MMM Encanto (HMO-POS) is a Medicare Advantage Plan by Medicare y Mucho Más.
This page features plan details for 2024 MMM Encanto (HMO-POS) H4003 – 054 – 0 available in Puerto Rico Northwest.
IMPORTANT: This page features the 2024 version of this plan. See the 2025 version using the link below:
MMM Encanto (HMO-POS) is offered in the following locations.
MMM Encanto (HMO-POS) offers the following coverage and cost-sharing.
Insurer: | Medicare y Mucho Más |
Health Plan Deductible: | $0.00 |
MOOP: | $3,250 In and Out-of-network $3,250 In-network $3,250 Out-of-network |
Drugs Covered: | Yes |
Ready to sign up for MMM Encanto (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
The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans.
MMM Encanto (HMO-POS) qualifies for a monthly Medicare Give Back Benefit of $150.00.
Premium Reduction: | $150.00 |
Part B | Part C | Part D | Part B Give Back | Total |
---|---|---|---|---|
$174.70 | $0.00 | $0.00 | $150.00 | $ |
MMM Encanto (HMO-POS) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
Drug Deductible: | $0.00 |
Initial Coverage Limit: | $5,030.00 |
Catastrophic Coverage Limit: | $8,000.00 |
Drug Benefit Type: | Enhanced Alternative |
Additional Gap Coverage: | Yes |
Formulary Link: | Formulary Link |
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 D | LIS Full |
---|---|
$0.00 | $ |
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 $5,030.00. Once you reach that amount, you will enter the next coverage phase.
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $1.00 copay | |||
2 (Generic) | $2.00 copay | |||
3 (Preferred Brand) | $7.00 copay | |||
4 (Non-Preferred Brand) | $10.00 copay | |||
5 (Specialty Tier) | 33% | |||
6 (Select Care Drugs) | $0.00 copay |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | ||||
2 (Generic) | ||||
3 (Preferred Brand) | ||||
4 (Non-Preferred Brand) | ||||
5 (Specialty Tier) | ||||
6 (Select Care Drugs) |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $2.00 copay | $2.00 copay | ||
2 (Generic) | $4.00 copay | $4.00 copay | ||
3 (Preferred Brand) | $14.00 copay | $14.00 copay | ||
4 (Non-Preferred Brand) | $20.00 copay | $20.00 copay | ||
5 (Specialty Tier) | ||||
6 (Select Care Drugs) | $0.00 copay | $0.00 copay |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $1.00 copay | |||
2 (Generic) * | $2.00 copay | |||
6 (Select Care Drugs) * | $0.00 copay | |||
1 (Preferred Generic) | ||||
2 (Generic) | ||||
3 (Preferred Brand) | ||||
4 (Non-Preferred Brand) | ||||
5 (Specialty Tier) | ||||
6 (Select Care Drugs) |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $2.00 copay | $2.00 copay | ||
2 (Generic) * | $4.00 copay | $4.00 copay | ||
6 (Select Care Drugs) * | $0.00 copay | $0.00 copay | ||
1 (Preferred Generic) | ||||
2 (Generic) | ||||
3 (Preferred Brand) | ||||
4 (Non-Preferred Brand) | ||||
5 (Specialty Tier) | ||||
6 (Select Care Drugs) |
Tier | Cost |
---|---|
All other tiers (Generic) | 25% |
All other tiers (Brand-name) | 25% |
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $8,000.00, 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.
MMM Encanto (HMO-POS) also provides the following benefits.
$0 |
In-network | No |
$3,250 In and Out-of-network $3,250 In-network $3,250 Out-of-network |
No |
In-network | Yes, contact plan for further details |
In-network | $25 copay per visit (Authorization is required.) (Referral is not required.) |
out-of-network | 20% coinsurance per visit (Authorization is required.) (Referral is not required.) |
In-network Primary | $0 copay (Not applicable.) (Not applicable.) |
out-of-network Primary | 20% coinsurance per visit (Not applicable.) (Not applicable.) |
In-network Specialist | $0-5 copay per visit (Authorization is required.) (Referral is not required.) |
out-of-network Specialist | 20% coinsurance per visit (Authorization is required.) (Referral is not required.) |
In-network | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network | 20% coinsurance (Authorization is required.) (Referral is not required.) |
Emergency | $75 copay per visit (always covered) (Not applicable.) (Not applicable.) |
Urgent care | $0 copay (Not applicable.) (Not applicable.) |
In-network Diagnostic tests and procedures | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network Diagnostic tests and procedures | 20% coinsurance (Authorization is required.) (Referral is not required.) |
In-network Lab services | 0-20% coinsurance (Authorization is required.) (Referral is not required.) |
out-of-network Lab services | 20% coinsurance (Authorization is required.) (Referral is not required.) |
In-network Diagnostic radiology services (e.g., MRI) | $0-25 copay (Authorization is required.) (Referral is not required.) |
out-of-network Diagnostic radiology services (e.g., MRI) | 20% coinsurance (Authorization is required.) (Referral is not required.) |
In-network Outpatient x-rays | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network Outpatient x-rays | 20% coinsurance (Authorization is required.) (Referral is not required.) |
In-network Hearing exam | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network Hearing exam | 20% coinsurance (Authorization is required.) (Referral is not required.) |
In-network Fitting/evaluation | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Fitting/evaluation | 20% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Hearing aids | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Hearing aids | 20% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Oral exam | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Oral exam | 20% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Cleaning | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Cleaning | 20% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Fluoride treatment | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Fluoride treatment | 20% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Dental x-ray(s) | 20% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
Non-routine services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
In-network Diagnostic services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Diagnostic services | 20% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Restorative services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Restorative services | 20% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Endodontics | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Endodontics | 20% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Periodontics | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Periodontics | 20% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Extractions | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Extractions | 20% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Prosthodontics, other oral/maxillofacial surgery, other services | 20% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Routine eye exam | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Routine eye exam | 20% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
In-network Contact lenses | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Contact lenses | 20% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
out-of-network Eyeglasses (frames and lenses) | 20% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
Eyeglass frames | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Eyeglass lenses | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Upgrades | Not covered (Not applicable.) (Not applicable.) |
In-network Occupational therapy visit | $4 copay (Authorization is required.) (Referral is not required.) |
out-of-network Occupational therapy visit | 20% coinsurance (Authorization is required.) (Referral is not required.) |
In-network Physical therapy and speech and language therapy visit | $4 copay (Authorization is required.) (Referral is not required.) |
out-of-network Physical therapy and speech and language therapy visit | 20% coinsurance (Authorization is required.) (Referral is not required.) |
In-network | $0 copay (Not applicable.) (Not applicable.) |
out-of-network | 20% coinsurance (Not applicable.) (Not applicable.) |
In-network | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Foot exams and treatment | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network Foot exams and treatment | 20% coinsurance (Authorization is required.) (Referral is not required.) |
In-network Routine foot care | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
In-network Durable medical equipment (e.g., wheelchairs, oxygen) | $0 copay (Authorization is required.) (Not applicable.) |
out-of-network Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
In-network Prosthetics (e.g., braces, artificial limbs) | 5% coinsurance per item (Authorization is required.) (Not applicable.) |
out-of-network Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
In-network Diabetes supplies | $0 copay (Authorization is required.) (Not applicable.) |
out-of-network Diabetes supplies | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
Covered (Authorization is required.) (Referral is not required.) |
In-network Chemotherapy | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
out-of-network Chemotherapy | 20% coinsurance (Authorization is required.) (Not applicable.) |
In-network Other Part B drugs | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
out-of-network Other Part B drugs | 20% coinsurance (Authorization is required.) (Not applicable.) |
In-network Part B Insulin drugs | $35 copay (Authorization is required.) (Not applicable.) |
out-of-network Part B Insulin drugs | 20% coinsurance (Authorization is required.) (Not applicable.) |
In-network | Tier 1 $0 copay per stay Tier 2 $50 per stay (Authorization is required.) (Referral is not required.) |
out-of-network | 20% per stay (Authorization is required.) (Referral is not required.) |
In-network Inpatient hospital – psychiatric | $50 per stay (Authorization is required.) (Referral is not required.) |
out-of-network Inpatient hospital – psychiatric | 20% per stay (Authorization is required.) (Referral is not required.) |
In-network Outpatient group therapy visit with a psychiatrist | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network Outpatient group therapy visit with a psychiatrist | 20% coinsurance (Authorization is required.) (Referral is not required.) |
In-network Outpatient individual therapy visit with a psychiatrist | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network Outpatient individual therapy visit with a psychiatrist | 20% coinsurance (Authorization is required.) (Referral is not required.) |
In-network Outpatient group therapy visit | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network Outpatient group therapy visit | 20% coinsurance (Authorization is required.) (Referral is not required.) |
In-network Outpatient individual therapy visit | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network Outpatient individual therapy visit | 20% coinsurance (Authorization is required.) (Referral is not required.) |
In-network | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network | 20% per stay (Authorization is required.) (Referral is not required.) |
Ready to sign up for MMM Encanto (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
Need more information on MMM Encanto (HMO-POS)? See 2025 MMM Encanto (HMO-POS) at MedicareAdvantageRX.com.
Get help enrolling in a Medicare Advantage or Medicare Prescription Drug Plan by calling a licensed insurance agent today.
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SMID: MULTIPLAN_HCIHNDOGMED01PY25_M
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