Controlling Blood Pressure
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Plan All-Cause Readmissions
Statin Therapy


Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Timely Care and Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints and Changes in MMM Cero (HMO-POS) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement


Health Plan Customer Service Rating for MMM Cero (HMO-POS)

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language


MMM Cero (HMO-POS) Drug Plan Customer Service ratings

Total Rating
Call Center, TTY, Foreign Language
Appeals Auto
Appeals Upheld


Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement


Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs


Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes


Coverage Area for MMM Cero (HMO-POS)

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Source: CMS.
Data as of September 2, 2018.
Star Rating as of October 10, 2018.
For More Information on Ratings Please See the CMS Tech Notes.
Notes: Data are subject to change as contracts are finalized. For 2019, 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. Includes 2019 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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