Guide to Medicare Advantage Plans in Carolina Municipio, PR for 2025
There are 29 Medicare Advantage plans available in Carolina Municipio, PR for the 2025 plan year, including 27 plans with $0 premiums. Most plans include prescription drug coverage. These counts exclude Special Needs Plans.
Not in Carolina Municipio? Enter your ZIP code to see plans in your area.
- Top 3 Plans by Enrollment:
1. MCS Classicare Exacto (HMO) — 2,148 enrollees
2. MMM Balance (HMO-POS) — 1,537 enrollees
3. MMM Plenitud (HMO-POS) — 1,436 enrollees - Average Monthly Premium: $2.10
- Average Maximum Out-of-Pocket Limit: $3,893
- Average Prescription Drug Deductible: $0.00
- Ratings (Plan Mix): 4+ Stars: 95% · 3 Stars: 5% · Below 3: 0%
- Plan Type Breakdown 14 HMO · 13 HMO-POS · 2 PPO
Carolina Municipio, Puerto Rico Medicare Advantage Plans
| Plan Name | Type | Premium | MOOP | Rx Ded. | Rating |
|---|---|---|---|---|---|
| MCS Classicare Efectivo* | HMO | $0 | $3,400 | $0 | |
| MCS Classicare En Tu Hogar* | HMO | $0 | $3,400 | $0 | |
| MCS Classicare Essential* | HMO-POS | $0 | $3,400 | $0 | |
| MCS Classicare Exacto* | HMO | $0 | $3,400 | $0 | |
| MCS Classicare Hero* | HMO | $0 | $3,400 | $0 | |
| MCS Classicare InteliCare* | HMO | $0 | $3,400 | $0 | |
| MCS Classicare Metro* | HMO | $0 | $3,400 | $0 | |
| MCS Classicare Patriot* | HMO | $0 | $3,400 | N/A | |
| MCS Classicare RxMax* | HMO | $0 | $3,400 | $0 | |
| MMM Deluxe* | HMO-POS | $0 | $3,250 | $0 | |
| MMM Elite* | HMO-POS | $0 | $3,250 | $0 | |
| MMM Unico* | HMO-POS | $15 | $3,250 | $0 | |
| Triple S Advantage Brillante | HMO-POS | $0 | $3,650 | $0 | |
| Enlace Plus | HMO | $0 | $3,650 | $0 | |
| Humana Gold Plus H4007-012 | HMO | $0 | $5,000 | $0 | |
| Humana Gold Plus H4007-021 | HMO | $0 | $5,000 | $0 | |
| Humana Gold Plus H4007-024 | HMO | $0 | $5,000 | $0 | |
| Humana Gold Plus H4007-028 | HMO-POS | $0 | $5,000 | $0 | |
| Humana Gold Plus H4007-029 | HMO | $0 | $5,000 | $0 | |
| Triple S Advantage Magno | HMO-POS | $0 | $3,650 | $0 | |
| MMM Balance | HMO-POS | $0 | $3,250 | $0 | |
| MMM Grandioso | HMO-POS | $0 | $3,250 | $0 | |
| MMM Mega Flex | HMO-POS | $0 | $3,250 | $0 | |
| MMM Plenitud | HMO-POS | $0 | $3,250 | $0 | |
| MMM Valioso | HMO-POS | $0 | $3,250 | $0 | |
| PMC Max | HMO-POS | $0 | $3,250 | $0 | |
| Triple S Advantage Real | HMO | $0 | $3,650 | $0 | |
| Óptimo Plus | PPO | $0 | $6,751 | $0 | |
| HumanaChoice Value H2029-001 | PPO | $46 | $6,700 | $0 | |
| **Certain PFFS, MSA, and HMO-POS plans have a combined in and out-of-network maximum. Limits are detailed on the plan pages. | |||||
📊 At a Glance: Medicare Advantage in Carolina Municipio
- Average Monthly Premium
- $2.10
- Plans with $0 Premium
- 27
- Average MOOP Limit
- $3,893 ($9,350 max. in 2025)
- Average Rx Deductible
- $0.00
- Plans Without Drug Coverage
- 4 (standalone Puerto Rico Part D plans)
- Plans with 5-Star Ratings
- There are 9 5-star plans.
- Stars Ratings (Plan Mix)
- 4+ Stars: 95% · 3 Stars: 5% · Below 3: 0%
- Plans Available
- 29 (excluding Carolina Municipio SNP plans)
- Plan Type Breakdown
- 14 HMO · 13 HMO-POS · 2 PPO
- Countywide Enrollments
- 13,023 (excluding SNP plans)
- Top 3 Plans by Enrollment
- 1. MCS Classicare Exacto (HMO) — 2,148 enrollees
2. MMM Balance (HMO-POS) — 1,537 enrollees
3. MMM Plenitud (HMO-POS) — 1,436 enrollees
Data Sources: CY2025 Landscape, PBP Benefits, Star Ratings Data, Monthly Enrollment by CPSC, and SimpleMaps U.S. Counties. Enrollment data last updated . County demographic data last updated .
Understanding Your Medicare Advantage Options
Medicare Advantage Plans, also known as Medicare Part C, are private health plans that provide all-in-one coverage, including Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). On top of the core benefits, many of the plans in Carolina Municipio throw in some nice extras - think prescription drug coverage, dental, vision, and wellness programs - making them a solid choice for those in Carolina Municipio looking for something more than Original Medicare.
🏥 Health Maintenance Organization (HMO) Plans
HMO plan members must use the plan's network of doctors and hospitals in Carolina Municipio, and typically need a referral to see a specialist. Some Medicare Advantage HMO Plans may have lower costs but offer less flexibility in choosing healthcare providers. There are 5,826 residents enrolled in HMO plans in this county. The most popular plan is MCS Classicare Exacto .
🔓 Preferred Provider Organization (PPO)
A PPO allows more flexibility in choosing healthcare providers, with the option to see specialists without referrals, though often at a higher cost. Medicare Advantage PPOs usually have higher premiums and out-of-pocket expenses. There are 227 Carolina Municipio residents enrolled in PPO plans. The most popular of these plans by enrollments is Óptimo Plus .
🔀 Health Maintenance Organization Point of Sale (HMO-POS)
Medicare HMO-POS plans are a type of HMO that offers a little more flexibility. Like a regular HMO, you typically use the plan's network of doctors and hospitals for care, usually requiring a referral to see specialists. However, an HMO-POS plan lets you receive certain healthcare services outside of the network at a higher cost. There are 6,970 residents enrolled in HMO-POS plans in this Carolina Municipio. The most popular plan by enrollments is MMM Balance .
Advantages of Enrolling in Medicare Advantage
Many Medicare Advantage Plans offer extra benefits that go beyond Original Medicare, making them an attractive option for some people. These plans provide comprehensive coverage, often including additional services like prescription drug coverage, dental, vision, and wellness programs, all bundled into one plan. By choosing a Medicare Advantage Plan, you can simplify your healthcare and potentially save on costs.
Take a look at the main benefits provided by Medicare Advantage Plans in Carolina Municipio:
🧑⚕️Coordinated Care
Plans often include care coordination services, which help you manage your healthcare across different providers and services.
💸 Cost Savings
Many plans have low or $0 premiums and offer capped out-of-pocket costs, providing financial protection against high medical expenses.
🧾 Comprehensive Coverage
Includes Medicare Part A, Part B, and often Part D (prescription drug coverage), along with additional benefits like dental, vision, and hearing.
🧘 Wellness Programs
Many Yavapai County plans offer free gym memberships, wellness programs, and preventive care services. You need to stay healthy, right?
Tips for Selecting a Medicare Advantage Plan
Choosing the right Medicare Advantage Plan out of the 29 plans available in Carolina Municipio requires careful consideration of several key factors:
🏥1. Provider Network
Verify that your current doctors and preferred hospitals are included in the plan's network. Access to your healthcare providers can significantly impact your care experience.
💊 2. Prescription Drug Coverage
Make sure the plan covers your medications, particularly if you have specific prescriptions you rely on regularly.
💰 3. Costs
Examine the plan's premiums, copayments, and out-of-pocket limits. Compare these costs against your budget to avoid unexpected expenses.
🎁 4. Additional Benefits
Consider what extra services, such as dental, vision, or wellness programs, are important to you, and check if the plan offers them.
⭐ 5. Plan Ratings
Look into the plan's star ratings, which provide insight into the plan's overall quality and member satisfaction.
Learn more about the basics of comparing Medicare Advantage Plans.
Medicare Advantage Enrollment Periods
Making sense of Medicare Advantage enrollment periods can seem overwhelming, but it's worth the effort for better health coverage. Missing these key dates could delay your coverage or limit your plan choices for 2025 in Carolina Municipio.
📅 Initial Enrollment Period (IEP)
This initial enrollment window starts three months before and ends three months after your 65th birthday, offering a total of seven months to enroll in a Medicare Advantage Plan.
🗓️ Annual Enrollment Period (AEP)
Every year from October 15 to December 7, you have the option to change, enroll, or disenroll from a Medicare Advantage Plan.
🔁 Open Enrollment Period (OEP)
Running from January 1 to March 31, this period allows changes to your Medicare Advantage Plan if you’re already enrolled or lets you switch back to Original Medicare.
For comprehensive details on how to enroll, visit our detailed guide on Medicare Enrollment.
Frequently Asked Questions
What are the most popular Medicare Advantage plan types in Carolina Municipio?
Based on the 2025 plan data, PPO plans are the most common in Carolina Municipio. The full breakdown of plan types is: 14 HMO · 13 HMO-POS · 2 PPO.
How much can I expect to pay out of pocket for Medicare Advantage plans?
The average maximum out-of-pocket limit (MOOP) in Carolina Municipio is $3,893 for 2025.
Do any Medicare Advantage plans in Carolina Municipio have 5-star ratings?
There are 9 5-star rated Medicare Advantage plans in Carolina Municipio, and 95% of all plans have a rating of 4 stars or higher.
What is the average monthly premium for Medicare Advantage plans in Carolina Municipio?
The average monthly premium for Medicare Advantage plans in Carolina Municipio is $2.10. A total of 27 offer $0 premiums, though costs vary by plan type and benefits.
More About These Plans
Carrier Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
Master Plan Pages by Plan ID
The plan pages listed in the table above have been modified for localization to help consumers identify plans available in their area. Most plans are available in multiple areas. The following list of plan IDs link to each plan's master page.
Plan Availability
The MA and MAPD plans on this page are available to people on Medicare enrolled in both Medicare Part A and Part B living in Carolina, and all other areas of Carolina Municipio, Puerto Rico, including the following zip codes: 00914, 00924, 00976, 00979, 00981, 00982, 00983, 00984, 00985, 00986, 00987, 00988.
Citations & References
- Medicare.gov, "Understanding Medicare Advantage Plans", Last Accessed 19 March, 2025
- CMS.gov, "Special Needs Plans (SNP)", Last Accessed 24 May, 2024
- Medicare.gov, "What's Medicare Supplement Insurance (Medigap)?", Last Accessed 19 March, 2025
- Plan and enrollment data provided by the Centers for Medicare & Medicaid Services (CMS)
- Data processed and interpreted by MedicareWire.com editorial team.
- Read our methodology and sourcing policy.