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Triple-S Care Plus Medigap
Health Insurance


Triple-S Care Plus Medigap
Health Insurance

Who is eligible for this plan?

Care Plus Medigap is the plan for government retirees subscribed to Parts A and B of Medicare. In addition, optional dependents of active government employees will be eligible for the supplemental coverage as long as they are not subscribed to Medicare on grounds of disability or End Stage Renal Disease (ESRD).

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Learn more about the requirements and steps to join any of our health plans

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What is Care Plus Medigap?

It is the name of our supplemental policy to Original Medicare which is offered to retired government employees with the Medicare Parts A and Part B and can help pay for some of the health care costs that Original Medicare does not cover, such as coinsurance and deductibles.


Triple-S Salud offers you the C and D models of Medicare supplemental plans. The coinsurance and deductibles covered by this policy will accrue according to the charges accepted under Original Medicare.


Model C is a plan that covers deductibles and coinsurance established for benefits covered in Part A and Part B Medicare Program. This model applies to affiliates who turn 65 years on or before December 31, 2019, be disabled or have Medicare before that date.


Model D is a plan that covers deductible established for Part A and coinsurance for benefits covered in the Medicare Part A and Part B. That means, it covers all Model C benefits, except the annual Medicare Part B. This applies to affiliates who turn 65 after December 31, 2019 or are disabled after that date.


Benefits

The following table allows you to compare some of the benefits, deductibles, and coinsurance covered by Medicare and the Care Plus Medigap for Models C and D.

BENEFITS MEDICARE CARE PLUS ELA YOU
Hospitalization Services
Deductible for illness period $0 $1,364 $0
First 60 days 100% $0 $0
Coinsurance days 61 al 90 All, except $341 daily $341 daily $0
Coinsurance days 91 al 150 All, except $682 daily $682 daily $0
Lifetime reserve days (365 days per lifetime) $0 100% of the eligible expenses of Medicare $0*
More than 365 days $0 $0 All expenses
SKILLED NURSING FACILITY
First 20 days 100% $0 $0
Coinsurance days 21 al 100 All, except $170.50 daily $170.50 daily $0
Day 101 and subsequent days $0 $0 All expenses
MEDICAL SERVICES IN AND OUT OF THE HOSPITAL

Physician services, supplies and medical services for hospitalized and ambulatory patients, physical and speech therapy, diagnostic tests, durable medical equipment.

Annual Deductible $0 $185 $0
Coinsurance 80% Generally 20% $0
Charges in excess of Part B (over the amounts approved by Medicare) $0 $0 All expenses
OUT OF AREA TRIPS – NOT COVERED BY MEDICARE

Medically necessary services for emergency care beginning during the first 60 days of every trip outside the United States of America.

First $250 every calendar year $0 $0 $250
Remaining charges $0 80% up to a Lifetime maximum benefit of $50,000 20% and amounts over the Lifetime maximum of $50,000

* When your Part A Medicare hospital benefit has been exhausted, Triple-S Salud will pay any amount Medicare would have paid up to 365 additional days, as provided in the policy’s basic coverage. During this period the hospital cannot charge you for the balance based in any difference between the billed charges and the amount Medicare would have paid.


Frequently Asked Questions

Autorizado por la Administración de Servicios de Salud del Gobierno de Puerto Rico (ASES).

Contact us:

Call us at

(787) 774-6070

787-277-6653