Triple-S Prescription Drug Program (Triple-S Óptimo PSHB)

A Medicare prescription drug benefit for eligible members who qualify for Medicare Part A and/or Medicare Part B utilizing Medicare as their Primary Health Care coverage. While Triple-S prescription drug benefits are considered creditable coverage (meaning they meet Medicare’s minimum requirements) we are offering Medicare Prescription Drug Program (MPDP) as a Part D plan to help members with Part A and/or Part B save on their prescriptions. MPDP is just one way we are making your Triple-S coverage and Medicare work together for you.

Who is eligible for this plan?

You are eligible for membership in our plan as long as:

1. You have Medicare Part A , Part B, or both
2. You live in our geographic service area (Puerto Rico or USVI)
3. You meet the eligibility requirements to enroll

With Triple-S Prescription Drug Program (Triple-S Óptimo PSHB), you get:

• The same health plan benefits you are used to
• Lower out-of-pocket costs for higher-cost drugs
• A broad pharmacy network
• Medicare required Part D medication plus Triple-S expanded prescription benefits

No added premium cost to members eligible for Medicare.

Depending on your income level, you may need to pay an Income-Related Monthly Adjustment Amount (IRMAA) to Social Security for this Part D coverage. Most Triple-S members will not reach the threshold to pay an IRMAA. To learn more, visit medicare.gov

Auto Enrollment Process

Triple-S Prescription Drug Program (Triple-S Óptimo PSHB) will automatically enroll eligible members in Triple-S Óptimo PSHB PDP. Every year in the fall, Triple-S will automatically enroll eligible members (for an effective date starting the next benefit year) who:

1. Have Medicare Part A, Part B, or both
2. Do not have Medicare because of End-Stage Renal Disease (ESRD)
3. A resident of Puerto Rico or USVI

If you meet the above criteria, you will receive an eligibility letter in the mail prior to enrollment.

Voluntary Enrollment

If you were not part of the automatic enrollment and want Triple-S Óptimo PSHB PDP, you can still get it. You can elect to enroll any time if you meet the eligibility requirements. Download an enrollment form to get started.

Important Documents for you

Medicare Prescription Payment Plan information

The Medicare Prescription Payment Plan is a new payment option in the prescription drug law that works with your current drug coverage to help you manage your out-of-pocket costs for your Medicare Part D drugs. Starting January 1, 2025, anyone who has a Medicare drug plan (known as Part D) or a Medicare Advantage health plan with drug coverage can use this payment option where the health plan covers your cost instead of you having to pay the pharmacy, helping you distribute the expense throughout the year.

Learn More

Have a question about Triple-S Óptimo PSHB PDP?

• Related to benefits and costs of your prescription call CVS Caremark at call 1-833-251-9747.
• Regarding enrollment, you can call 787-792-1370 or 1-866-215-1999 Toll Free.