PMC Max (HMO-POS)
Medicare Advantage Plan H4004-056 • 2026 • Aguas Buenas Municipio, PR
PMC Max (HMO-POS) Medicare Advantage Plan H4004-056 • 2026 • Aguas Buenas Municipio, PR
This Medicare Advantage HMO-POS plan, identified by CMS Plan ID H4004-056, is offered by Medicare y Mucho Mas (MMM) for the 2026 plan year. The plan uses a Health Maintenance Organization with a Point of Service (HMO-POS) provider network and comes with prescription coverage (Part D ).
PMC Max Overview
Plan Overview for H4004-056-0 |
|
|---|---|
| CMS Plan ID: | H4004-056-0 |
| Plan Type: | HMO-POS |
| Plan Year: | 2026 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Medical Deductible: | $0.00 |
| Maximum Out-of-Pocket: | $3250.00 (In-Network) |
| Part B Give Back: | Not offered |
| Prescription Drug Coverage: | Enhanced, $0.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | Aguas Buenas Municipio, PR |
| Enrollment (Nationwide) | 3,147 beneficiaries |
| Enrollment (CMS – Local) | 11 beneficiaries in Aguas Buenas Municipio |
| Provided By: | Medicare y Mucho Mas (MMM) |
Plan Details for PMC Max
This Medicare Advantage Prescription Drug (MAPD) HMO-POS plan includes hospital, medical, and prescription drug coverage under Medicare Parts A and B. The monthly premium is $0.00, and the plan provides coverage through a network of participating providers, with limited access to out-of-network services in certain situations. The annual Part D deductible is $0.00.
Primary care visits have a $0 copay | Out-of-network: 20% coinsurance, specialist visits come with a $0-$3 copay | Out-of-network: 20% coinsurance, urgent care services carry a $0 copay, and ambulance transportation is $0 copay | Out-of-network: 20% coinsurance. These costs apply toward the maximum out-of-pocket (MOOP) limit of $3250.00. Once this limit is reached, in-network services are fully covered for the remainder of the year.
This plan is listed by CMS under Plan ID {title_plan_id}. Cost-sharing details are provided below.
Cost Sharing Expenses
PMC Max includes cost-sharing, which refers to out-of-pocket expenses for covered healthcare services. The table below outlines the most common in-network out-of-pocket costs associated with plan H4004-056.
This section outlines in-network costs for primary care and specialist office visits, along with related preventive services.
| Covered Service | In-Network Cost |
|---|---|
| Primary: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Specialist: | In-network: $0-$3 copay | Out-of-network: 20% coinsurance |
This section outlines in-network costs for preventive and wellness services included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Annual wellness exam: | Not covered |
| Telehealth benefit: | In-network: $0 copay |
| Routine chiropractic: | In-network: $5 copay | Out-of-network: 20% coinsurance |
| Fitness benefits: | In-network: $0 copay |
| Health education: | In-network: $0 copay |
| Counseling services: | Not covered |
| Over-the-counter drug benefits: | In-network: $0 copay |
| Health transportation (non-emergency): | In-network: $0 copay |
This section outlines in-network costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Covered Service | In-Network Cost |
|---|---|
| Diagnostic radiology services: | In-network: $0-$25 copay | Out-of-network: 20% coinsurance |
| Lab services: | In-network: 0%-20% coinsurance | Out-of-network: 20% coinsurance |
| Outpatient x-rays: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Diagnostic tests and procedures: | In-network: $0 copay | Out-of-network: 20% coinsurance |
This section outlines in-network costs for emergency services, urgent care, ambulance transportation, inpatient hospital stays, and skilled nursing facility care.
| Covered Service | In-Network Cost |
|---|---|
| Emergency room care: | $75 copay |
| Worldwide emergency care: | $100 copay |
| Urgent care: | $0 copay |
| Inpatient hospital care: | In-network: | Tier 1 | $0 per stay | Tier 2 | $50 per stay | Out-of-network: | 20% per stay |
| Skilled Nursing Facility: | 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 |
This section outlines in-network costs for mental health services, including outpatient therapy and inpatient psychiatric care.
| Covered Service | In-Network Cost |
|---|---|
| Outpatient individual therapy: | In-network: $0-$5 copay | Out-of-network: 20% coinsurance |
| Outpatient group therapy: | 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 |
This section outlines in-network costs for rehabilitation services, including physical therapy, speech and language therapy, and occupational therapy.
| Covered Service | In-Network Cost |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $4 copay | Out-of-network: 20% coinsurance |
| Occupational therapy: | In-network: $4 copay | Out-of-network: 20% coinsurance |
This section outlines in-network costs for medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Covered Service | In-Network Cost |
|---|---|
| Diabetes supplies: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Durable medical equipment: | In-network: 0%-10% coinsurance | Out-of-network: 20% coinsurance |
| Prosthetics: | In-network: $0 copay | Out-of-network: 20% coinsurance |
This section outlines in-network cost sharing for chemotherapy and other Medicare Part B-covered drugs.
| Covered Service | In-Network Cost |
|---|---|
| Chemotherapy: | 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 |
This section outlines in-network cost sharing for dental services, including preventive care, exams, x-rays, cleanings, and comprehensive dental procedures.
| Covered Service | In-Network Cost |
|---|---|
| Oral exam: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Dental x-rays: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Cleaning: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Periodontics: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Endodontics: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Restorative services: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Implant services: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | In-network: $0 copay | Out-of-network: 20% coinsurance |
This section outlines in-network cost sharing for vision services, including eye exams, eyeglasses, and contact lenses.
| Covered Service | In-Network Cost |
|---|---|
| Routine eye exam: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Contact lenses: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Eyeglass frames only: | Not covered |
| Eyeglass lenses only: | Not covered |
| Eyeglasses (frames & lenses): | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Upgrades: | Not covered |
This section outlines in-network cost sharing for hearing-related services, including exams, fittings, and hearing aids.
| Covered Service | In-Network Cost |
|---|---|
| Hearing exam: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Fitting/evaluation: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Prescription hearing aids: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| OTC hearing aids: | Not covered |
This section outlines in-network cost sharing for additional and special needs services that may be included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Adult day health services: | Not covered |
| Home-based palliative care: | Not covered |
| Personal emergency response system: | Not covered |
| Weight management programs: | Not covered |
| Wigs for chemotherapy-related hair loss: | Not covered |
| Alternative therapies: | In-network: $0 copay |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | In-network: $0 copay |
Certain preventive services are covered 100% by PMC Max as a Part B benefit.
Prescription Drug Coverage
PMC Max 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 Advantage coverage.
| Basic Part D Premium: | $-90.30 |
|---|---|
| Supplemental Part D Premium: | $90.30 |
| 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, PMC Max 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 |
| Preferred Specialty Tier | 25% coinsurance | Coming soon |
| Specialty Tier | 33% coinsurance | Coming soon |
| Select Care Drugs | $0.00 copay | Coming soon |
| *Deductible does not apply. | ||
Medicare Plan Star Ratings
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 |
|---|---|
| 2026 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 |
How much does plan H4004-056 cost per month?
For 2026, the monthly premium is $0.00. Medicare Part B premiums apply in addition to this amount.
What is the in-network MOOP for plan H4004-056?
The 2026 in-network MOOP is $3250.00. Once this limit is reached, covered in-network costs are fully covered.
What is the CMS star rating for this plan?
For 2026, plan H4004-056 has a CMS star rating of ★5.0 out of 5 stars.
What is the current enrollment for PMC Max?
CMS reports 3,147 beneficiaries enrolled in this plan.
What is the prescription drug deductible for 2026?
The plan’s Part D deductible is $0.00, applied to covered prescription drug costs.
Contact Information for Medicare y Mucho Mas (MMM)
| Contact Type | Details |
|---|---|
| Website: | Medicare y Mucho Mas (MMM) Plan Page |
| New Members: | 1-833-668-2402 |
| Existing Members: | 1-866-333-5471 |
| Plan Address: | 350 Chardon Avenue | Suite 500 Torre Chardon | San Juan, PR 00918 |
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed May 2, 2026
- CMS.gov, Medicare Part C & D Performance — Last accessed May 2, 2026
- CMS.gov, Plan Benefits Package — Last accessed May 2, 2026
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed May 2, 2026
Data sources and methodology documentation..
- Medicare y Mucho Mas (MMM) (official source), http://www.mmmpr.com — Last accessed October 13, 2025
- Medicare.gov, "Understanding Medicare Advantage Plans" — Last accessed 25 May, 2025
- NCOA.org, "5 Steps to Choosing the Right Medicare Plan for You" — Last accessed 25 May, 2025
- Medicare.gov, "Explore your Medicare coverage options" — Last accessed 25 May, 2025
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