MMM Combo Platino (HMO D-SNP)
Available to residents of Adjuntas County, PR for 2026. Contract H4004, plan 068, segment 0.
- ✉ Email a copy of the plan benefit details
- Plan health benefits
- Benefits in plain text
- Rx cost-sharing for all pharmacies and tiers
- Other plans in Adjuntas County
- Plan website
- Browse the MMM Combo Platino (HMO D-SNP) formulary
Renewed for 2026. CMS carries this plan forward from 2025.
Plan details
| Monthly premium (Part C + D) | $0.00 |
|---|---|
| — medical (Part C) part | $0.00 |
| — drug (Part D) part | $0.00? |
| Monthly premium with full Extra Help (LIS) | $0.00? |
| Part B premium reduction (giveback) | $50.00 a month?You must continue to pay your Medicare Part B premium. |
| Health plan deductible (in-network) | None |
| In-network out-of-pocket maximum | $3,250.00? |
| Drug deductible | $615.00 |
| Drug out-of-pocket threshold | $2,100.00 |
| Plan type | HMO D-SNP? |
| Special needs plan | Dual-eligible SNP |
| Contract / plan | H4004-068-0 |
| Offered by | Medicare y Mucho Mas (MMM) |
| Parent organization | Elevance Health, Inc. |
| Formulary drugs | 3,597 |
| Pharmacy search | www.mmmpr.com |
| Member services | (833)668-2401TTY 711 |
CMS star ratings
- Overall
- 5 out of 5 stars for Overall
- Health plan (Part C)
- 5 out of 5 stars for Health plan (Part C)
- Drug plan (Part D)
- 5 out of 5 stars for Drug plan (Part D)
Published per contract — every plan under contract H4004 shares this rating.
Plan health benefits
| Service | In-network |
|---|---|
| Doctor visits | |
| Primary care doctor | $0 copay |
| Specialist | $0 copay(authorization and referral required) |
| Other health care professional | $0 copay(authorization and referral required) |
| Additional telehealth services | $0 copay(authorization required) |
| Preventive care | |
| Medicare-covered preventive services | $0 copay(authorization required) |
| Annual physical exam | Not covered |
| Kidney disease education | $0 copay(authorization required) |
| Glaucoma screening | $0 copay(authorization required) |
| Diabetes self-management training | $0 copay(authorization required) |
| Diagnostic tests, labs and imaging | |
| Diagnostic tests and procedures | $0 copay(authorization required) |
| Lab services | $0 copay(authorization required) |
| Diagnostic radiology (e.g. MRI, CT) | $0 copay(authorization required) |
| Therapeutic radiology | $0 copay(authorization required) |
| Outpatient x-rays | $0 copay(authorization required) |
| Emergency and urgent care | |
| Emergency room | $0 copay |
| Urgent care | $0 copay |
| Worldwide emergency coverage | $75 copay · $500 plan limit |
| Worldwide urgent care | $75 copay · $500 plan limit |
| Worldwide emergency transportation | Not covered |
| Hospital care | |
| Inpatient hospital stay | $0 per stay(authorization required) |
| Outpatient hospital services | $0 copay(authorization required) |
| Outpatient observation | $0 copay(authorization required) |
| Ambulatory surgical center | $0 copay(authorization required) |
| Outpatient blood services | $0 copay(authorization required) |
| Skilled nursing and home health | |
| Skilled nursing facility | $0 per stay(authorization required) |
| Home health care | $0 copay(authorization required) |
| Kidney dialysis | $0 copay(authorization required) |
| Rehabilitation | |
| Occupational therapy | $0 copay(authorization and referral required) |
| Physical therapy and speech-language therapy | $0 copay(authorization required) |
| Cardiac rehabilitation | $0 copay(authorization and referral required) |
| Pulmonary rehabilitation | $0 copay(authorization and referral required) |
| Mental health and substance use | |
| Inpatient psychiatric hospital stay | $0 per stay(authorization required) |
| Outpatient mental health, individual session | $0 copay(authorization and referral required) |
| Outpatient mental health, group session | $0 copay(authorization and referral required) |
| Psychiatrist, individual session | $0 copay(authorization and referral required) |
| Psychiatrist, group session | $0 copay(authorization and referral required) |
| Partial hospitalization | $0 copay(authorization and referral required) |
| Intensive outpatient program | $0 copay(authorization and referral required) |
| Outpatient substance use, individual session | $0 copay(authorization and referral required) |
| Outpatient substance use, group session | $0 copay(authorization and referral required) |
| Opioid treatment program | $0 copay(authorization required) |
| Ambulance and transportation | |
| Ground ambulance | $0 copay(authorization required) |
| Air ambulance | $0 copay(authorization required) |
| Transportation to plan-approved locations | $0 copay(authorization required, limits apply) |
| Medical equipment and supplies | |
| Durable medical equipment (e.g. wheelchairs, oxygen) | 20% coinsurance(authorization required) |
| Prosthetics (e.g. braces, artificial limbs) | 20% coinsurance(authorization required) |
| Medical supplies | 20% coinsurance(authorization required) |
| Diabetes supplies | $0 copay(authorization required) |
| Diabetic therapeutic shoes or inserts | $0 copay(authorization required) |
| Chiropractic, acupuncture and foot care | |
| Chiropractic (Medicare-covered) | $0 copay(authorization and referral required, limits apply) |
| Routine chiropractic care | $0 copay(authorization and referral required, limits apply) |
| Acupuncture | $0 copay(authorization and referral required, limits apply) |
| Foot exams and treatment (Medicare-covered) | $0 copay(authorization and referral required) |
| Routine foot care | $0 copay(authorization and referral required, limits apply) |
| Dental? | |
| Oral exams | Not covered |
| Cleanings | Not covered |
| Fluoride treatment | Not covered |
| Dental x-rays | Not covered |
| Other diagnostic dental services | Not covered |
| Other preventive dental services | Not covered |
| Comprehensive dental plan limit | $1,000 plan limit every year |
| Endodontics (root canals) | Not covered |
| Periodontics (gum disease) | Not covered |
| Maxillofacial prosthetics | Not covered |
| Oral and maxillofacial surgery | Not covered |
| Orthodontics | Not covered |
| Vision? | |
| Eye exam (Medicare-covered) | $0 copay(authorization required) |
| Routine eye exam | Not covered |
| Eyewear after cataract surgery (Medicare-covered) | $0 copay(authorization required, limits apply) |
| Eyewear plan limit | $1,000 plan limit every year |
| Contact lenses | $0 copay(authorization required, limits apply) |
| Eyeglasses (frames and lenses) | $0 copay(authorization required, limits apply) |
| Eyeglass lenses | Not covered |
| Eyeglass frames | Not covered |
| Eyewear upgrades | Not covered |
| Hearing? | |
| Hearing exam (Medicare-covered) | $0 copay(authorization required) |
| Routine hearing exam | Not covered |
| Hearing aid fitting and evaluation | Not covered |
| Hearing aids (all types) | Not covered |
| Hearing aids, inner ear | Not covered |
| Hearing aids, outer ear | Not covered |
| Hearing aids, over the ear | Not covered |
| Medicare Part B drugs | |
| Part B insulin | $0 copay(authorization required, step therapy may apply) |
| Chemotherapy and radiation drugs | $0 copay(authorization required, step therapy may apply) |
| Other Part B drugs | $0 copay(authorization required, step therapy may apply) |
| Other extra benefits? | |
| Over-the-counter (OTC) allowance | Covered (allowance not stated) |
| Meals after a hospital stay or for a chronic condition | $0 copay(authorization and referral required) |
| Fitness benefit | $0 copay(authorization required) |
| Health education | $0 copay(authorization required) |
| Nutritional / dietary benefit | $0 copay(authorization required) |
| Extra smoking and tobacco cessation counseling | $0 copay(authorization required) |
| Enhanced disease management | Not covered |
| Telemonitoring | Not covered |
| Remote access technologies (web/phone, nurse line) | $0 copay(authorization required) |
| Home and bathroom safety devices | $0 copay(authorization required) |
| Counseling services | Not covered |
| In-home safety assessment | Not covered |
| Personal emergency response system (PERS) | Not covered |
| Medical nutrition therapy | Not covered |
| Post-discharge in-home medication reconciliation | Not covered |
| Re-admission prevention | Not covered |
| Wigs for hair loss from chemotherapy | Not covered |
| Weight management programs | Not covered |
| Alternative therapies | $0 copay(authorization required) |
| Therapeutic massage | Not covered |
| Adult day health services | Not covered |
| Home-based palliative care | Not covered |
| In-home support services | Not covered |
| Support for caregivers | Not covered |
In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2026). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed. Contact the plan for the full Evidence of Coverage.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 | 25% |
| Tier 2 | 25% |
| Tier 3 | 25% |
| Tier 4 | 25% |
| Tier 5 | 25% |
| Tier 6 | 25% |
| Tier 7 | 25% |
Rx cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | 25% | 25% | n/a | 25% | 25% | 25% |
| Tier 2: Generic | 25% | 25% | n/a | 25% | 25% | 25% |
| Tier 3: Preferred Brand | 25% | 25% | n/a | 25% | 25% | 25% |
| Tier 4: Non-Preferred Drug | 25% | 25% | n/a | 25% | 25% | 25% |
| Tier 5: Specialty Tier | 25% | 25% | n/a | 25% | 25% | 25% |
| Tier 6: Select Care Drugs | 25% | 25% | n/a | 25% | 25% | 25% |
| Tier 7: Vaccines | 25% | 25% | n/a | 25% | 25% | 25% |
| Catastrophic coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 4: Non-Preferred Drug | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 5: Specialty Tier | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 7: Vaccines | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Also available in 77 other PR counties
- Aguada
- Aguadilla
- Aguas Buenas
- Aibonito
- Anasco
- Arecibo
- Arroyo
- Barceloneta
- Barranquitas
- Bayamon
- Cabo Rojo
- Caguas
- Camuy
- Canovanas
- Carolina
- Catano
- Cayey
- Ceiba
- Ciales
- Cidra
- Coamo
- Comerio
- Corozal
- Culebra
- Dorado
- Fajardo
- Florida
- Guanica
- Guayama
- Guayanilla
- Guaynabo
- Gurabo
- Hatillo
- Hormigueros
- Humacao
- Isabela
- Jayuya
- Juana Diaz
- Juncos
- Lajas
- Lares
- Las Marias
- Las Piedras
- Loiza
- Luquillo
- Manati
- Maricao
- Maunabo
- Mayaguez
- Moca
- Morovis
- Naguabo
- Naranjito
- Orocovis
- Patillas
- Penuelas
- Ponce
- Quebradillas
- Rincon
- Rio Grande
Benefits in plain text
MMM Combo Platino (HMO D-SNP) (H4004-068-0) is a 2026 HMO D-SNP Medicare Advantage plan offered by Medicare y Mucho Mas (MMM), available to residents of Adjuntas County, PR.
The monthly premium is $0.00 (Part C and Part D together).
The plan reduces the member's Medicare Part B premium by $50.00 a month (a "giveback"); the Part B premium itself must still be paid.
With full Extra Help (the Low-Income Subsidy), the total monthly premium is $0.00.
There is no in-network deductible for health services.
Its in-network out-of-pocket maximum is $3,250.00.
The drug deductible is $615.00.
It is a special needs plan (Dual-eligible SNP).
The plan's formulary lists 3,597 drugs.
At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1: 25%; tier 2: 25%; tier 3: 25%; tier 4: 25%; tier 5: 25%; tier 6: 25%; tier 7: 25%.
CMS gives the plan's contract (H4004) an overall rating of 5 out of 5 stars.
Email a copy of the plan benefit details
Plan facts come from the CMS quarterly prescription drug plan public use files; the premium split, Extra Help premium, MOOP and plan type from the CMS Landscape file; the Part B giveback and health benefits from the CMS plan benefit package (PBP) files.