2022 MMM Unico (HMO-POS)


MMM Unico (HMO-POS) H4003-019 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 Unico (HMO-POS) has a monthly premium of $15.00 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 Unico (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 Unico (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

Name:
MMM Unico (HMO-POS)
Plan ID:
H4003-019
Provider:Medicare y Mucho Mas
Year:2022
Type: Local HMO
Monthly Premium C+D: $15.00
Part C Premium:$15.00
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
Benchmark:not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced
Similar Plan: H4003-034
New Plan: 2023 H4003-034




MMM Unico (HMO-POS) Part-C Premium

Medicare y Mucho Mas charges a $15.00 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.



H4003-019 Part-D Deductible and Premium

MMM Unico (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.



H4003-019 Formulary or Drug Coverage

MMM Unico (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 Unico (HMO-POS) H4003-019 Formulary here.

Drug Tier Copay
Preferred
Pharmacy
Copay
Nonpreferred
Pharmacy
Tier 1 NA $0
Tier 2 NA $0
Tier 3 NA $1
Tier 4 NA $1
Tier 5 NA 25%
*Initial Coverage Phase and 30 day supply





2021 MMM Unico (HMO-POS) Summary of Benefits

*This will be updated with 2022 data when available.



Additional Benefits


No



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



Deductible


$0



Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI) 20% coinsurance (Out-of-Network)
Diagnostic radiology services (e.g., MRI) $10-20 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



Doctor Visits


Primary 20% coinsurance per visit (Out-of-Network)
Primary $0 copay
Specialist $0-5 copay per visit
Specialist 20% coinsurance per visit (Out-of-Network)



Emergency care/Urgent Care


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



Foot Care (podiatry services)


Foot exams and treatment 20% coinsurance (Out-of-Network)
Foot exams and treatment $5 copay
Routine foot care 20% coinsurance (Out-of-Network)
Routine foot care $5 copay



Ground Ambulance


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



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)



Inpatient Hospital Coverage


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



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) 0-20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs) $0 copay
Prosthetics (e.g., braces, artificial limbs) 20% coinsurance per item (Out-of-Network)



Medicare Part B Drugs


Chemotherapy 5% coinsurance
Chemotherapy 20% coinsurance (Out-of-Network)
Other Part B drugs 20% coinsurance (Out-of-Network)
Other Part B drugs 0-10% coinsurance



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 $8 copay
Outpatient group therapy visit with a psychiatrist $8 copay
Outpatient group therapy visit with a psychiatrist 20% coinsurance (Out-of-Network)
Outpatient individual therapy visit $8 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 $8 copay



MOOP


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



Option


Yes, contact plan for further details



Optional supplemental benefits


No



Outpatient Hospital Coverage


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



Preventive Care


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



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)



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



Skilled Nursing Facility


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



Transportation


$0 copay



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



Wellness Programs (e.g. fitness nursing hotline)


Covered




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



2021 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
Monitoring Physical Activity


Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy


Member Experience with Health Plan

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


Member Complaints and Changes in MMM Unico (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 Unico (HMO-POS)

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


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

Total Rating
Call Center, TTY, Foreign Language


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



Ready to Enroll?

Click Here

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




Coverage Area for MMM Unico (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.

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MedicareHelp.org is a privately-owned Non-governmental agency. The government website can be found at HealthCare.gov.

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.