Platino Enlace (D-SNP) Costs & Coverage, Arecibo Municipio, Puerto Rico
Platino Enlace (D-SNP) Costs & Coverage, Arecibo Municipio, Puerto Rico
Explore the benefits and costs of Platino Enlace (D-SNP HMO), a 2025 Medicare Special Needs Plan designed to meet your unique healthcare needs. Dive into this detail page to see how this Triple S Advantage SNP can support your specific health conditions or financial circumstances.
Available in Arecibo Municipio, PR, to qualified residents, Platino Enlace offers all of the same basic benefits as Original Medicare, but out-of-pocket costs are different. It may include additional benefits that Medicare Part A and Part B do not cover.
Plan ID H5774-035-0 Overview | |
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Health Plan ID: | H5774-035-0 |
Medicare Advantage Plan Type: | HMO |
Plan Year: | 2024 |
Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Annual Out-of-Pocket Maximum: | |
Part B Give Back: | $0.00/mo |
Part D Drug Plan Benefit: | Basic $545.00 deductible |
Supplemental Benefits: | Vision, Hearing |
Availability: | Arecibo Municipio, PR |
Insured By: | Triple S Advantage |
We're Here to Help You Enroll |
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Health Plan Cost Sharing & Benefits
Platino Enlace is a Health Maintenance Organization (HMO) plan. As an HMO D-SNP member, you typically receive healthcare services through the plan’s local network of providers, with referrals generally required to see specialists and other providers. However, Platino Enlace does cover out-of-network care for emergencies and out-of-area dialysis.
Service | Enrollee Cost |
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Doctor's Office Visit (In-Network) | |
Primary: | $0 |
Specialist: | $0 |
Wellness & Preventive Programs: | |
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: | $0 |
Routine chiropractic: | $0 |
Emergency and Urgent Care | |
Emergency room care: | $0 |
Urgent care: | $0 |
Ground ambulance: | $0 |
Inpatient hospital care: | Coming Soon |
Outpatient hospital care: | $0 |
Skilled Nursing Facility: | Unknown |
Optional supplemental benefits: | Not Covered |
Mental Health Services (In-Network) | |
Outpatient individual therapy: | $0 |
Outpatient group therapy: | $0 |
Inpatient psychiatric hospital care: | Coming Soon |
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: | 5% Coinsurance Prior Authorization Required |
Prosthetics: | 5% Coinsurance |
Diagnostics, Lab Services, and Imaging (In-Network) | |
Diagnostic radiology services: | $0 |
Lab services: | $0 |
Outpatient x-rays: | $0 |
Diagnostic tests and procedures: | $0 |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | $0 |
Other Part B drugs (Medicare-covered) | $0 |
Supplemental Health Plan Benefits (H5774-035-0)
The following is a summary of the supplemental benefits Triple S Advantage includes 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 | |
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: | $550.00 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 Supplemental Benefits
None specified.
Prescription Drug Plan Costs & Benefits
Platino Enlace includes an basic benefit Medicare Part D plan (PDP). This simply means that the plan covers the minimum amount required by the Centers for Medicare & Medicaid Services, whereas enhanced benefit plans cover more.
Prescription Drug Plan Premium
Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. 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 |
For more information about the Low-Income Subsidy (aka, "Extra Help") program, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $545.00. This is the amount you must pay 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, Platino Enlace has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
Drug Tier | Preferred | Standard |
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1 (Preferred Generic) | $16.00 copay | $19.00 copay |
2 (Generic) | $17.00 copay | $20.00 copay |
3 (Preferred Brand) | $42.00 copay | $47.00 copay |
4 (Non-Preferred Brand) | $95.00 copay | $100.00 copay |
5 (Specialty Tier) | 25% | 25% |
6 (Select Care Drugs) | $8.00 copay | $9.00 copay |
5-Star Rating Marks
Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates Medicare Advantage D-SNPs across nine broad categories using a 5-star rating system. These star ratings provide insight into the quality of care and service you can expect from this Triple S Advantage plan.
CMS Measure | Star Rating |
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2025 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 |
How to Qualify for Enrollment in Platino Enlace
To enroll in Platino Enlace you must qualify for both Medicare and Medicaid and live in one of the plan's service areas. Eligibility for Medicare requires you to be either 65 years of age or older, or have received Social Security Disability Insurance for at least 24 months. For Medicaid eligibility, your income and assets must fall at or below your state's thresholds.
Before enrolling in Platino Enlace, or any other dual-eligible SNP, make sure to ask yourself the following questions:
- What out-of-pocket costs should I anticipate (premiums, deductibles, copayments)?
- Will I be able to continue seeing my doctors? Are they within the plan's network?
- Are the plan's in-network providers and facilities conveniently located?
- Does the plan cover services from providers who are out-of-network?
- Will I need a referral to visit a specialist?
- Are my medications included in the Part D plan's formulary? What options are available if I can't afford my medications?
- What special accommodations does the plan provide for individuals with disabilities?
- Does the plan include free meal delivery after a hospital stay?
- What support is available for caregivers? Is adult day care covered?
- Does the plan provide a prepaid card for over-the-counter medications and covered groceries?
Medicare Special Needs Plan Enrollment Periods
Once you’ve confirmed your eligibility for Platino Enlace, it’s crucial to enroll during the appropriate Medicare Enrollment Period to ensure you receive the coverage you need without delay. Depending on your situation, you may need to enroll during one of the following periods:
- Initial Enrollment Period (IEP): The first time you can enroll in Medicare, typically around your 65th birthday.
- Annual Enrollment Period (AEP): Occurs yearly and allows you to make changes to your Medicare coverage.
- Special Enrollment Periods (SEPs): Special circumstances, such as moving or losing other coverage, may qualify you to enroll outside of the usual periods.
To get a deeper understanding of these enrollment periods, click here to learn more and stay informed about your Medicare choices.
Contact Triple S Advantage
Call 1-877-388-0596 (TTY 711) to speak with a licensed HealthCompare insurance agent (Mon-Sun 8am-11pm EST) and learn more about this Special Needs Plan and other plans on this site.
You may also Enroll Online using our safe and secure online enrollment website or take advantage of the following plan resources:
Plan Website: | http://www.sssadvantage.com |
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Formulay Information: | http://www.sssadvantage.com |
Pharmacy Information: | Triple S Advantage Pharmacy Page |
Prospective Members: | (833)221-2234 |
TTY Users: | (866)620-2520 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Plans Offered through Medicare.org
Medicare Advantage and Part D plans and benefits offered are 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.