2027 Medicare Advantage plan

PLATINO ADVANCE (HMO D-SNP): 2027 benefits and costs

Triple S Advantage HMO D-SNP Special Needs Plan

CMS plan ID: H5774-041-1 · Plan year: 2027

PLATINO ADVANCE (HMO D-SNP) is a 2027 Medicare Advantage plan offered by Triple S Advantage. It is listed in Puerto Rico.

2027 plan costs at a glance

Monthly plan premium$0.00

Drug deductible$700.00

In-network medical out-of-pocket maximum$3,650.00

Costs shown are before Medicaid or Extra Help; your costs depend on your eligibility and assistance.

Organization: Triple S Advantage
Plan organization: TRIPLE S ADVANTAGE, INC.
Parent company: Guidewell Mutual Holding Corporation
Plan type: HMO D-SNP
Part C premium: $0.00
Part D premium: $0.00
Prescription drug coverage: Yes
Special Needs Plan type: Dual-Eligible
2027 CMS Star Rating

Standard monthly Medicare Part B premium: $209.50 (estimated)

You must continue to pay your Medicare Part B premium.

In-network medical deductible: None
In-network medical maximum: $3,650.00

Who can join this Special Needs Plan?

This plan is for people who qualify for both Medicare and Medicaid. The plan must confirm the required Medicaid eligibility level. Your costs can depend on your assistance level.

Plan eligibility type: Dual-Eligible

2027 benefit summary

Doctor visits and medical care

Common medical services and member costs
Service	In-network	What to know
Primary care doctor	$0 Service-specific deductible No
Specialist visit	$0 Service-specific deductible No	Approval required Yes Referral required Yes
Telehealth	$0 Service-specific deductible No	Approval required No Referral required Yes
Emergency care	$0
Urgent care	$0
Home health	$0 Service-specific deductible No	Approval required Yes Referral required No
Dialysis	$0 Service-specific deductible No	Approval required No Referral required No
Part B chemotherapy and radiation drugs	$0 Deductible applies No	Approval required Yes
Other Part B drugs	$0 Deductible applies No	Approval required Yes
Kidney disease education services	$0 Service-specific deductible No	Approval required No Referral required No
Medicare-covered chiropractic	$0 Service-specific deductible No	Approval required No Referral required Yes
Medicare-covered foot care	$0 Service-specific deductible No	Approval required No Referral required Yes
Other health professionals	$0 Service-specific deductible No	Approval required Yes Referral required Yes

Hospital, outpatient surgery and observation care

Hospital, outpatient surgery and observation care and member costs
Service	In-network	What to know
Outpatient hospital care	$0 Service-specific deductible No
Hospital observation services	$0 Service-specific deductible No
Ambulatory surgical center	$0 Service-specific deductible No	Approval required Yes Referral required Yes
Outpatient blood	$0 Service-specific deductible No	Approval required No Referral required No

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
Service	In-network	What to know
Diagnostic procedures and tests	$0 Service-specific deductible No	Approval required Yes Referral required No
Laboratory services	$0 Service-specific deductible No	Approval required Yes Referral required No
Diagnostic radiology (CT, MRI)	$0 Service-specific deductible No	Approval required Yes Referral required Yes
Therapeutic radiology	$0 Service-specific deductible No	Approval required Yes Referral required Yes
X-rays	$0 Service-specific deductible No	Approval required Yes Referral required Yes

Mental health and substance use treatment

Mental health and substance use treatment and member costs
Service	In-network	What to know
Partial hospitalization	$0 Service-specific deductible No	Approval required Yes Referral required No
Intensive outpatient program	$0 Service-specific deductible No	Approval required Yes Referral required No
Substance use treatment, individual sessions	$0 Service-specific deductible No	Approval required No Referral required No
Substance use treatment, group sessions	$0 Service-specific deductible No	Approval required No Referral required No
Opioid treatment program	$0 Service-specific deductible No	Approval required No Referral required No
Mental health, individual sessions	$0 Service-specific deductible No	Approval required No Referral required No
Mental health, group sessions	$0 Service-specific deductible No	Approval required No Referral required No
Psychiatry, individual sessions	$0 Service-specific deductible No	Approval required No Referral required No
Psychiatry, group sessions	$0 Service-specific deductible No	Approval required No Referral required No

Therapy and rehabilitation

Therapy and rehabilitation and member costs
Service	In-network	What to know
Occupational therapy	$0 Service-specific deductible No	Approval required Yes Referral required Yes
Physical and speech therapy	$0 Service-specific deductible No	Approval required Yes Referral required No
Cardiac rehabilitation	$0 Service-specific deductible No	Approval required Yes Referral required Yes
Intensive cardiac rehabilitation	$0 Service-specific deductible No	Approval required Yes Referral required Yes
Pulmonary rehabilitation	$0 Service-specific deductible No	Approval required Yes Referral required Yes
Supervised exercise for peripheral artery disease	$0 Service-specific deductible No	Approval required Yes Referral required Yes

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
Service	In-network	What to know
Ground ambulance	$0 Service-specific deductible No	Approval required Yes
Air ambulance	$0 Service-specific deductible No	Approval required Yes
Durable medical equipment	$0 Service-specific deductible No	Approval required Yes
Prosthetic devices	$0 Service-specific deductible No	Approval required Yes
Medical supplies	$0 Service-specific deductible No	Approval required Yes
Diabetic supplies	$0 Service-specific deductible No	Approval required Yes
Diabetic shoes and inserts	$0 Service-specific deductible No	Approval required Yes
Diabetic monitors	$0 Service-specific deductible No	Approval required Yes

Dental benefits

Dental benefits and member costs
Service	In-network	What to know
Medicare-covered dental	$0
Restorative dental careAdditional plan benefit	$0
Root canal treatment (endodontics)Additional plan benefit	$0
Gum treatment (periodontics)Additional plan benefit	$0
Removable dentures (prosthodontics)Additional plan benefit	$0
Fixed dental restorations (prosthodontics)Additional plan benefit	$0
Oral surgeryAdditional plan benefit	$0
Other dental servicesAdditional plan benefit	$0

Vision benefits

Vision benefits and member costs
Service	In-network	What to know
Medicare-covered eye exams	$0 Service-specific deductible No	Approval required No Referral required No
Routine eye examsAdditional plan benefit	$0	Approval required No Referral required No
Medicare-covered eyewear	$0 Service-specific deductible No	Approval required No Referral required No
Contact lensesAdditional plan benefit	$0	Approval required No Referral required No
Eyeglasses, lenses and framesAdditional plan benefit	$0	Approval required No Referral required No
Eyeglass lensesAdditional plan benefit	$0	Approval required No Referral required No
Eyeglass framesAdditional plan benefit	$0	Approval required No Referral required No

Hearing benefits

Hearing benefits and member costs
Service	In-network	What to know
Medicare-covered hearing exams	$0 Service-specific deductible No	Approval required No Referral required No
Routine hearing examsAdditional plan benefit	$0	Approval required No Referral required No
Hearing aid fitting and evaluationAdditional plan benefit	$0	Approval required No Referral required No
Prescription hearing aids (all types)Additional plan benefit	$0 Service-specific deductible No	Approval required No Referral required No

Extra benefits

Extra benefits and member costs
Service	In-network	What to know
Supplemental acupunctureAdditional plan benefit	$0 Service-specific deductible No	Approval required No Referral required No

Allowances and optional benefits

Supplemental Benefit 1

One shared limit covers the listed services, not a separate allowance for each service.

Services sharing this allowance: Acupuncture Treatments; Alternative Therapies
How benefits are provided: Claims Processing
Advance choice of benefits required: No
Shared limit on visits or trips: Yes
Indicate number of shared visits/trips: 12
How often this limit applies: Every year

Benefits for qualifying members

Package 1

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions: Other 1; Other 2; Other 3; Other 4
Qualifying conditions: Oncology patients undergoing active chemo by infusion or systemic radiotherapy.
Qualifying conditions: Post-inpatient stay for acute stroke with the transition of care to patient’s home.
Qualifying conditions: Patients discharged from thoracic, abdominal, musculoskeletal, and peripheral vascular surgeries.
Qualifying conditions: Bedridden patients with essential services requirements.
All listed conditions required: No
Combination of conditions required: No
Included services: In-Home Support Services
Some package benefits are exempt from the deductible: No

Package 2

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions: Chronic alcohol use disorder and other substance use disorders (SUDs); Autoimmune disorders; Cancer; Cardiovascular disorders; Chronic heart failure; Dementia; Diabetes mellitus; Chronic gastrointestinal disease; Chronic kidney disease (CKD); Severe hematologic disorders; HIV/AIDS; Chronic lung disorders; Chronic and disabling mental health conditions; Neurologic disorders; Stroke
Included services: Over-the-counter health items; Food and produce; Pest control; Transportation for non-medical needs; Support for daily living
Some package benefits are exempt from the deductible: No
Package limit: $270.00
How often this limit applies: Every month
How benefits are provided: Debit Card
Services sharing the package limit: Over-the-counter health items; Food and produce; Pest control; Transportation for non-medical needs; Support for daily living

Prescription drug coverage

Costs shown are for initial coverage.

This plan uses a non-tiered standard drug benefit; individual drug prices are not listed here.

Available prescription supply lengths, not price quotes
Pharmacy	Supply
Standard retail	30 days
Standard retail	90 days
Standard mail order	90 days
Out-of-network pharmacy	30 days
Long-term care pharmacy	31 days

Where this plan is offered

CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.

View all locations 46 county listings across 1 state or territory