MMM Balance (HMO-POS) Medicare Advantage Plan H4004-073-2 • 2027
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $3250.00In-network
- Part B Giveback
- −$52.00 reduction
- Prescription Coverage
- Enhanced, $0.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 17,830 beneficiaries
MMM Balance (HMO-POS) Introduction
CMS Plan ID H4004-073-2 identifies MMM Balance, a Medicare Advantage HMO-POS plan offered by Medicare y Mucho Mas (MMM). The plan uses a Health Maintenance Organization with a Point of Service (HMO-POS) provider network and comes with prescription drug coverage. Its costs for the 2027 plan year include a $0.00 monthly premium, $0.00 medical deductible, and $3250.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $0.00.
Plan Benefits
MMM Balance has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H4004-073-2.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
| Specialist | In-network: $0-$5 copay Out-of-network: 20% coinsurance |
In-network: $0-$5 copay Out-of-network: 20% coinsurance |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | Not covered | Not covered |
| Telehealth benefit | In-network: $0 copay | In-network: $0 copay |
| Routine chiropractic | In-network: $5 copay Out-of-network: 20% coinsurance |
In-network: $5 copay Out-of-network: 20% coinsurance |
| Fitness benefits | Coming soon | In-network: $0 copay |
| Health education | In-network: $0 copay | In-network: $0 copay |
| Counseling services | Not covered | Not covered |
| Over-the-counter drug benefits | In-network: $0 copay | In-network: $0 copay |
| Health transportation (non-emergency) | Coming soon | In-network: $0 copay |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $0-$40 copay Out-of-network: 20% coinsurance |
In-network: $0-$40 copay Out-of-network: 20% coinsurance |
| Lab services | In-network: 0%-20% coinsurance Out-of-network: 20% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 20% coinsurance |
| Outpatient x-rays | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
| Diagnostic tests and procedures | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $75 copay | $75 copay |
| Worldwide emergency care | Coming soon | $100 copay |
| Urgent care | $0 copay | $0 copay |
| Inpatient hospital care | In-network: Tier 1 $0 per stay Tier 2 $50 per stay Out-of-network: 20% per stay |
In-network: Tier 1 $0 per stay Tier 2 $50 per stay Out-of-network: 20% per stay |
| Skilled Nursing Facility | In-network: $0 copay Out-of-network: 20% per stay |
In-network: Tier 1 Tier 2 $0 copay Out-of-network: 20% per stay |
| Ground ambulance | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $0-$5 copay Out-of-network: 20% coinsurance |
In-network: $0-$5 copay Out-of-network: 20% coinsurance |
| Outpatient group therapy | In-network: $0-$5 copay Out-of-network: 20% coinsurance |
In-network: $0-$5 copay Out-of-network: 20% coinsurance |
| Inpatient psychiatric hospital care | In-network: Tier 1 $0 per stay Tier 2 $50 per stay Out-of-network: 20% per stay |
In-network: Tier 1 $0 per stay Tier 2 $50 per stay Out-of-network: 20% per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $4 copay Out-of-network: 20% coinsurance |
In-network: $4 copay Out-of-network: 20% coinsurance |
| Occupational therapy | In-network: $4 copay Out-of-network: 20% coinsurance |
In-network: $4 copay Out-of-network: 20% coinsurance |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
| Durable medical equipment | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
| Prosthetics | In-network: 5% coinsurance Out-of-network: 20% coinsurance |
In-network: 5% coinsurance Out-of-network: 20% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance Out-of-network: 20% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 20% coinsurance |
| Other Part B drugs (Medicare-covered) | In-network: $0-$8 copay, 0%-20% coinsurance Out-of-network: 20% coinsurance |
In-network: $0-$8 copay, 0%-20% coinsurance Out-of-network: 20% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
| Dental x-rays | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
| Cleaning | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
| Periodontics | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
| Endodontics | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
| Restorative services | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
| Implant services | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
| Contact lenses | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
| Eyeglass frames only | Not covered | Not covered |
| Eyeglass lenses only | Not covered | Not covered |
| Eyeglasses (frames & lenses) | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
| Upgrades | Not covered | Not covered |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
| Fitting/evaluation | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
| Prescription hearing aids | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
| OTC hearing aids | Not covered | Not covered |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Not covered |
| Home-based palliative care | Not covered | Not covered |
| Personal emergency response system | Coming soon | Not covered |
| Weight management programs | Not covered | Not covered |
| Wigs for chemotherapy-related hair loss | Coming soon | Not covered |
| Alternative therapies | In-network: $0 copay | In-network: $0 copay |
| Massage therapy | Not covered | Not covered |
| Home/bathroom safety devices | In-network: $0 copay | In-network: $0 copay |
Certain preventive services are covered 100% by MMM Balance as a Part B benefit.
Prescription Drug Coverage
MMM Balance includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | ($97.00) |
| Supplemental Part D Premium: | $$97.00 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | Not Applicable |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $0.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Medicare y Mucho Mas (MMM) starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, MMM Balance may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $0.00 copay | Coming soon |
| Preferred Brand | $6.00 copay | Coming soon |
| Non-Preferred Drug | $8.00 copay | Coming soon |
| Specialty Tier | 33% coinsurance | Coming soon |
| Select Care Drugs | $0.00 copay | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H4004)
The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for Medicare y Mucho Mas (MMM)
- Website
- Medicare y Mucho Mas (MMM) Plan Page
- Providers
- Medicare y Mucho Mas (MMM) Providers Page
- Formulary
- Medicare y Mucho Mas (MMM) Formulary Page
- Pharmacy
- Medicare y Mucho Mas (MMM) Pharmacy Page
- New Member Health Plan Help
- (833)668-2402
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (833)668-2401
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Plan Availability
MMM Balance (H4004-073-2) is available in the following locations:
Puerto Rico Municipios Served
- Adjuntas
- Aguas Buenas
- Aibonito
- Arroyo
- Barceloneta
- Barranquitas
- Bayamon
- Cabo Rojo
- Canovanas
- Catano
- Cayey
- Ceiba
- Ciales
- Cidra
- Coamo
- Comerio
- Corozal
- Culebra
- Fajardo
- Florida
- Guanica
- Guayama
- Guayanilla
- Hormigueros
- Jayuya
- Juana Diaz
- Lajas
- Lares
- Las Marias
- Las Piedras
- Loiza
- Luquillo
- Manati
- Maricao
- Maunabo
- Mayaguez
- Morovis
- Naguabo
- Naranjito
- Orocovis
- Penuelas
- Sabana Grande
- Salinas
- San German
- San Juan
- Santa Isabel
- Toa Alta
- Toa Baja
- Trujillo Alto
- Vega Alta
- Vega Baja
- Vieques
- Yabucoa
- Yauco
Frequently Asked Questions
Here are some of the most frequently asked questions about this plan (click to open).
Frequently Asked Questions About MMM Balance (HMO-POS)
How much does plan H4004-073-2 cost per month?
The plan’s monthly premium is $0.00 for 2027. The Part B premium is not included.
What is the annual out-of-pocket maximum (MOOP) for this plan?
The annual in-network MOOP is $3250.00 for 2027. After this limit is reached, covered in-network services are fully paid.
What is the CMS star rating for MMM Balance?
The 2027 CMS star rating for MMM Balance is ★0.0 out of 5.
What is the current enrollment for MMM Balance?
The plan has 17,830 enrolled beneficiaries according to CMS.
What is the prescription drug deductible for 2027?
For 2027, the prescription drug deductible is $0.00.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Medicare y Mucho Mas (MMM) (official source) | http://www.mmmpr.com | October 4, 2026 |
| Medicare.gov | Compare types of Medicare Advantage Plans | 25 May, 2025 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | 25 May, 2025 |
| Medicare.gov | Compare Original Medicare & Medicare Advantage | 25 May, 2025 |
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Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.