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County

Apply For This Plan

Zip Code	00926
Applicant	10/20/1983 Male
Coverage Start	10/22/2018

Insurance Type	Medicare Advantage Plan (Part C w/ RX)
Insurance Provider	Triple-S Advantage, Inc.
Plan ID	H5774-26-0
Plan Year	2018
CMS Rating
Plan Type	HMO SNP
Annual Deductible	$405.00

What To Know About This Plan	This plan has health and drug coverage This plan is available for 2019. see plan

Why We Like This Plan	has both Health and Drug Coverage has no additional premium costs outside of your Medicare Part B premium

Costs and Other Important Information

Plan Year	2018
Optional Supplemental Benefits	No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$3,400 In-network
Other health plan deductibles?	No
Health Plan Deductible	$0
Monthly Drug Plan Premium	$0.00
Monthly Health Plan Premium	$0.00

Benefits

SERVICE	COST
Inpatient hospital coverage	$0 or $8 per stay
Outpatient hospital coverage	$0 or $2 per visit
Doctor visits	Primary: $0 copay Specialist: $0 or $0-2 per visit
Preventive care	$0 copay
Emergency care/Urgent care	Emergency: $0 copay Urgent care: $0 copay
Diagnostic procedures/lab services/imaging	Diagnostic tests and procedures: $0 or $0-1.50 Lab services: $0 or $0-1.50 Diagnostic radiology services (e.g., MRI): $0 or $0-2 Outpatient x-rays: $0 or $0-1.50
Mental health services	$0 or $8 per stay Outpatient group therapy visit with a psychiatrist: $0 or $2 Outpatient individual therapy visit with a psychiatrist: $0 or $2 Outpatient group therapy visit: $0 or $2 Outpatient individual therapy visit: $0 or $2
Skilled Nursing Facility	$0 copay
Rehabilitation services	Occupational therapy visit: $0 or $2 Physical therapy and speech and language therapy visit: $0 or $0-2
Ambulance	$0 copay
Transportation	Not covered
Foot care (podiatry services)	Foot exams and treatment: $0 or $0-2 Routine foot care: $0 copay
Medical equipment/supplies	Durable medical equipment (e.g., wheelchairs, oxygen): 0% or 0-20% per item Prosthetics (e.g., braces, artificial limbs): 0% or 0-20% per item Diabetes supplies: $0 copay
Wellness programs (e.g., fitness, nursing hotline)	Covered
Medicare Part B drugs	Chemotherapy: $0 copay Other Part B drugs: $0 copay

Coverage Area for Platino Advance (HMO SNP)

State	Puerto Rico
County	San Juan

All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day Supply	Preferred Retail Pharmacies	Non-Preferred Retail Pharmacies	Mail-Order Pharmacies
Tier 1: Preferred Generic	$4 copay	$10 copay	Not offered
Tier 2: Non-Preferred Generic	$10 copay	$20 copay	Not offered
Tier 3: Preferred Brand Name	$35 copay	$45 copay	Not offered
Tier 4: Non-Preferred Brand Name	$50 copay	$95 copay	Not offered
Tier 5: Specialty Tier	25% coinsurance	25% coinsurance	Not offered

90 Day Supply	Preferred Retail Pharmacies	Non-Preferred Retail Pharmacies	Mail-Order Pharmacies
Tier 1: Preferred Generic	$8 copay	$20 copay	Not offered
Tier 2: Non-Preferred Generic	$20 copay	$40 copay	Not offered
Tier 3: Preferred Brand Name	$70 copay	$90 copay	Not offered
Tier 4: Non-Preferred Brand Name	$100 copay	$190 copay	Not offered
Tier 5: Specialty Tier	25% coinsurance	25% coinsurance	Not offered

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Colorectal cancer screening
Annual flu vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Adult BMI assessment

Managing Chronic Conditions

Special needs plan care management
Care for older adults – medication review
Care for older adults – functional status assessment
Care for older adults – Pain screening
Osteoporosis management in women who had a fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Controlling blood pressure
Rheumatoid arthritis management
Reducing the risk of falling
Plan all-cause readmissions

Member Experience with Health Plan

Getting needed care
Getting appointments and care quickly
Customer service
Overall rating of health care quality
Overall rating of plan
Care Coordination

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Members choosing to leave the health plan
Beneficiary access and performance problems
Health plan quality improvement

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability - Medical

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - Drugs
Appeals auto-forward
Appeals upheld

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Members choosing to leave the drug plan
Beneficiary access and performance problems
Drug plan quality improvement

Member Experience with Drug Plan

Rating of drug plan
Getting needed prescription drugs

Drug Pricing and Patient Safety

MPF Price Accuracy
High risk medication
Part D medication adherence for diabetes
Part D medication adherence for hypertension
Part D medication adherence for cholesterol
Medication Therapy Management program completion rate

Physicians that accept Platino Advance (HMO SNP) for Puerto Rico

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