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MAPD/MA Enrollment Form 2026

2026 MA/MAPD Enrollment Form (Platino / Non Platino)

After having received orientation about the different options available at MCS Classicare (HMO), you may fill out the Enrollment Form.

Before making an enrollment decision, it is important that you fully understand our benefits and rules. To understand our benefits:

  • Review the full list of benefits found in the Evidence of Coverage (EOC), especially for those services for which you routinely see a doctor. Visit www.mcsclassicare.com or call 787-620-2530 (metro area) or 1-866-627-8183 (toll free) to view a copy of the EOC.
  • Review the Provider Directory (or ask your doctor) to ensure that the doctors you currently visit are in our provider network. If your current doctor is not listed among the providers, you may need to consider selecting a new one who is in the network.
  • Does not apply to MCS Classicare Patriot (HMO) - Review the Pharmacy Directory to make sure the pharmacy you use for any prescription drug is in our provider network. If the pharmacy is not listed, you will likely have to select a new pharmacy for your prescriptions. If your current pharmacy is not listed, you may need to consider selecting a new pharmacy that is in-network.
  • Does not apply to MCS Classicare Patriot (HMO) - Review the List of Covered Drugs (Formulary) to make sure that the drug that you use is covered. If your drug is not on the Drug List or if your drug is restricted, you may be able to get a temporary supply of the drug (only members in certain situations can get a temporary supply), change to another drug or request an exception.

Understanding important rules

  • You must continue paying your Medicare Part B premium. This premium is generally deducted each month from your Social Security check.
  • Benefits, premiums and/or copayments/coinsurance may change on January 1, 2027.
  • Except in emergency or urgent situations, we do not cover services by out-of-network providers (doctors who are not listed in the Provider Directory).

For MCS Classicare Essential (HMO-POS) and MAPD groups (HMO-POS) plans, you should know:

  • Our plan allows you to see providers outside of our network (non-contracted providers). However, while we will pay for certain covered services provided by a non-contracted provider, the provider must agree to treat you. Except in an emergency or urgent situation, non-contracted providers may deny care. In addition, you will pay higher co-pay or coinsurance for services received by non-contracted providers.

For MCS Classicare Primero (HMO C-SNP), you should know:

  • This plan is a chronic condition special needs plan (C-SNP). Your eligibility to enroll will depend on our ability to confirm that you have a severe or disabling chronic condition that meets the established criteria.

For MCS Classicare Excede (HMO), you should know:

  • Your eligibility to enroll and the benefits available will depend on the geographic region corresponding to your municipality or place of residence.
  • Region 1: Aguada, Aguadilla, Añasco, Arecibo, Camuy, Hatillo, Isabela, Mayagüez, Moca, Quebradillas, Rincón, San Sebastián y Utuado.
  • Region 2: Adjuntas, Barceloneta, Cabo Rojo, Ciales, Corozal, Florida, Guánica, Hormigueros, Jayuya, Lajas, Lares, Las Marías, Manatí, Maricao, Morovis, Orocovis, Sabana Grande, San Germán, Vega Alta, Vega Baja and Yauco.
  • Region 3: Arroyo, Coamo, Guayama, Guayanilla, Juana Díaz, Patillas, Peñuelas, Ponce, Salinas, Santa Isabel y Villalba.
  • Your municipality or place of residence will NOT limit your ability to receive services from any participant provider in our network throughout Puerto Rico. For details see the Evidence of Coverage or contact the plan.

For MCS Classicare Firme (HMO), you should know:

  • Your ability to enroll will depend on whether you reside in any of the following 39 municipalities: Adjuntas, Aguada, Aguadilla, Añasco, Arecibo, Barceloneta, Cabo Rojo, Camuy, Ciales, Corozal, Florida, Guánica, Guayanilla, Hatillo, Hormigueros, Isabela, Jayuya, Juana Díaz, Lajas, Lares, Las Marías, Manatí, Maricao, Mayagüez, Moca, Morovis, Orocovis, Peñuelas, Ponce, Quebradillas, Rincón, Sabana Grande, San Germán, San Sebastián, Utuado, Vega Alta, Vega Baja, Villalba and Yauco.
  • Your municipality or place of residence will NOT limit your ability to receive services from any participant provider in our network throughout Puerto Rico. For details see the Evidence of Coverage or contact the plan.

For MCS Classicare Estrella (HMO), you should know:

  • Your ability to enroll will depend on whether you reside in any of the following 37 municipalities: Aguada, Aguadilla, Añasco, Arroyo, Camuy, Canóvanas, Carolina, Cataño, Corozal, Dorado, Fajardo, Florida, Guayama, Guaynabo, Gurabo, Humacao, Isabela, Juncos, Lajas, Las Piedras, Manatí, Moca, Patillas, Peñuelas, Ponce, Rincón, Río Grande, San Juan, San Lorenzo, Toa Alta, Toa Baja, Trujillo Alto, Vega Alta, Vega Baja, Vieques, Villalba y Yauco.
  • Your municipality or place of residence will NOT limit your ability to receive services from any participant provider in our network throughout Puerto Rico. For details see the Evidence of Coverage or contact the plan.

For MCS Classicare Platino plans, you should know:

  • This plan is a dual eligible Special Needs Plan (D-SNP). Your eligibility to enroll will depend on our ability to confirm that you qualify for both Medicare and state medical assistance through Medicaid.

For MCS Classicare Platino Máximo (HMO D-SNP), you should know:

  • Your eligibility to enroll and the benefits available will depend on the geographic region corresponding to your municipality or place of residence.
  • Region 1: Aguada, Aguadilla, Añasco, Arecibo, Camuy, Hatillo, Isabela, Mayagüez, Moca, Quebradillas, Rincón, San Sebastián and Utuado.
  • Region 2: Adjuntas, Barceloneta, Cabo Rojo, Ciales, Corozal, Florida, Guánica, Hormigueros, Jayuya, Lajas, Lares, Las Marías, Manatí, Maricao, Morovis, Orocovis, Sabana Grande, San Germán, Vega Alta, Vega Baja and Yauco.
  • Region 3: Aguas Buenas, Aibonito, Arroyo, Barranquitas, Bayamón, Caguas, Canóvanas, Carolina, Cataño, Cayey, Ceiba, Cidra, Coamo, Comerío, Culebra, Dorado, Fajardo, Guayama, Guayanilla, Guaynabo, Gurabo, Humacao, Juana Diaz, Juncos, Las Piedras, Loíza, Luquillo, Maunabo, Naguabo, Naranjito, Patillas, Peñuelas, Ponce, Río Grande, Salinas, San Juan, San Lorenzo, Santa Isabel, Toa Alta, Toa Baja, Trujillo Alto, Vieques, Villalba and Yabucoa.
  • Your municipality or place of residence will NOT limit your ability to receive services from any participant provider in our network throughout Puerto Rico. For details see the Evidence of Coverage or contact the plan.

For MCS Classicare Platino Superior (HMO D-SNP), you should know:

  • Your ability to enroll will depend on whether you reside in any of the following 37 municipalities: Aguada, Aguadilla, Añasco, Arroyo, Camuy, Canóvanas, Carolina, Cataño, Corozal, Dorado, Fajardo, Florida, Guayama, Guaynabo, Gurabo, Humacao, Isabela, Juncos, Lajas, Las Piedras, Manatí, Moca, Patillas, Peñuelas, Ponce, Rincón, Río Grande, San Juan, San Lorenzo, Toa Alta, Toa Baja, Trujillo Alto, Vega Alta, Vega Baja, Vieques, Villalba y Yauco.
  • Your municipality or place of residence will NOT limit your ability to receive services from any participant provider in our network throughout Puerto Rico. For details see the Evidence of Coverage or contact the plan.

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Link Pre-Enrollment Checklist

The following instructions can help you in the process of filling out the Enrollment Form.

SELECT THE BENEFITS PLAN YOU WANT TO JOIN

Choose the plan you want and select it. Also, please let us know the name of your previous medical plan.

BENEFICIARY INFORMATION

Fill out all the sections related to the information of the beneficiary:

  • Write your full name, exactly as it appears on your Medicare card.
  • Date of birth (month/day/year) and sex.
  • Home phone number and alternate phone number (cell phone number or other than home phone number).
  • Write the permanent residential and mailing address (only if different from the residential).

YOUR MEDICARE INFORMATION

Fill out the section related to your Original Medicare:

  • Use your Original Medicare card to fill out the following information: full name (exactly as it appears on your Medicare card), Medicare number, and effective date for Medicare Parts A and/or B.

PAYING YOUR PLAN PREMIUM / PREMIUM PAYMENT METHOD, IF APPLICABLE

Please review this section carefully and select your payment method. This section only applies if:

  • The plan that you selected includes a monthly premium,
  • If we determine that you owe a late enrollment penalty, or
  • If you currently have an active late enrollment penalty.

If none of these conditions apply, you may skip this section.

ANSWER TO THESE IMPORTANT QUESTIONS

Read and answer all the questions in this section of the Enrollment Form.

PRIMARY CARE PHYSICIAN (PCP) INFORMATION

Select your primary care physician (PCP) from the MCS Classicare provider network and write down the name of the physician in the space provided. If you do not have a primary care physician, MCS Classicare will assign one for you, which you may change later if you wish to do so. To obtain the Providers Directory, access our webpage https://mcsclassicare.com/en/Pages/providers-directory.aspx.

INFORMATIONAL MATERIALS

  • Indicate whether you wish to receive information in another language different from English (for example, in Spanish) or in another accessible format such as audio CD, data CD, braille or large print.
  • Select if you agree or do not agree to receive plan information by email. If you answer “Yes,” please provide an email address.
  • Select if you agree or do not agree to receive text messages related to your health services. If you answer “Yes,” please provide a cell phone number.

CHRONIC SPECIAL NEEDS PLAN (C-SNP)

IMPORTANT: READ BELOW

  • Read all the information in this part.
  • You (or your authorized representative) must sign and include the date when you have completed the application.

Carefully read the terms and conditions established by MCS Classicare. This way, you will have completed the application. If you wish to receive additional orientation about how to fill out the application, you may contact us at:

Metro Area: 787.620.2528

Toll Free: 1.866.627.8181

TTY (Hearing Impaired): 1.866.627.8182

Our customer services hours are Monday through Sunday from 8:00 a.m. to 8:00 p.m. from October 1 to March 31; and 8:00 a.m. to 8:00 p.m. Monday through Friday from 8:00 a.m. to 8:00 p.m., and Saturday from 8:00 a.m. to 4:30 p.m., from April 1 to September 30.

Remember that there are limits as to when and how often you can change the way you receive Medicare services:

During the Medicare Advantage Open Enrollment Period (MA OEP) - From January 1 through March 31st, anyone enrolled to a Medicare Advantage Plan may enroll in another Medicare Advantage plan or disenroll from their Medicare Advantage plan and return to Original Medicare. Members may have only one election during the MA OEP. Individuals may add or drop Part D coverage during this period.

Medicare limits when you can make changes to your coverage. From October 15 through December 7 of each year, you can join a new Medicare Prescription Drug Plan or Medicare Health Plan for next year. You cannot enroll in a new plan at other time in the year unless you meet certain special exceptions, such as, for example, if you move outside MCS Classicare service area, lose creditable coverage or if you qualify for extra help with the costs of your prescription drugs.

Benefits, prescription drugs formulary, providers, and/or pharmacy networks, premium and/or co-payments/co-insurance may change from year to year. Plans may not be available in the following contract year because by law, plans can choose not to renew their contract with CMS or reduce their service area and CMS may also refuse to renew the contract, thus resulting in a termination or non-renewal.

Special Enrollment Period (SEP) for Dual-eligible individuals (Medicare and Medicaid) – The SEP allows an individual to change their current special needs plan (D-SNP) to any other available special need plan (D-SNP) once a month. Members can make only one selection per month, and the new plan will become effective on the first day of the following month.

Benefits, prescription drug formulary, providers, and/or pharmacy networks, premium and/or co-payments/co-insurance may change from year to year. Plans may not be available the following contract year because by law, plans can choose not to renew their contract with CMS or reduce their service area and CMS may also refuse to renew the contract, thus, resulting in a termination or non-renewal.



2026

To subscribe any 2026 product press here to access our Enrollment Form . To see our product’s health coverage’s benefits please refer to our Summary of Benefits Section. Also, you may refer to Plan Rating Every year, Medicare evaluates plans based on a 5-star rating system. Press here for more information:

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Medicare Advantage Plans

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Enrollment Form
  • MCS Classicare Efectivo (HMO)
  • MCS Classicare En Tu Hogar (HMO)
  • MCS Classicare Essential (HMO-POS)
  • MCS Classicare Estrella (HMO)
  • MCS Classicare Hero (HMO)
  • MCS Classicare InteliCare (HMO)
  • MCS Classicare Firme (HMO)
  • MCS Classicare Patriot (HMO)
  • MCS Classicare Primero (HMO C-SNP)
  • MCS Classicare Excede (HMO)
  • MCS Classicare RxMax (HMO)
  • MCS Classicare Platino Ideal (HMO D-SNP)
  • MCS Classicare Platino 185 (HMO D-SNP)
  • MCS Classicare Platino Progreso (HMO D-SNP)
  • MCS Classicare Platino Total (HMO D-SNP)
  • MCS Classicare Platino Superior (HMO D-SNP)
  • MCS Classicare Platino Máximo (HMO D-SNP)

If you wish to subscribe to our products, you may fill out the Enrollment Form and hand it in at any of our Service Centers or send it by fax at 787.620.1343 or mail to the following address:



MCS Advantage
Enrollment Department
PO Box 191720
San Juan PR 00919-1720


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To get the Automatic Discount Request Form (ACH) press here

Medicare beneficiaries may enroll in MCS Classicare through the CMS Medicare Online Enrollment Center located at https://www.medicare.gov. Press here to enroll at medicare.gov.

This information is available for free in other languages. Please contact our customer service number at 787.620.2530 (metro) or 1.866.627.8183 (toll free) and TTY (people with hearing disabilities) 1.866.627.8182, service hours are Monday through Sunday from 8:00 a.m. to 8:00 p.m. from October 1 to March 31 and 8:00 a.m. to 8:00 p.m.; Monday through Friday from 8:00 a.m. to 8:00 p.m., and Saturday from 8:00 a.m. to 4:30 p.m. from April 1 to September 30.

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