Triple S Advantage Brillante (HMO-POS) H5774-031-0 Plan Details
Triple S Advantage Brillante (HMO-POS) H5774-031-0 Plan Details
When selecting a Medicare Advantage plan for 2025, it's important to compare all your options. Triple S Advantage Brillante (HMO-POS) is among the plans you can review side-by-side with others, ensuring you find the coverage that suits your needs. You can easily enroll online or reach out to a licensed agent for personalized guidance.
Triple S Advantage Brillante Overview
Plan ID H5774-031-0 Overview | |
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Health Plan ID: | H5774-031-0 |
Medicare Advantage Plan Type: | Local HMO |
Plan Year: | 2024 |
Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Annual Out-of-Pocket Maximum: | $3,650 |
Part B Give Back: | $0.00/mo |
Part D Drug Plan Benefit: | Enhanced, $0.00 deductible |
Part D Gap Coverage: | Yes |
Supplemental Benefits: | Vision, Hearing |
Availability: | See List |
Insured By: | Triple S Advantage |
Why Choose Triple S Advantage Brillante?
Triple S Advantage Brillante is a Medicare Advantage Prescription Drug (MAPD) Health Maintenance Organization - Point of Service (HMO-POS) plan that offers a balance of comprehensive coverage and flexibility. With a monthly premium of $0.00, this plan includes all the benefits of Medicare Part A and Part B, plus additional services like prescription drug coverage. There is no annual deductible. Cost sharing begins with your first prescription. As an HMO-POS plan, you can receive care from providers both in and out of the plan’s network, though using in-network providers typically results in lower costs.
Triple S Advantage Brillante also features an annual maximum out-of-pocket (MOOP) limit of $3,650, providing financial protection against high healthcare expenses. Once you reach this limit, the plan covers 100% of your in-network healthcare costs for the rest of the year. This makes Triple S Advantage Brillante a strong choice for those seeking the structure of an HMO with added flexibility for out-of-network care.
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Cost-Sharing Overview
Triple S Advantage Brillante has cost-sharing, meaning you'll have out-of-pocket costs when using approved healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H5774-031-0.
Service | Enrollee Cost |
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Doctor's Office Visit (In-Network) | |
Primary: | $0 |
Specialist: | $3 Copay Prior Authorization Required |
Wellness & Preventive Programs: | None |
Preventive care: | $0 |
Foot Care (In-Network) | |
Foot Exams and Treatments (Medicare-covered): | $0 |
Routine Foot Care: | $0 |
Chiropractic Treatment (In-Network) | |
Medicare-covered chiropractic: | $5 Copay |
Routine chiropractic: | Not Covered |
Emergency and Urgent Care | |
Emergency room care: | $50 Copay |
Urgent care: | $0 |
Ground ambulance: | $0 |
Inpatient hospital care: | $0.00 per stay |
Outpatient hospital care: | $25 Copay Prior Authorization Required |
Skilled Nursing Facility: | |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy: | $0 |
Outpatient group therapy: | $0 |
Inpatient psychiatric hospital care: | |
Outpatient group therapy: | $0 |
Outpatient individual therapy: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy: | $0 |
Occupational therapy: | $0 |
Medical Equipment and Supplies (In-Network) | |
Diabetes supplies: | $0 |
Durable medical equipment: | 10% Coinsurance Prior Authorization Required |
Prosthetics: | 10% Coinsurance |
Diagnostics, Lab Services, and Imaging (In-Network) | |
Diagnostic radiology services: | $50 Copay Prior Authorization Required |
Lab services: | 10% Coinsurance Prior Authorization Required |
Outpatient x-rays: | $0 |
Diagnostic tests and procedures: | 10% Coinsurance Prior Authorization Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 10% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Most preventive services are covered 100% by Triple S Advantage Brillante as a Part B benefit.
Supplemental Benefits
Here’s an overview of the additional benefits that Triple S Advantage offers with this plan:
Supplemental Healthcare Service | Member Cost |
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Preventive Dental | |
Oral exam (In-Network) | Not Covered |
Fluoride treatment (In-Network) | Not Covered |
Dental x-ray(s) (In-Network) | Not Covered |
Cleaning (In-Network) | Not Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Not Covered |
Non-routine services (In-Network) | Not Covered |
Diagnostic services (In-Network) | Not Covered |
Extractions (In-Network) | Not Covered |
Endodontics (In-Network) | Not Covered |
Restorative services (In-Network) | Not Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
Hearing Aids | |
Fitting/evaluation (In-Network) | Covered Limits may apply |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | Covered Limits may apply |
Vision | Maximum vision benefit: | $600.00 Every year |
Eyeglasses (frames and lenses) (In-Network) | Covered Limits may apply |
Routine eye exam (In-Network) | Covered Limits may apply |
Contact lenses (In-Network) | Covered Limits may apply |
Additional Benefits
None specified.
Part D Prescription Drug Costs & Benefits
Triple S Advantage Brillante includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
While the prescription drug plan (Part D) premium is included in the overall plan cost, some plans may have additional costs or provide assistance through the Low-Income Subsidy (LIS) program. Also known as Extra Help, LIS is a Social Security program that assists individuals with limited income and resources in reducing or eliminating Part D expenses.
The following table outlines the prescription drug plan premium details of this plan.
Basic Part D Premium: | $0.00 |
Supplemental Part D Premium: | $0.00 |
Total Part D Premium: | $0.00 |
Part D Premium with Full LIS Assistance: | $0.00 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $0.00. You must pay this amount at the pharmacy before Triple S Advantage begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Triple S Advantage Brillante has out-of-pocket costs that you must pay when you pick up your prescriptions.
Drug Tier | Preferred | Standard |
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1 (Preferred Generic) | $0.00 copay | $5.00 copay |
2 (Generic) | $0.00 copay | $8.00 copay |
3 (Preferred Brand) | $25.00 copay | $35.00 copay |
4 (Non-Preferred Brand) | $40.00 copay | $45.00 copay |
5 (Specialty Tier) | 33% | 33% |
6 (Select Care Drugs) | $0.00 copay | $3.00 copay |
Understanding CMS Star Ratings
Each year, the Centers for Medicare & Medicaid Services (CMS) assesses health plans (Part C) and drug plans (Part D) based on a 5-star rating system. These ratings provide an overview of the plan’s performance in areas such as preventive care, managing chronic conditions, and member experience.
Considering a plan’s star rating can be an important part of your decision-making process, as higher ratings often reflect stronger performance in key areas of healthcare and customer service.
CMS Measure | Star Rating |
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2024 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 |
Plan Availability
Triple S Advantage Brillante (H5774-031-0) is available in the following locations (click to open):
Am I Eligible for Triple S Advantage Brillante?
You are eligible to enroll in Triple S Advantage Brillante if you meet the following conditions:
- You qualify for Medicare Part A and Part B.
- You live in the plan’s service area.
- You do not have End-Stage Renal Disease (ESRD), with some exceptions.
If these criteria describe your situation, you’re eligible to sign up for Triple S Advantage Brillante and take advantage of its full range of benefits.
When Should You Enroll in Triple S Advantage Brillante?
To ensure you don’t miss your chance to enroll in Triple S Advantage Brillante, be aware of these important enrollment periods:
- Initial Enrollment Period (IEP): Your IEP offers a seven-month window around your 65th birthday to sign up for Medicare.
- Annual Enrollment Period (AEP): The AEP, occurring from October 15 to December 7 each year, allows you to enroll in or make changes to your Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): From January 1 to March 31, the MA OEP provides an opportunity to switch Medicare Advantage plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Certain life changes, like moving or losing insurance coverage, may qualify you for a SEP, giving you a chance to make adjustments outside the standard periods.
Need help figuring out the right time to enroll? Call HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711) to get assistance from a licensed insurance agent.
How to Enroll in Triple S Advantage Brillante
Joining Triple S Advantage Brillante is straightforward. Here are the steps you can take:
- Online: Use our online enrollment partner's Secure Online Enrollment Form to sign up.
- By Phone: Reach out to HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711). A licensed insurance agent will help you with the enrollment process and answer any questions you might have.
- Through Medicare.gov: Enroll directly through the official Medicare website. Visit Medicare.gov, log in or create an account, and follow the steps to join Triple S Advantage Brillante.
- Direct Enrollment: You can also choose to enroll directly with Triple S Advantage Brillante. The contact information can be found below in the "Contact" section.
Make sure you enroll during the appropriate period to activate your coverage as soon as possible.
Contact Triple S Advantage
Website: | http://www.sssadvantage.com |
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Formulary: | http://www.sssadvantage.com |
Pharmacy: | Triple S Advantage Pharmacy Page |
New Members: | (833)221-2234 |
TTY Users: | (866)620-2520 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, you can do so on the Social Security Administration website. For more information about the Medicare Part C program, visit the official Medicare website or call 1-800-MEDICARE.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.
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