Triple-S’s Medicare Advantage plans differ in their coverage for prescription drugs, specialist health care, and cardio-respiratory diseases. To learn more about these differences, you may use our comparison tool available here.

PPO – Preferred Provider Organization Plan: In a PPO plan, you pay less if you choose physicians, hospitals, and other health care providers from the plan network. You will have to pay more if you choose out-of-network physicians, hospitals, and providers. HMO – Health Maintenance Organization Plan: In most HMO plans, you may only be seen by network physicians, hospitals, and health care providers, except in cases of emergency. You may also need your primary care physician’s referral. POS – Point of Service: This is a type of HMO where you can obtain certain out-of-network services at a higher cost. SNP – Special Needs Plan: Medicare SNPs limit their membership to people with specific diseases or conditions. Medicare SNPs adjust their benefits, provider options, and drug lists to best fulfill the specific needs of the groups they serve.

To enroll in Part A, you should do it during:

The initial enrollment period – When you become eligible for Medicare for the first time (three months before your birthday, on the month of your birthday, and for three months after your birthday).

The General Enrollment Period – Every year, from January 1 to March 31; coverage begins on July 1.

A Special Enrollment Period – This period happens at any given time of the year and for various reasons. Medicare will determine when a special enrollment period begins.

To enroll in Part B in Puerto Rico:

To enroll in Part B, members must fill out the Application for Enrollment in Medicare Part B (CMS-40B).

This form and its instructions are available in both English and Spanish at Medicare.gov. Please contact Social Security if you do not have Medicare and you wish to enroll in Part A first. Some people may have to pay a premium for Part A.

If you choose to enroll in a Medicare Advantage plan, there is a series of steps that will help you make an informed decision:

• Choose which type of Medicare Advantage plan you want, such as HMO or PPO
• Choose whether you would like Prescription Drug Coverage (Part D)
• Contact your preferred plan, either by phone, through their website, or by visiting your local office.
• You may also obtain personalized health insurance advice free of cost through your local State Health Insurance Assistance Program (SHIP). SHIP for Puerto Rico is offered through the Puerto Rico Governor’s Office of Elderly Affairs.

Medigap policies are sold by private insurance companies. They can help cover deficiencies in Original Medicare, such as copays, coinsurances, and deductibles.

• You will generally have to pay a monthly premium while also paying for Part B.
• They only cover one person.
• You must have Medicare Parts A and B.
• You may not have a Medicare Advantage plan and a Medigap policy at the same time.

This is the term used to determine when the Medicare health coverage is NOT primarily responsible for paying. This process is known as Coordination of Benefits (COB).

The Coordination of Benefits is a written statement establishing which health insurance plan or policy will pay first if there are two health insurance plans or policies covering the same benefits.

When a member reaches this limit, he/she goes into a gap stage, which means that from that particular moment their coverage will be limited, including discounts for certain prescriptions, and everything else will have to be covered out of pocket.