2022 MMM Elite (HMO-POS)

MMM Elite (HMO-POS) H4003-034 is a 2022 Medicare Advantage Plan or Part-C by Medicare y Mucho Mas available to residents in Puerto Rico. This plan includes additional prescription drug (Part-D) coverage. The MMM Elite (HMO-POS) has a monthly premium of $0 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 Elite (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.

Medicare y Mucho Mas works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for MMM Elite (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 Mas and not Original Medicare. With Medicare Advantage you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from Medicare y Mucho Mas except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.

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2022 Medicare y Mucho Mas Medicare Advantage Plan Costs

MMM Elite (HMO-POS) Part-C Premium

Medicare y Mucho Mas 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.

H4003-034 Part-D Deductible and Premium

MMM Elite (HMO-POS) has a monthly drug premium of $0.00 and a $0.00 drug deductible. This Medicare y Mucho Mas 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 Mas 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 lowered due to negative basic or supplemental premiums.

Medicare y Mucho Mas Gap Coverage

In 2022 once you and your plan provider have spent $4430 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 prescription drugs unless your plan offers additional coverage. This Medicare y Mucho Mas plan does offer additional coverage through the gap.

H4003-034 Formulary or Drug Coverage

MMM Elite (HMO-POS) formulary is divided into Tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price. You can see complete 2022 MMM Elite (HMO-POS) H4003-034 Formulary here.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	NA	$0
Tier 2	NA	$0
Tier 3	NA	$0
Tier 4	NA	$0
Tier 5	NA	25%

*Initial Coverage Phase and 30 day supply

2021 MMM Elite (HMO-POS) Summary of Benefits

*This will be updated with 2022 data when available.

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Additional Benefits

No

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Comprehensive Dental

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

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Deductible

$0

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	20% coinsurance (Out-of-Network)
Diagnostic radiology services (e.g., MRI)	$20-25 copay
Diagnostic tests and procedures	$0 copay
Diagnostic tests and procedures	20% coinsurance (Out-of-Network)
Lab services	0-20% coinsurance
Lab services	20% coinsurance (Out-of-Network)
Outpatient x-rays	20% coinsurance (Out-of-Network)
Outpatient x-rays	$0 copay

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Doctor Visits

Primary	20% coinsurance per visit (Out-of-Network)
Primary	$0 copay
Specialist	$0 copay
Specialist	20% coinsurance per visit (Out-of-Network)

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Emergency care/Urgent Care

Emergency	$50 copay per visit (always covered)
Urgent care	$0 copay

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Foot Care (podiatry services)

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

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Ground Ambulance

$0 copay
20% coinsurance (Out-of-Network)

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Hearing

Fitting/evaluation	$0 copay
Fitting/evaluation	20% coinsurance (Out-of-Network)
Hearing aids	20% coinsurance (Out-of-Network)
Hearing aids	$0 copay
Hearing exam	$0 copay
Hearing exam	20% coinsurance (Out-of-Network)

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Inpatient Hospital Coverage

20% per stay (Out-of-Network)
Tier 1 $0 copay per stay Tier 2 $50 per stay

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Medical Equipment/Supplies

Diabetes supplies	20% coinsurance per item (Out-of-Network)
Diabetes supplies	$0 copay
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	$0 copay
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs)	5% coinsurance per item

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Medicare Part B Drugs

Chemotherapy	20% coinsurance (Out-of-Network)
Chemotherapy	$0 copay
Other Part B drugs	20% coinsurance (Out-of-Network)
Other Part B drugs	0-10% coinsurance

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Mental Health Services

Inpatient hospital - psychiatric	$50 per stay
Inpatient hospital - psychiatric	20% per stay (Out-of-Network)
Outpatient group therapy visit	20% coinsurance (Out-of-Network)
Outpatient group therapy visit	$0 copay
Outpatient group therapy visit with a psychiatrist	$0 copay
Outpatient group therapy visit with a psychiatrist	20% coinsurance (Out-of-Network)
Outpatient individual therapy visit	$0 copay
Outpatient individual therapy visit	20% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	20% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$0 copay

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MOOP

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

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Option

Yes, contact plan for further details

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Optional supplemental benefits

No

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Outpatient Hospital Coverage

$25 copay per visit
20% coinsurance per visit (Out-of-Network)

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Preventive Care

20% coinsurance (Out-of-Network)
$0 copay

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Preventive Dental

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

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Rehabilitation Services

Occupational therapy visit	20% coinsurance (Out-of-Network)
Occupational therapy visit	$4 copay
Physical therapy and speech and language therapy visit	20% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit	$4 copay

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Skilled Nursing Facility

20% per stay (Out-of-Network)
$0 copay

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Transportation

$0 copay

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Vision

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

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for MMM Elite (HMO-POS) H4003

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

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

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

MMM Elite (HMO-POS) Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

Coverage Area for MMM Elite (HMO-POS)

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, 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 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.