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MMM Valioso (HMO-POS)

H4004 - 066 - 0
4 out of 5 stars (4 / 5)

MMM Valioso (HMO-POS) is a Medicare Advantage Plan by PMC Medicare Choice.

This page features plan details for 2025 MMM Valioso (HMO-POS) H4004 – 066 – 0 available in Puerto Rico.

Locations

MMM Valioso (HMO-POS) is offered in the following locations.

Adjuntas County, Puerto Rico
Aguada County, Puerto Rico
Aguadilla County, Puerto Rico

Click to see more locations

Plan Overview

MMM Valioso (HMO-POS) offers the following coverage and cost-sharing.

Insurer:PMC Medicare Choice
Health Plan Deductible:–
MOOP:$3,250.00 combined
Drugs Covered:Yes

Ready to sign up for MMM Valioso (HMO-POS) ?

Get help from a licensed insurance agent.

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

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Medicare Part B Give Back Benefit

The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans. 

MMM Valioso (HMO-POS) qualifies for a monthly Medicare Give Back Benefit of $174.70.

Premium Reduction:$174.70

Premium Breakdown

MMM Valioso (HMO-POS) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$185.00 $0.00 $0.00 $174.70 $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

MMM Valioso (HMO-POS) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $0.00
Drug Out-Of-Pocket maximum: $2,000.00
Drug Benefit Type: Enhanced Alternative

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$0.00$0.00

Initial Coverage Phase

After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

MMM Valioso (HMO-POS) also provides the following benefits.

Cardiac and Pulmonary Rehabilitation Services

Additional Cardiac Rehabilitation Services

  • Copay: $10.00

Additional Pulmonary Rehabilitation Services

  • Copay: $10.00

Additional Intensive Cardiac Rehabilitation Services

  • Copay: $10.00

Additional Supervised Exercise Therapy for Peripheral Artery Disease

  • Copay: $10.00
  • Authorization Required: Yes
  • Referral Required: Yes

Durable Medical Equipment, Prosthetics/Orthotics, and Medical Supplies

Prosthetics/Medical Supplies

  • Authorization Required: Yes
  • Preferred Vendors: No

Prosthetics/Orthotics – Orthotic Devices

  • Coinsurance: 20%

Prosthetics/Orthotics – Orthotic Devices

  • Coinsurance: 20%
  • Specified Manufacturers: No
  • Limits Apply: No

Emergency and Urgent Care Services

Urgently Needed Services

  • Copay: $100.00
  • Enhanced Benefits: Worldwide Emergency Coverage; Worldwide Urgent Coverage
  • Waivers if Admitted: Yes

Worldwide Urgent Coverage

  • Copay: $100.00
  • Limits Apply: No

Eye Exams and Eye Wear Services

Eyewear

  • Enhanced Benefits: Contact lenses; Eyeglasses (lenses and frames); Upgrades

Contact Lenses

  • Limits Apply: Yes

Eyeglasses (Lenses and Frames)

  • Limits Apply: Yes

Eyewear

  • Authorization Required: No
  • Referral Required: No

Eye Exams and Eye Wear Services

Eye Exams

  • Enhanced Benefits: Routine Eye Exams

Routine Eye Exams

  • Limits Apply: No

Eyewear

  • Authorization Required: Yes
  • Referral Required: No
  • Enhanced Benefits: Contact lenses; Eyeglasses (lenses and frames)

Contact Lenses

  • Limits Apply: Yes

Eyeglasses (Lenses and Frames)

  • Limits Apply: Yes

Health Care Professional Services

Chiropractic Services

  • Enhanced Benefits: Routine Care

Routine Chiropractic Care

  • Limits Apply: No

PT and SP Services

  • Copay: $10.00
  • Authorization Required: Yes
  • Referral Required: No

Psychiatric Services – Inpatient Care

  • Copay: $0.00 – $10.00

Psychiatric Services – Outpatient Care

  • Copay: $0.00 – $10.00

Podiatry Services

  • Enhanced Benefits: Routine Foot Care

Podiatry Services

  • Copay: $0.00 – $10.00
  • Limits Apply: No

Additional Telehealth Services

  • Coinsurance: 10%

Hearing Exams and Hearing Aids Services

Hearing Exams

  • Enhanced Benefits: Fitting/Evaluation for Hearing Aid

Fitting/Evaluation for Hearing Aid

  • Limits Apply: Yes

Hearing Aids

  • Authorization Required: No
  • Referral Required: No
  • Enhanced Benefits: Hearing Aids (all types)

Hearing Aids (All Types)

  • Limits Apply: Yes

Hearing Exams and Hearing Aids Services

Hearing Exams

  • Enhanced Benefits: Routine Hearing Exams; Fitting/Evaluation for Hearing Aid

Routine Hearing Exams

  • Limits Apply: No

Fitting/Evaluation for Hearing Aid

  • Limits Apply: No

Hearing Aids

  • Authorization Required: Yes
  • Referral Required: No
  • Enhanced Benefits: Hearing Aids (all types)

Hearing Aids (All Types)

  • Limits Apply: Yes

Home Health Services

Home Health Services

  • Authorization Required: Yes
  • Referral Required: No

Inpatient Hospital Acute Services

Inpatient Hospital-Acute

  • Enhanced Benefits: Additional Days

Inpatient Acute Additional Days

  • Limits Apply: Yes

Inpatient Hospital-Acute

  • Authorization Required: Yes
  • Referral Required: No

Inpatient Hospital Psychiatric Services

Inpatient Hospital-Psychiatric

  • Authorization Required: Yes
  • Referral Required: No

Medicare Part B Prescription Drugs

Medicare Part B Drugs – Tier 2

  • Coinsurance: 0% – 20%

Medicare Part B Drugs – Tier 3

  • Copay: $6.00 – $20.00
  • Coinsurance: 0% – 20%

Medicare Part B Drugs – Tier 1

  • Copay: $35.00
  • Authorization Required: Yes

Non-Primarily Health Related Benefits for the Chronically Ill

General Supports for Living

  • Authorization Required: No
  • Referral Required: No

Meals (Beyond limited basis)

  • Limits Apply: Yes

Other Non-Primarily Health Related Benefits for the Chronically Ill

13i-O1(NMC)

  • Authorization Required: No
  • Referral Required: No

13i-O1(NMC)

  • Authorization Required: No
  • Referral Required: No

Out-of-Network Data for PPO Plans

Outpatient Blood, Acupuncture, and Other Services

Outpatient Clinical, Diagnostic, and Therapeutic Radiology Services

Outpatient Lab Services

  • Coinsurance: 0% – 20%
  • Authorization Required: Yes
  • Referral Required: No

Outpatient Diagnostic Radiology

  • Copay: $0.00 – $60.00

Outpatient Hospital, ASC, Substance Abuse, and Cardiac Rehabilitation Services

Outpatient Hospital Services – General

  • Copay: $100.00

Outpatient Hospital Services – Observation

  • Copay: $20.00 – $100.00
  • Authorization Required: Yes
  • Referral Required: No

Outpatient Blood Services – Type 1

  • Copay: $10.00

Outpatient Blood Services – Type 2

  • Copay: $10.00

Partial Hospitalization Services

Partial Hospitalization

  • Authorization Required: Yes
  • Referral Required: No

Preventive Services (Health Education, Immunizations, Routine Physicals, Pap/Pelvic Exams)

Kidney Disease Education Services

  • Authorization Required: Yes
  • Referral Required: No

Other Defined Supplemental Benefits

  • Enhanced Benefits: 14c1: Health Education;14c2: Nutritional/Dietary Benefit;14c3: Additional Sessions of Smoking and Tobacco Cessation Counseling;14c7: Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)*;14c17: Alternative Therapies*;

Nutritional/Dietary Benefit

  • Limits Apply: No

Alternative Therapies

  • Limits Apply: No

Diabetes Self-Management Training – Level 1

  • Authorization Required: Yes

Diabetes Self-Management Training – Level 2

  • Authorization Required: Yes

Diabetes Self-Management Training – Level 3

  • Authorization Required: Yes

Diabetes Self-Management Training – Level 4

  • Authorization Required: Yes

Diabetes Self-Management Training – Level 5

  • Authorization Required: Yes
  • Referral Required: No

Preventive and Comprehensive Dental Services

Oral Exams

  • Limits Apply: Yes

Adjunctive General Services

  • Authorization Required: No
  • Referral Required: No

Dental X-Rays

  • Limits Apply: Yes

Other Diagnostic Services

  • Limits Apply: Yes

Restorative Services

  • Limits Apply: Yes

Endodontics

  • Limits Apply: Yes

Periodontics

  • Limits Apply: Yes

Prosthodontics, Removable

  • Limits Apply: Yes

Implant Services

  • Limits Apply: Yes

Prosthodontics, Fixed

  • Limits Apply: Yes

Oral and Maxillofacial Surgery

  • Limits Apply: Yes

Renal Dialysis Services

Dialysis Services

  • Coinsurance: 20%
  • Authorization Required: Yes
  • Referral Required: No

Skilled Nursing Facility (SNF) Services

SNF Medicare-covered stay

  • Authorization Required: Yes
  • Referral Required: No

Supplemental Benefits Preventive Services

Other Defined Supplemental Benefits

  • Enhanced Benefits: 14c4: Fitness Benefit*;14c8: Home and Bathroom Safety Devices and Modifications*;14c17: Alternative Therapies*;

Alternative Therapies

  • Authorization Required: No
  • Referral Required: No
  • Limits Apply: Yes

Ready to sign up for MMM Valioso (HMO-POS) ?

Get help from a licensed insurance agent.

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

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

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