PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
MMM Healthcare
CMS Rating
Plan Type
HMO-POS
Annual Deductible
$0.00

What To Know About This Plan

  • This plan has health and drug coverage

Plan Details

Costs and Other Important Information

Plan Year:
2013
Optional Supplemental Benefits?
No
Choice of Doctors?
Plan Doctors Only (some exceptions)
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$3,250 In-Network$3,250 Out-of-Network$3,250 In and Out-of-Network
Other Deductibles?
In Network: No. Out of Network: No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$0.00
Monthly Health Plan Premium
$0.00

Benefits

Service
In Network
Out of Network
Doctor Office Visits
$0Point of Service: 20% maximum per visit
In Network: $0Point of Service: 20% maximum per visit
Specialist Office Visit
$15 maximum per visit. Point of Service: 20% maximum per visit
In Network: $15 maximum per visit. Point of Service: 20% maximum per visit
Outpatient Services
$25 maximum per visit. Point of Service: 20% maximum per visit
In Network: $25 maximum per visit. Point of Service: 20% maximum per visit
Emergency Care
$65 maximum per visit. Point of Service: Not Applicable
In Network: $65 maximum per visit. Point of Service: Not Applicable
Ambulance Services
$0Point of Service: 20% maximum
In Network: $0Point of Service: 20% maximum
Kidney Disease and Conditions
$0Point of Service: Not Applicable
In Network: $0Point of Service: Not Applicable
Home Health Care
$0Point of Service: 20% maximum per visit
In Network: $0Point of Service: 20% maximum per visit
Durable Medical Equipment
20% maximum per item. Point of Service: 20% maximum per item
In Network: 20% maximum per item. Point of Service: 20% maximum per item
Inpatient Hospital Care
Days 1-4: $40 copay per day. Days 5-90: $0 copay per day. Point of Service: 20%
In Network: Days 1-4: $40 copay per day. Days 5-90: $0 copay per day. Point of Service: 20%
Skilled Nursing Facility (SNF)
Days 1-4: $25 copay per day. Days 5-100: $0 copay per day. Point of Service: 20%
In Network: Days 1-4: $25 copay per day. Days 5-100: $0 copay per day. Point of Service: 20%
Inpatient Mental Health Care
Days 1-4: $40 copay per day. Days 5-90: $0 copay per day. Point of Service: 20%
In Network: Days 1-4: $40 copay per day. Days 5-90: $0 copay per day. Point of Service: 20%

Cost Sharing Information

Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$5 copay$5 copayNot offered
Tier 2: Non-Preferred Generic$29 copay$29 copayNot offered
Tier 3: Preferred Brand Name$50 copay$50 copayNot offered
Tier 4: Non-Preferred Brand Name25% coinsurance25% coinsuranceNot offered
Tier 5: Specialty Tier
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$15 copay$15 copay$10 copay
Tier 2: Non-Preferred Generic$87 copay$87 copay$58 copay
Tier 3: Preferred Brand Name$150 copay$150 copay$100 copay
Tier 4: Non-Preferred Brand Name25% coinsurance25% coinsurance25% coinsurance
Tier 5: Specialty Tier

CMS Ratings

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Not Rated
Colorectal cancer screening
Cholesterol screening for patients with heart disease
Glaucoma testing
Annual flu vaccine
Pneumonia vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Access to primary care doctor visits
Adult BMI assessment

Managing Chronic Conditions

Care for older adults – medication review
Care for older adults – functional status assessment
Care for older adults – Pain screening
Osteoporosis management in women who had a fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Diabetes care – cholesterol controlled
Controlling blood pressure
Rheumatoid arthritis management
Improving bladder control
Reducing the risk of falling
Plan all-cause readmissions

Ratings of Plan Responsiveness and Care

Getting needed care
Getting appointments and care quickly
Customer service
Overall rating of health care quality
Overall rating of plan

Member Complaints, Problems Getting Services, and Choosing to Leave the Plan

Complaints about the health plan
Beneficiary access and performance problems
Members choosing to leave the plan
Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability

Physician Finder

Physicians that accept Medicare y Mucho Mas - ELITE (HMO-POS) for Puerto Rico

/
SALINAS-SEINE, GLORIA
124 AVE WINSTON CHURCHILL
SAN JUAN, PR 00926
PEREZ-CUEVAS, HORTENSIA
287 AVE WINSTON CHURCHILL
SAN JUAN, PR 00926
DIEZ-DELGADO, RICARDO
124 AVE WINSTON CHURCHILL
SAN JUAN, PR 00926
HERRERO GRANDA, MANUEL
287 AVE WINSTON CHURCHILL
SAN JUAN, PR 00926
CENTRO DE DIABETES PARA PR
PRIMER PISO
SAN JUAN, PR 00936
DIAZ RIVERA, RAFAEL
CONDO MEDICINA CENTER ALTOS CORREO RIO PIEDRAS
RIO PIEDRAS, PR 00928
PENA JIMENO, IVELISSE
346 CALLE 32
SAN JUAN, PR 00927
ROJAS DAVIS, ACACIA
1056 CALLE FERROCARRIL
RIO PIEDRAS, PR 00925
POLICLINICA RIO PIEDRAS
1056 CALLE FERROCARRIL
SAN JUAN, PR 00925
LIZASOAIN SANTIAGO, AIDA
1056 CALLE FERROCARRIL
RIO PIEDRAS, PR 00925
DMRA LLC
864 AVE SAN PATRICIO
SAN JUAN, PR 00921
ALFONSO, GISHLAINE
CLINICA LAS AMERICAS SUITE 402
HATO REY, PR 00918
MENDEZ, CELIA
URB PARQUE CENTRAL STE 3
SAN JUAN, PR 00918
RIOS, WALDEMAR
400 AVE DOMENECH
SAN JUAN, PR 00918
RODRIGUEZ PEREZ, HECTOR
420 AVE PONCE DE LEON
SAN JUAN, PR 00918
LOPEZ-NEGRON, ARTURO
LAS AMERICAS PROFESSIONAL CENTER, 400 DOMENECH AVENUE
HATO REY, PR 00918
LASTRA ARACIL, JUAN
COND CRYSTAL HOUSE
SAN JUAN, PR 00923
MIRO-DIAZ, ANGEL
369 DE DIEGO AVE
SAN JUAN, PR 00923
MELENDEZ ORTIZ, ELIUT
369 CALLE DE DIEGO
SAN JUAN, PR 00923
GONZALEZ CASTRO, RAFAEL
COND CRYSTAL HOUSE
SAN JUAN, PR 00923
RAMIREZ-VAZQUEZ, JOSE
369 CALLE DE DIEGO
SAN JUAN, PR 00923
ROSADO, JOSE
735 PONCE DE LEON AVE
SAN JUAN, PR 00917
MENDOZA RODRIGUEZ, OLGA
C 24 S-19 URB CIUDAD UNIVERSITARIA
TRUJILLO AITO, PR 00976
SANTOS GONZALEZ, CARLOS
730 J ANDINO AVE
SAN JUAN, PR 00924
MALDONADO, CARLOS
CALLE GENERAL VALERO 1020 URG LAS DELICIAS
SAN JUAN, PR 00924
Details
GLORIA SALINAS-SEINE, MPT
Phone Number
(787) 767-7370
Office Locations
124 AVE WINSTON CHURCHILL
SAN JUAN, PR 00926
124 AVE WINSTON CHURCHILL SAN JUAN PR, 00926

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