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Basic (HMO)

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Why choose Basic (HMO)?

If you already have a drug coverage and are only looking for a plan with no monthly premium, to have extra money every month and with additional benefits, Basic (HMO) is for you. Basic (HMO) is a plan specially designed for people looking for a reduction to their Medicare Part B premium with affordable co-payments and attractive benefits such as eyeglasses, dental, among others.

Who is elegible?

  • Beneficiaries with Medicare Parts A and B
  • Residents living in one of Puerto Rico’s 78 municipalities
  • Patients who have not been diagnosed with end-stage renal disease (ESRD)
  • United States citizens or legal residents

For additional information about copayments, coinsurances and details about the benefits and restrictions that apply, please read the Evidence of Coverage and Summary of Benefits.

Some benefits of this plan:

  • $50 Monthly Reduction to Medicare Part B Premium
  • $0 Hospital Stay*
  • $0 Primary Care Physicians (PCP)
  • $2 Specialists*
  • $0 Laboratory* Tests and X-Rays
  • Preventive Dental Benefit
  • $1,000 every year for Comprehensive Dental Benefit.
  • $200 annually for prescription eyeglasses or contact lenses
  • $300 every year for Hearing Aids
  • 4 one-way trips to plan approved locations
  • 4 supplemental nutritionist visits


*Copay/coinsurance applies for services in the Preferred Provider Network or preferred brands/manufacturers or SALUS. Other providers are available in our network.

This information is not a complete description of benefits. Call: 1-833-779-7999 (TTY 1-866-620-2520) for more information. This is a brief summary for informational purposes and it does not replace or modify your Evidence of Coverage (EOC).

Important documents for you

Summary of Benefits (SB)

The Summary of Benefits tells you about some of the characteristics of the plan. It does not include all covered services or all limitations or exclusions. For a complete list of benefits, refer to the Evidence of Coverage.


Evidence of Coverage (EOC)

The EOC gives you details about your Medicare health care for the calendar year. It also explains how to get coverage for the services you need. This is an important legal document.


Annual Notice of Change (ANOC)

This document is sent to members every fall to inform you about all the changes to benefits, costs and providers for the next year. The ANOC helps you compare your current health benefits and costs with those for next year.


List of Durable Medical Equipment (DME)

The Durable Medical Equipment (DME) list information about brands, equipment manufacturers and medical providers in this plan, as described in your Evidence of Coverage.


Provider Directory 2020

Provider Directory

This document provides you with a list of all our contracted health care providers such as primary care physicians, specialists, hospitals, outpatient facilities among other health professionals. This directory contains contracted providers and preferred network providers.


Find the right plan for you!

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I am undecided. Please call me to provide some guidance.

By completing this form, you as a beneficiary or authorized representative agree to have one of our sales representatives contact you to discuss the products Triple-S Advantage offers under Part C. Please be aware that the person calling you is a Medicare employee or subcontractor. They do not work directly with the federal government. This person could receive compensation based on your plan enrollment.

This selection does NOT obligate you to enroll in a plan, it does not affect your current membership, and it will not enroll you in another Medicare plan.

Last update: 15/10/2020

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