Óptimo (PPO)

Why choose Óptimo (PPO)?

Óptimo (PPO) is for people that have a prescription drugs coverage and look for an additional coverage for your medical care with $0 monthly premium. You will have access to providers in and out of network in Puerto Rico and United States, plus savings with money on the ComboCard and OTC, in addition to attractive supplemental benefits like transportation dental coverage and eyeglasses

  • $900 per year Medicare Part B Premium giveback benefit (BuyDown)
  • $900 per year in the ComboCard*
  • $200 per year in OTC items and drugs
  • $0 copay in: Specialists**, Laboratories**, X-Rays**
  • $2,000 per year in Comprehensive Dental (including individual implants)
  • $500 per year for eyeglasses and contact lenses
  • 24 trips per year to medical destinations

To compare this and other plans click here

Who is eligible for this plan?

  • Beneficiaries with Medicare Parts A and B
  • Residents living in one of Puerto Rico’s 78 municipalities
  • 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.

*Certain restrictions apply. You must be eligible to the benefit.

**Copay/coinsurance applies to services rendered at SALUS facilities. Other providers are available in our network.

This information is not a complete description of benefits. Call: 1-888-620-1919 (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 healthcare 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 Equipment (DME)

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


Provider Directory 2024

Provider Directory

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


OTC Items and Drugs

Guide for Over-the-Counter (OTC) Drugs and items

This guide includes over-the-counter (OTC) medications and health-related items that do not require a prescription to help treat injuries or illnesses. It contains a list of some commonly used drugs but does not include all the drugs covered by the plan and some items that assist in your healthcare. This list was selected by a team of health professionals and represents the therapies of medications and non-prescription items that we understand are important to complement your treatment program with prescription drugs.


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I wish to receive information about the coverage products and services offered by Triple-S Advantage

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By completing this form, you agree to a meeting with a sales agent to discuss the types of products you check above. Please note, the person who will discuss the products is either employed or contracted by a Medicare plan. They do not work directly for the Federal government. This individual may also be paid based on your enrollment in a plan.

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: 10/15/2023