Ahorro Plus (HMO)

TRIPLE S ADVANTAGE, INC. · 2026 plan year

Plan ID H5774-047-002

HMO★ 4.5 CMS Stars
MOOP (in-network)
$4,200
MOOP (combined)
—
Monthly premium
$0/mo
Part C $0 + Part D $0
Prescription drugs
Included

This plan in 2027

Plan information

Contract / Plan / Segment
H5774-047-002
Medical deductible
$0 — no deductible
Part D premium
$0/mo (part of the monthly premium above)
Part D deductible
$0/yr
Also owed
Your Medicare Part B premium, paid separately

More TRIPLE S ADVANTAGE, INC. plans in PR

Benefits & cost sharing

Primary Care

BenefitIn-network
Chiropractic — Routine Care$0-$5

Hospital

BenefitIn-network
Inpatient Hospital — AcuteTier 1: No charge; Tier 2: $40 per stay
Inpatient Hospital — Additional Days (Acute)No charge
Inpatient Hospital — PsychiatricNo charge
Worldwide Urgent Care CoverageNo charge

Pharmacy

BenefitIn-network
Other Part B Drugs0%-20% coinsurance
Part B DrugsSee plan details
Chemotherapy & Radiation Drugs (Part B)0%-20% coinsurance

Mental Health

BenefitIn-network
Mental Health Specialty ServicesSee plan details
Mental Health — Individual SessionsNo charge
Mental Health — Group SessionsNo charge
Supplemental Health BenefitsSee plan details

Other

BenefitIn-network
Supervised Exercise Therapy (SET)No charge
Vision — Eyeglass LensesNo charge
Cardiac & Pulmonary RehabilitationSee plan details
Cardiac Rehabilitation — Additional SessionsNo charge
Psychiatric ServicesSee plan details
Outpatient Substance Abuse ServicesSee plan details
Hearing — ExamsNo charge
Hearing — ExamsSee plan details
Hearing — Routine ExamsNo charge
Hearing — Fitting & Evaluation for Hearing AidNo charge
Hearing — Prescription Hearing AidsSee plan details
Hearing — Hearing Aids (All Types)No charge
Chiropractic Services$0-$5
Chiropractic ServicesSee plan details
Occupational Therapy ServicesNo charge
Physician Specialist Services$0-$5
Podiatry ServicesNo charge
Hospital Observation ServicesNo charge
Ambulatory Surgical Center (ASC)$25
Substance Abuse — Individual SessionsNo charge
Substance Abuse — Group SessionsNo charge
Outpatient Blood ServicesNo charge
Ambulance ServicesSee plan details
Ground AmbulanceNo charge
Air AmbulanceNo charge
Health EducationNo charge
Dental — Medicare-Covered ServicesNo charge
Dental — PreventiveSee plan details
Dental — Oral ExamsNo charge
Vision — Eyeglasses (Lenses & Frames)No charge
Vision — Eyeglass FramesNo charge
Vision — Eyewear UpgradesNo charge
Skilled Nursing Facility (SNF)No charge
Intensive Cardiac Rehabilitation — Additional SessionsNo charge
Pulmonary Rehabilitation — Additional SessionsNo charge
Emergency Services$50
Urgently Needed ServicesNo charge
Worldwide Emergency & Urgent CoverageSee plan details
Worldwide Emergency CoverageNo charge
Partial Hospitalization ProgramNo charge
Intensive Outpatient Program (IOP)No charge
Home Health ServicesNo charge
Primary Care Physician ServicesNo charge
Podiatry ServicesNo charge
Other Health Care Professional Services$0-$5
Psychiatric Services — Individual SessionsNo charge
Psychiatric Services — Group SessionsNo charge
Physical Therapy & Speech-Language PathologyNo charge
Additional Telehealth Services (Part B)$0-$5
Opioid Treatment Program ServicesNo charge
Diagnostic Tests & Lab ServicesSee plan details
Diagnostic Procedures & Tests0%-20% coinsurance
Laboratory Services0%-20% coinsurance
Radiological ServicesSee plan details
Diagnostic Radiology$0-$20
Therapeutic RadiologyNo charge
X-Ray ServicesNo charge
Outpatient Hospital Services$25-$50
Non-Emergency Transportation — Any Health LocationNo charge
Durable Medical Equipment (DME)0%-10% coinsurance
Prosthetics & OrthoticsSee plan details
Prosthetic Devices0%-10% coinsurance
Medical Supplies0%-10% coinsurance
Diabetic Supplies & ServicesSee plan details
Diabetic SuppliesNo charge
Diabetic Therapeutic Shoes & InsertsNo charge
Dialysis Services20% coinsurance
AcupunctureNo charge
Over-the-Counter (OTC) ItemsNo charge
Medicare-Covered Preventive ServicesSee plan details
Nutritional & Dietary BenefitNo charge
Enhanced Disease ManagementNo charge
Remote Access TechnologiesNo charge
Counseling ServicesNo charge
Alternative TherapiesNo charge
Kidney Disease Education ServicesNo charge
Glaucoma ScreeningNo charge
Diabetes Self-Management TrainingNo charge
Digital Rectal ExamsNo charge
Welcome to Medicare EKGNo charge
Insulin (Part B)No charge
Dental — X-RaysNo charge
Dental — Diagnostic ServicesNo charge
Dental — Prophylaxis (Cleaning)No charge
Dental — Fluoride TreatmentNo charge
Dental — Other Preventive ServicesNo charge
Dental — ComprehensiveSee plan details
Dental — Restorative ServicesNo charge
Dental — Endodontics (Root Canal)No charge
Dental — Periodontics (Gum Care)No charge
Dental — Removable Prosthodontics (Dentures)No charge
Dental — Implant ServicesNo charge
Dental — Fixed Prosthodontics (Bridges)No charge
Dental — Oral & Maxillofacial SurgeryNo charge
Dental — Adjunctive General ServicesNo charge
Vision — Eye ExamsNo charge
Vision — Eye ExamsSee plan details
Vision — Routine Eye ExamsNo charge
Vision — Other Eye ServicesNo charge
Vision — EyewearNo charge
Vision — EyewearSee plan details
Vision — Contact LensesNo charge

Service area

  • PR: 10 counties

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