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Physicians that accept Platino Advance (HMO SNP) for Puerto Rico
Platino Advance (HMO SNP)
$0/mo
Benefits & Coverage
| Insurance Type | Medicare Advantage Plan (Part C w/ RX) |
| Insurance Provider | Triple-S Advantage, Inc. |
| Plan ID | H5774-26-0 |
| Plan Year | 2019 |
| CMS Rating | |
| Plan Type | HMO SNP |
| Annual Deductible | $415.00 |
| What To Know About This Plan |
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| Why We Like This Plan |
|
Plan Details
Costs and Other Important Information
| Plan Year | 2019 |
| Monthly Health Plan Premium | $0.00 |
| Monthly Drug Plan Premium | $0.00 |
| Health Plan Deductible | $0 |
| Other health plan deductibles? | No |
| Maximum out-of-pocket enrollee responsibility (does not include prescription drugs) | $3,400 In-network |
| Optional Supplemental Benefits | No |
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 | Inpatient hospital - psychiatric:$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 $2 |
| Ground ambulance | $0 copay |
| Transportation | Not covered |
| Foot care (podiatry services) | Foot exams and treatment:$0 or $0-2 Routine foot care:$0 copay. There may be limits on how much the plan will provide. |
| 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 |
Benefits Services
| Hearing | |
| Hearing exam | $0 or $2 |
| Fitting/evaluation | Not covered |
| Hearing aids - inner ear | Not covered |
| Hearing aids - outer ear | Not covered |
| Hearing aids - over the ear | Not covered |
| Preventive Dental | |
| Oral exam | $0 copay. There may be limits on how much the plan will provide. |
| Cleaning | $0 copay. There may be limits on how much the plan will provide. |
| Fluoride treatment | $0 copay. There may be limits on how much the plan will provide. |
| Dental x-ray(s) | $0 copay. There may be limits on how much the plan will provide. |
| Comprehensive Dental | |
| Non-routine services | $2There may be limits on how much the plan will provide. |
| Diagnostic services | $2There may be limits on how much the plan will provide. |
| Restorative services | $2There may be limits on how much the plan will provide. |
| Endodontics | $2There may be limits on how much the plan will provide. |
| Periodontics | Not covered |
| Extractions | $2There may be limits on how much the plan will provide. |
| Prosthodontics, other oral/maxillofacial surgery, other services | $2There may be limits on how much the plan will provide. |
| Vision | |
| Routine eye exam | Not covered |
| Other | Not covered |
| Contact lenses | Not covered |
| Eyeglasses (frames and lenses) | Not covered |
| Eyeglass frames | Not covered |
| Eyeglass lenses | Not covered |
| Upgrades | Not covered |
Coverage Area for Platino Advance (HMO SNP)
| State | Puerto Rico |
| County | San Juan |
CMS Ratings
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 | Not Rated |
| Appeals upheld | Not Rated |
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 |
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