MCS Classicare Patriot (HMO)

H5577 - 016 - 0
5 out of 5 stars (5 / 5)

MCS Classicare Patriot (HMO) is a Medicare Advantage (Part C) Plan by MCS Classicare.

This page features plan details for 2024 MCS Classicare Patriot (HMO) H5577 – 016 – 0 available in Puerto Rico.

IMPORTANT: This page has been updated with plan and premium data for 2024.

Locations

MCS Classicare Patriot (HMO) is offered in the following locations.

Plan Overview

MCS Classicare Patriot (HMO) offers the following coverage and cost-sharing.

Insurer:MCS Classicare
Health Plan Deductible:$0.00
MOOP:$3,400 In-network
Drugs Covered:No

Ready to sign up for MCS Classicare Patriot (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

8am – 11pm EST. 7 days a week

Premium Breakdown

MCS Classicare Patriot (HMO) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.
Part B Part C Part B Give Back Total
$174.70 $0.00 $0.00 $174.70
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.

Additional Benefits

MCS Classicare Patriot (HMO) also provides the following benefits.

Health plan deductible

$0

Other health plan deductibles?

In-network No

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

$3,400 In-network

Optional supplemental benefits

No

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

In-network No

Outpatient hospital coverage

$0 copay (Authorization is required.) (Referral is not required.)

Doctor visits

Primary$0 copay (Not applicable.) (Not applicable.)
Specialist$0 copay (Authorization is not required.) (Referral is not required.)

Preventive care

$0 copay (Authorization is not required.) (Referral is not required.)

Emergency care/Urgent care

Emergency$40 copay per visit (always covered) (Not applicable.) (Not applicable.)
Urgent care$0 copay (Not applicable.) (Not applicable.)

Diagnostic procedures/lab services/imaging

Diagnostic tests and procedures0-20% coinsurance (Authorization is required.) (Referral is not required.)
Lab services0-20% coinsurance (Authorization is required.) (Referral is not required.)
Diagnostic radiology services (e.g., MRI)0-20% coinsurance (Authorization is required.) (Referral is not required.)
Outpatient x-rays$0 copay (Authorization is required.) (Referral is not required.)

Hearing

Hearing exam$0 copay (Authorization is not required.) (Referral is not required.)
Fitting/evaluation$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Hearing aids$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)

Preventive dental

Oral exam$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Cleaning$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Fluoride treatment$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Dental x-ray(s)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Comprehensive dental

Non-routine services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Diagnostic services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Restorative services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Endodontics$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Periodontics$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Extractions$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Prosthodontics, other oral/maxillofacial surgery, other services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)

Vision

Routine eye exam$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
OtherNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Contact lenses$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Eyeglasses (frames and lenses)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Eyeglass frames$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Eyeglass lenses$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
UpgradesNot covered (Not applicable.) (Not applicable.)

Rehabilitation services

Occupational therapy visit$0 copay (Authorization is required.) (Referral is not required.)
Physical therapy and speech and language therapy visit$0 copay (Authorization is required.) (Referral is not required.)

Ground ambulance

$0 copay (Not applicable.) (Not applicable.)

Transportation

$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Foot care (podiatry services)

Foot exams and treatment$0 copay (Authorization is not required.) (Referral is not required.)
Routine foot careNot covered (Not applicable.) (Not applicable.)

Medical equipment/supplies

Durable medical equipment (e.g., wheelchairs, oxygen)$0 copay (Authorization is required.) (Not applicable.)
Prosthetics (e.g., braces, artificial limbs)0-20% coinsurance per item (Authorization is required.) (Not applicable.)
Diabetes supplies$0 copay (Authorization is required.) (Not applicable.)

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

Covered (Authorization is not required.) (Referral is not required.)

Medicare Part B drugs

Chemotherapy0-5% coinsurance (Authorization is required.) (Not applicable.)
Other Part B drugs0-10% coinsurance (Authorization is required.) (Not applicable.)
Part B Insulin drugs0-10% coinsurance (up to $35) (Authorization is required.) (Not applicable.)

Inpatient hospital coverage

Tier 1
$0 copay per stay
Tier 2
$50 per stay (Authorization is required.) (Referral is not required.)

Mental health services

Inpatient hospital – psychiatric$0 copay (Authorization is required.) (Referral is not required.)
Outpatient group therapy visit with a psychiatrist$0 copay (Authorization is not required.) (Referral is not required.)
Outpatient individual therapy visit with a psychiatrist$0 copay (Authorization is not required.) (Referral is not required.)
Outpatient group therapy visit$0 copay (Authorization is required.) (Referral is not required.)
Outpatient individual therapy visit$0 copay (Authorization is required.) (Referral is not required.)

Skilled Nursing Facility

$0 copay (Authorization is required.) (Referral is not required.)

Ready to sign up for MCS Classicare Patriot (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

8am – 11pm EST. 7 days a week

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