Medicare Plan Lookup Official CMS data · Contract Year 2026
CMS 2026 data

2026 Medicare plan code

H4004-073

Medicare Plan

MMM Balance (HMO-POS) · Medicare y Mucho Mas (MMM) · HMOPOS · East

Full CMS plan ID: H4004-073-003

H4004-073-003 is the full CMS identifier for the H4004-073 Medicare plan. Common searches include H4004 073 and H4004073.

Historical 2026 record. Benefits and service areas shown apply to that year.

2026

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2026 plan record

MMM Balance (HMO-POS)

H4004-073-003 East HMOPOS

At-a-glance

Quick view

01

In-network

Inpatient hospital

Cost-sharing tier 1

Per admission $0 per stay
Plan-listed inpatient copay $0

Cost-sharing tier 2

Per admission $50 per stay
Plan-listed inpatient copay $50

inpatient cost sharing varies by a CMS plan-defined group

02

Emergency transport

Ambulance

Ground · in-networkVerify in plan documents
Air · in-networkVerify in plan documents

Ground ambulance: In-network: cost sharing varies by a CMS plan-defined group; Air ambulance: In-network: cost sharing varies by a CMS plan-defined group

03

Emergency services

Emergency room

$75 copay

Waived if admitted within 24 hours

04

Medical maximum

Maximum out-of-pocket

In-network$3,250
Combined in + out$3,250
05

Skilled care at home

Home health

In-networkVerify in plan documents
Out-of-networkNot separately reported
06

Monthly cost

Premium & giveback

Part C premium$0 / month
Consolidated C + D$0 / month

Plan details

All plan benefits

Medical care3 benefits

Primary care physician

Verify in plan documents
In-networkVerify in plan documents
Out-of-networkNot separately reported

Specialist

Verify in plan documents
In-network$0–$5 copay
Out-of-networkNot separately reported

Preventive care

Verify in plan documents
In-networkCost share not reported
Out-of-networkNot separately reported
Diagnostics & imaging4 benefits

Diagnostic procedures & tests

Verify in plan documents
In-networkCost share not reported
Out-of-networkNot separately reported

Laboratory services

Verify in plan documents
In-network0%–20% coinsurance
Out-of-networkNot separately reported

X-rays & standard imaging

Verify in plan documents
In-network$0–$40 copay
Out-of-networkNot separately reported

MRI, CT & PET imaging

Verify in plan documents
In-networkCost share not reported
Out-of-networkNot separately reported
Urgent & hospital care6 benefits

Urgent care

In-networkCost share not reported
Out-of-networkNot separately reported

Emergency room

In-network$75 copay
Out-of-networkNot separately reported

Ground ambulance

Verify in plan documents
In-networkVerify in plan documents
Out-of-networkNot separately reported

Air ambulance

Verify in plan documents
In-networkVerify in plan documents
Out-of-networkNot separately reported

Outpatient hospital

Verify in plan documents
In-network$50 copay
Out-of-networkNot separately reported

Outpatient surgery / ASC

Verify in plan documents
In-networkVerify in plan documents
Out-of-networkNot separately reported
Recovery & therapy5 benefits

Home health

Verify in plan documents
In-networkVerify in plan documents
Out-of-networkNot separately reported

Skilled nursing facility

In-networkCost share not reported
Out-of-networkNot separately reported

Cardiac & pulmonary rehabilitation

Verify in plan documents
In-network$5 copay
Out-of-networkNot separately reported

Occupational therapy

Verify in plan documents
In-network$4 copay
Out-of-networkNot separately reported

Physical & speech therapy

Verify in plan documents
In-network$4 copay
Out-of-networkNot separately reported
Behavioral health2 benefits

Mental health services

Verify in plan documents
In-networkCost share not reported
Out-of-networkNot separately reported

Substance use treatment

Verify in plan documents
In-network$5 copay
Out-of-networkNot separately reported
Specialty care2 benefits

Podiatry

Verify in plan documents
In-networkVerify in plan documents
Out-of-networkNot separately reported

Chiropractic

Verify in plan documents
In-network$5 copay
Out-of-networkNot separately reported
Supplemental benefits7 benefits

Dental

Verify in plan documents
In-networkCost share not reported
Out-of-networkNot separately reported

Vision

Verify in plan documents
In-networkCost share not reported
Out-of-networkNot separately reported

Hearing

Verify in plan documents
In-networkCost share not reported
Out-of-networkNot separately reported

Transportation

In-networkCost share not reported
Out-of-networkNot separately reported

Fitness & wellness

In-networkCost share not reported
Out-of-networkNot separately reported

Over-the-counter allowance

In-networkCost share not reported
Out-of-networkNot separately reported

Meals

In-networkCost share not reported
Out-of-networkNot separately reported
Plan costs & rulesCoverage overview

Premium & Part B giveback

$0 Part C premium / month · Part B giveback not separately reported

Maximum out-of-pocket (MOOP)

In-network$3,250
Combined in + out$3,250

Medical deductibles

In-networkNot reported
Out-of-networkNot reported

Network & referrals

HMOPOS · Referrals: Required for some services · Out-of-network coverage: Not reported

Prescription drugs7 tiers

Part D deductible

Not reported

Drug tier 1

$0 retail copay · 30-day supply

Drug tier 2

$0 retail copay · 30-day supply

Drug tier 3

$6 retail copay · 30-day supply

Drug tier 4

$8 retail copay · 30-day supply

Drug tier 5

25% retail coinsurance · 30-day supply

Drug tier 6

33% retail coinsurance · 30-day supply

Drug tier 7

$0 retail copay · 30-day supply

Using this plan

Understand H4004-073-003

Plain-language context built from this plan’s 2026 CMS record. It is a guide to the reported benefits, not a personalized cost estimate.

Plan at a glance

A quick read on this plan

MMM Balance (HMO-POS) is a 2026 HMOPOS offered by Medicare y Mucho Mas (MMM) in East. Referrals are required for some services. Its listed inpatient copay stages total $0 across null charged days.

Common benefit costs

What you may pay

These are individual in-network benefit amounts. A real visit may involve more than one separately billed service.

Routine care

Primary care physician
Verify in plan documents
Specialist
$0–$5 copay
Laboratory services
0%–20% coinsurance

Separate visits or services; costs are not added together.

Tests & outpatient care

Diagnostic procedures & tests
Cost share not reported
MRI, CT & PET imaging
Cost share not reported
Outpatient hospital
$50 copay

The service setting and billing details can change what you pay.

Emergency & hospital care

Emergency room
$75 copay
Listed inpatient stages
$0 total

null charged inpatient days are included in the calculated total. Actual costs depend on the care received and plan rules.

Helpful context

Terms worth knowing

Maximum out-of-pocket (MOOP)

This is the most you generally pay during the plan year for covered Part A and Part B medical services under the applicable network limit. Premiums and prescription drug costs generally do not count toward it.

Availability

Who can enroll

Service area
East (PR)
Plan type
HMOPOS
Contract / plan
H4004-073
Coverage year
2026

Enrollment generally requires Medicare eligibility and residence in the plan's service area. Confirm eligibility and the exact service area with the plan before enrolling.

Supplemental coverage

Extra benefits reported

Availability is summarized here; allowances, frequency limits, networks, and prior-authorization rules may apply.

DentalCost share not reported
VisionCost share not reported
HearingCost share not reported
Over-the-counter allowanceCost share not reported
Fitness & wellnessCost share not reported
TransportationCost share not reported
MealsCost share not reported

Plan-specific answers

Frequently asked questions

Where is H4004-073-003 available?

MMM Balance (HMO-POS) is listed for East (PR). Enrollment generally requires Medicare eligibility and residence in the plan's service area.

What is the in-network maximum out-of-pocket limit for H4004-073-003?

The 2026 CMS record lists an in-network medical maximum out-of-pocket limit of $3,250. Prescription drug spending generally does not count toward this medical limit.

What is the monthly plan premium for H4004-073-003?

The listed consolidated Part C and Part D premium is $0 per month. This does not replace the standard Medicare Part B premium.

What does an emergency room visit cost on H4004-073-003?

The plan record lists $75 copay, waived when an admission meets the plan's stated timing rule.

Does H4004-073-003 report extra benefits?

Yes. CMS reports dental, vision, hearing, over-the-counter allowance, fitness & wellness, and other supplemental benefits. See the detailed benefit rows and official plan documents for limits and conditions.

Source trail

Official CMS, Contract Year 2026

Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release; county identity is sourced from segment-level Landscape rows and stable codes are enriched from the aligned MA contract service-area release where matched. Quick-reference values should be confirmed in 2026 official plan documents.

PBP benefits ↗ Landscape data ↗ County service area ↗

Plan context

Where H4004-073-003 fits

Full CMS plan ID
H4004-073-003
Contract
H4004
Base plan code
H4004-073
Segment
003
Carrier
Medicare y Mucho Mas (MMM)
Plan type
HMOPOS
Service area
East (PR)

County/service-area foundation

CMS service-area entries

Named county entries are tied to this exact contract, plan, and segment in CMS Landscape data. County codes are enriched from the aligned CMS contract service-area release where a match exists.

  • Aguas Buenas, PR
  • Aguas Buenas, PR
  • Aibonito, PR
  • Aibonito, PR
  • Arroyo, PR
  • Arroyo, PR
  • Barranquitas, PR
  • Barranquitas, PR
  • Bayamon, PR
  • Bayamon, PR
  • Caguas, PR
  • Caguas, PR

76 additional service-area entries are retained in the data record.

Same CMS contract

H4004-073-001 MMM Balance (HMO-POS) Northwest · HMOPOS H4004-073-002 MMM Balance (HMO-POS) North & Southwest · HMOPOS H4004-056-000 PMC Max (HMO-POS) Puerto Rico · HMOPOS H4004-065-000 MMM Plenitud (HMO-POS) Puerto Rico · HMOPOS H4004-066-000 MMM Valioso (HMO-POS) Puerto Rico · HMOPOS H4004-070-000 MMM Grandioso (HMO-POS) Puerto Rico · HMOPOS H4004-071-000 MMM Mega Flex (HMO-POS) Puerto Rico · HMOPOS H4004-817-000 PMC Group A Calendar (HMO-POS) Puerto Rico · HMOPOS

About this code

What H4004-073-003 identifies

H4004-073-003 is a Contract Year 2026 Medicare plan segment code. Searches written as H4004-073, H4004 073, or the compact full CMS ID H4004073003 refer to this plan or its base plan code.

Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.