Medicare Advantage plans are another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D). Mostly, they offer additional benefits such as acupuncture, hearing aids and prosthodontics.
Generally, your out-of-pocket costs, such as copayments and deductibles are lower than those you would have to pay with Original Medicare. Costs and benefits may vary from plan to plan.
MCS Classicare offers the following types of Medicare Advantage Plans:
In HMO Plans, you generally must get your care and services from providers in the plan's network, except:
In some plans, you may be able to go out-of-network for certain services. But, it usually costs less if you get your care from a network provider. This is called an HMO with a point-of-service (POS) option.
Medicare SNPs limit membership to people with specific diseases or characteristics. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.
A Medicare prescription drugs plan is an insurance plan that helps people who have Medicare to pay their drugs in a contracted pharmacy network. This type of plan helps to pay high cost medications or unexpected cost of drugs ordered by a doctor. It does not pay the whole cost of the drug since you must pay a share. A Medicare prescription drugs plan has a monthly premium, and is offered by a private company approved by Medicare to provide Part D coverage.
No. LIS does not apply to Puerto Rico, however if you are having problems paying for your prescription drugs, please contact our Call Center at 787-620-2530 (Metro Area) or 1-866-627-8183 (Toll Free). Hearing impaired users (TTY) should call 1-866-627-8182. Our hours of operation from October 1 to March 31 are Monday to Sunday from 8:00 a.m. to 8:00 p.m. Our hours of operation from April 1 to September 30 are Monday through Friday 8:00 a.m. to 8:00 p.m. and Saturday from 8:00 a.m. to 4:30 p.m.
Of course. You don't lose your Original Medicare benefits when you join MCS Classicare plan. However, there are limits on when and how often you change your Medicare plan options.
You can enroll in MCS Classicare if you have Medicare Part A and Medicare Part B and, you live in the plan's service area. There may also be other eligibility requirements for enrolling in MCS Classicare, like being eligible for the Government of Puerto Rico’s Health Plan (Medicaid).
Network providers are the doctors and other health care professionals, medical groups, hospitals and other health care facilities that have an agreement with MCS Classicare. We have arranged for these providers to deliver covered services to members in our plan. The providers in MCS Classicare’s network generally bill us directly for care they give you. When you see a network provider, you usually pay only your share of the cost for their services.To see if your doctor is part of our network, please refer to our Provider Directory.
MCS Classicare covered prescription drugs are listed in the prescription drugs list approved by Medicare for your plan. Read our List of Covered Drugs (Formulary) that applies to your coverage (also called a Formulary).
Yes. The List of Covered Drugs (Formulary) may change during the year. If you use your prescription drug coverage, you will receive an Explanation of Benefits along with the notifications of changes to the Formulary. Generally, changes occur frequently and can occur for security reasons (cases in which the Food and Drug Administration, or FDA, withdraws any drug from the market). It could also be that a brand name drug is available in generic version. These cases represent savings for the cost of drugs.
You may use your MCS Classicare card at any pharmacy within the Pharmacies Network.
You'll continue to receive them through Part B. Prescriptions received as part of a physician's services or because of surgery are covered through Part B (as well as certain prescription drugs).
You may contact one of our services representatives by calling Call Center at 787-620-2530 (Metro Area) or 1-866-627-8183 (Toll Free). Hearing impaired users (TTY) should call 1-866-627-8182. Our hours of operation from October 1 to March 31 are Monday to Sunday from 8:00 a.m. to 8:00 p.m. Our hours of operation from April 1 to September 30 are Monday through Friday 8:00 a.m. to 8:00 p.m. and Saturday from 8:00 a.m. to 4:30 p.m.
Internal coverage criteria used to make medical necessity determinations is publicly accessible for all enrollees and providers under Precertification, Criteria and Policies Section , and under Part B Prescription Drugs, Prior Authorization Section .