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Medicare Platino

Información General

Medicare Platino es una cubierta suplementaria a un Plan Medicare Advantage contratada por ASES, que cubre los beneficios y servicios que Medicare no cubre. Los beneficiarios que tengan las partes A y B de Medicare y estén certificados como elegibles por Medicaid, cualifican para los beneficios y servicios de Medicare Platino.

Si cumples con los siguientes requisitos:

  • Tener 65 años o más
  • Ser beneficiarios elegibles a Medicaid (Oficina de Medicaid del Departamento de Salud) y participantes del Plan Vital
  • Sin fallo renal en etapa terminal (ESRD)
  • Ser ciudadano de los Estados Unidos o estar legalmente en los Estados
  • Que vivas en el área de servicio del plan Medicare Advantage

Beneficios y Servicios

Algunos de los beneficios y servicios que ofrece Medicare Platino a sus beneficiarios son:

  • Medicamentos preferidos y no preferidos
  • Especialistas dentro de la red, sin referido del médico primario
  • Laboratorios, rayos x y estudios especializados
  • Servicios dentales, de audición, visión y de salud mental
  • Servicios preventivos como: mamografías, inmunizaciones y examen de cernimiento colorectal
  • Se unen tus cubiertas de las partes A y B de Medicare y Vital en una sola tarjeta

Cubierta Especial

Las siguiente condiciones ASES las clasifica como parte de la cubierta especial y no requieren referido para recibir servicios:

  • SIDA/VIH
  • Tuberculosis
  • Lepra
  • Lupus eritematoso sistémico (SLE)
  • Fibrosis Quística
  • Cáncer
  • Hemofilia
  • Esclerosis Múltiple
  • ESRD =>Niveles 3, 4 y 5
  • Escleroderma
  • Hipertensión Pulmonar
  • Anemia Aplásica
  • CHF Clase III y IV NHHA en un candidato potencial para trasplante de corazón
  • Artritis Reumatoide
  • Autismo
  • Cáncer de la Piel
  • Cáncer de la Piel: carcinoma IN SITU
  • Cáncer de la Piel: Invasivo Melanoma o células escamosas con evidencia de metástasis
  • Fenilcetonuria
  • Adultos con Hepatitis C

El tratamiento y servicios relacionados de las condiciones especiales no requieren referido una vez el diagnostico se haya establecido.

Beneficios Suplementarios

Puedes contar con copagos de $0 en los siguientes beneficios de tu cubierta de salud:

  • Hospital (admisión)
  • Sala de Emergencia

Visitas a

    a. Médico Primario

     b. Especialistas

     c. Sub-especialistas

  • Laboratorios
  • Rayos X
  • Pruebas Diagnósticas Especiales
  • Terapia Física
  • Terapia Ocupacional
  • Terapia Respiratoria
  • Vacunas
  • Cubierta Dental Preventiva y Restaurativa
  • Farmacia**
  • Salud Mental
  • Visión
  • Audición
  • Cirugía Ambulatoria
  • Cubierta Especial
  • Otros

      ** El Plan HUMANA Medicare Platino tiene copago de $0 hasta $3 en algunos medicamentos, según la cubierta y la etapa terapéutica.  
      ‍
      Además de los beneficios de tu cubierta de salud para la atención médica, cuentas con beneficios suplementarios tales como:

      • Servicios Dentales Preventivos y Comprensivos *
      • Audición *
      • Visión *
      • Transportación a destinos médicos y no médicos *
      • Medicamentos fuera de recetario *
      • Nutrición *
      • Telemedicina *
      • Acupuntura *
      • Masaje Terapéutico *
      • Servicio de asistencia o apoyo en el hogar *
      • Tarjetas de Débito con asignación de efectivo para la compra de: *

      a. Alimentos

      b. Entretenimiento

      c. Utilidades (agua, luz, teléfono)

      d. Combustible

      e. Otros disponibles según el Plan Médico de su selección

      *Los beneficios varían por Plan Médico y cubierta. Ciertas restricciones pueden aplicar.

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      APPENDIX C (1) (23) MEDICARE ADVANTAGE PRODUCT PLAN BENEFITS PACKAGE (PBP)
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      APPENDIX C (5) (23) COORDINATED CARE MODEL NORM (2022)
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      APPENDIX E (23) CMS CONTRACT 2022
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      24-004 MCS ADVANTAGE, INC. (CONTRACT)
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      24-004 Appendix A Services Area
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      24-004 Appendix B Premium Payments
      MCS Advantage
      2024
      24-004 Appendix C (1) Medicare Advantage Plan Benefit Package PBP
      MCS Advantage
      2024
      24-004 Appendix C (2) Medicaid Wrap-Around
      MCS Advantage
      2024
      24-004 Appendix C (3) Services Providers by Department of Health PR
      MCS Advantage
      2024
      24-004 Appendix C (4) Bid Report-Summary of Benefits
      MCS Advantage
      2024
      24-004 Appendix C (5) Medicare Platino Norms
      MCS Advantage
      2024
      24-004 Appendix C (6) Co-Payment Certification
      MCS Advantage
      2024
      24-004 Appendix C (7) Benefits Non-Covered by Wrap Around Supplementary Benefits Part C
      MCS Advantage
      2024
      24-004 Appendix C (8) Certification Added Valued Services
      MCS Advantage
      2024
      24-004 Appendix D Actuarial Certification
      MCS Advantage
      2024
      24-004 Appendix E CMS Contract 2024
      MCS Advantage
      2024
      24-004 Appendix F Guidelines for the Processing of Medicare Platino Enrollments and Disenrollment
      MCS Advantage
      2024
      24-004 Appendix G-1 Guidelines for the Development of Program Integrity Plan
      MCS Advantage
      2024
      Dropdown
      Appendix J (23) Relevant Puerto Rico and Federal Laws and Regulation
      Triple-S Advantage
      2023
      Appendix L (23) Deliverables
      Triple-S Advantage
      2023
      Appendix M (23) Strategic Plan for Health Information Organization (HIO)
      Triple-S Advantage
      2023
      Appendix N (23) HIV Drug Certification
      Triple-S Advantage
      2023
      Appendix O (23) Certification Consent for Sterilization
      Triple-S Advantage
      2023
      Appendix P (23) ASEM Certification
      Triple-S Advantage
      2023
      Appendix Q (23) Guidelines for Marketing Activities
      Triple-S Advantage
      2023
      23-002 Appendix R (23) Medicare Part D Appeal Process
      Triple-S Advantage
      2023
      24-002 TRIPLE-S ADVANTAGE, INC. (Contract)
      Triple-S Advantage
      2024
      24-002 Appendix A - Services Area
      Triple-S Advantage
      2024
      24-002 Appendix B - Premium Payments
      Triple-S Advantage
      2024
      24-002 Appendix C (1) Medicare Advantage Plan Benefit Package PBP
      Triple-S Advantage
      2024
      24-002 Appendix C (2) Medicaid Wrap-Around
      Triple-S Advantage
      2024
      24-002 Appendix C (3) Services Providers by Department of Health PR
      Triple-S Advantage
      2024
      24-002 Appendix C (4) Bid Report - Summary of Benefits
      Triple-S Advantage
      2024
      24-002 Appendix C (5) Medicare Platino Norms
      Triple-S Advantage
      2024
      24-002 Appendix C (6) Co-Payment Certification
      Triple-S Advantage
      2024
      24-002 Appendix C (7) Benefits Non-Covered by Wrap Around Supplementary Benefits Part C
      Triple-S Advantage
      2024
      24-002 Appendix C (8) Certification Added Valued Services
      Triple-S Advantage
      2024
      24-002 Appendix D - Actuarial Certification
      Triple-S Advantage
      2024
      24-002 Appendix E - CMS Contract 2024
      Triple-S Advantage
      2024
      24-002 Appendix F - Guidelines for the Processing of Medicare Platino Enrollment and Disenrollment
      Triple-S Advantage
      2024
      24-002 Appendix G - Business Associate Agreement
      Triple-S Advantage
      2024
      24-002 Appendix G1 - Guidelines for the Development of Program Integrity Plan
      Triple-S Advantage
      2024
      24-002 Appendix H - Sworn Statements No Debt with the Goverment (Sworn Statement and Appendix H-Declaraci�n Jurada, Sworn Statement)
      Triple-S Advantage
      2024
      24-002 Appendix I - Financial Certification
      Triple-S Advantage
      2024
      24-002 Appendix J - Relevant Puerto Rico and Federal Laws and Regulations
      Triple-S Advantage
      2024
      24-002 Appendix K - Information Data Processes and Data Exchange Layout
      Triple-S Advantage
      2024
      24-002 Appendix L - Deliverables
      Triple-S Advantage
      2024
      24-002 Appendix M - Intentionally Left Blank
      Triple-S Advantage
      2024
      24-002 Appendix N - HIV Drug Certification
      Triple-S Advantage
      2024
      24-002 Appendix O - Certification Consent of Sterilization
      Triple-S Advantage
      2024
      24-002 Appendix P - ASEM Certification
      Triple-S Advantage
      2024
      24-002 Appendix Q - Guidelines for Marketing Activities
      Triple-S Advantage
      2024
      24-002 Appendix R - Medicare Part D Appeal Process
      Triple-S Advantage
      2024
      24-002A TRIPLE-S ADVANTAGE, INC.
      Triple-S Advantage
      2024
      Dropdown
      20-002 MMM HEALTHCARE, LLC (CONTRACT)
      MMM Healthcare
      2020
      20-002 MMM HEALTHCARE, LLC (APPENDIX A)
      MMM Healthcare
      2020
      20-002 MMM HEALTHCARE, LLC (APPENDIX B)
      MMM Healthcare
      2020
      20-002 MMM HEALTHCARE, LLC (APPENDIX C-1)
      MMM Healthcare
      2020
      20-002 MMM HEALTHCARE, LLC (APPENDIX C-2)
      MMM Healthcare
      2020
      20-002 MMM HEALTHCARE, LLC (APPENDIX C-3)
      MMM Healthcare
      2020
      20-002 MMM HEALTHCARE, LLC (APPENDIX C-5)
      MMM Healthcare
      2020
      20-002 MMM HEALTHCARE, LLC (APPENDIX C-6)
      MMM Healthcare
      2020
      20-002 MMM HEALTHCARE, LLC (APPENDIX C-7)
      MMM Healthcare
      2020
      20-002 MMM HEALTHCARE, LLC (APPENDIX C-8)
      MMM Healthcare
      2020
      20-002 MMM HEALTHCARE, LLC (APPENDIX E)
      MMM Healthcare
      2020
      20-002 MMM HEALTHCARE, LLC (APPENDIX F)
      MMM Healthcare
      2020
      20-002 MMM HEALTHCARE, LLC (APPENDIX G)
      MMM Healthcare
      2020
      20-002 MMM HEALTHCARE, LLC (APPENDIX G-1)
      MMM Healthcare
      2020
      20-002 MMM HEALTHCARE, LLC (APPENDIX H)
      MMM Healthcare
      2020
      20-002 MMM HEALTHCARE, LLC (APPENDIX I)
      MMM Healthcare
      2020
      20-002 MMM HEALTHCARE, LLC (APPENDIX J)
      MMM Healthcare
      2020
      20-002 MMM HEALTHCARE, LLC (APPENDIX K)
      MMM Healthcare
      2020
      20-002 MMM HEALTHCARE, LLC (APPENDIX L)
      MMM Healthcare
      2020
      20-002 MMM HEALTHCARE, LLC (APPENDIX M)
      MMM Healthcare
      2020
      20-002 MMM HEALTHCARE, LLC (APPENDIX N)
      MMM Healthcare
      2020
      20-002 MMM HEALTHCARE, LLC (APPENDIX O)
      MMM Healthcare
      2020
      20-002 MMM HEALTHCARE, LLC (APPENDIX P)
      MMM Healthcare
      2020
      20-002 MMM HEALTHCARE, LLC (APPENDIX Q)
      MMM Healthcare
      2020
      20-002 MMM HEALTHCARE, LLC (APPENDIX R)
      MMM Healthcare
      2020
      21-002 MMM HEALTHCARE, LLC (CONTRACT)
      MMM Healthcare
      2021
      21-002 MMM HEALTHCARE, LLC (CONTRACT) (REC)
      MMM Healthcare
      2021
      21-002 MMM HEALTHCARE, LLC (Appendix A) Service Area
      MMM Healthcare
      2021
      21-002 MMM HEALTHCARE, LLC (Appendix B) Premium Payment
      MMM Healthcare
      2021
      21-002 MMM HEALTHCARE, LLC (Appendix C-1) PLAN BENEFITS
      MMM Healthcare
      2021
      21-002 MMM HEALTHCARE, LLC (Appendix C-2) Medicaid Wraparound
      MMM Healthcare
      2021
      21-002 MMM HEALTHCARE, LLC (Appendix C-3) Services Privided by the Department of Health
      MMM Healthcare
      2021
      21-002 MMM HEALTHCARE, LLC (Appendix C-4) BID Summary of Benefits
      MMM Healthcare
      2021
      21-002 MMM HEALTHCARE, LLC (Appendix C-5) Coordinated Care Model Norms 2021 Certification
      MMM Healthcare
      2021
      21-002 MMM HEALTHCARE, LLC (Appendix C-6) Co-Payment Certification
      MMM Healthcare
      2021
      21-002 MMM HEALTHCARE, LLC (Appendix C-7) Benefits Not-Covered by Wrap Around Supplementary Benefits Part C
      MMM Healthcare
      2021
      21-002 MMM HEALTHCARE, LLC (Appendix C-8) Certification Added Value Services
      MMM Healthcare
      2021
      21-002 MMM HEALTHCARE, LLC (Appendix E) CMS CONTRACT
      MMM Healthcare
      2021
      21-002 MMM HEALTHCARE, LLC (Appendix F) Guidelines for the Processing of MP Enrollments an Disenrollments
      MMM Healthcare
      2021
      21-002 MMM HEALTHCARE, LLC (Appendix G-1) Guuidelines for the Development of Program Integrity Plan
      MMM Healthcare
      2021
      21-002 MMM HEALTHCARE, LLC (Appendix G) Business Associate Agreement
      MMM Healthcare
      2021
      21-002 MMM HEALTHCARE, LLC (Appendix H) Sworn Statement
      MMM Healthcare
      2021
      21-002 MMM HEALTHCARE, LLC (Appendix I) Financial Certification
      MMM Healthcare
      2021
      21-002 MMM HEALTHCARE, LLC (Appendix J) Relevant PR and Federal Laws and Regulation
      MMM Healthcare
      2021
      21-002 MMM HEALTHCARE, LLC (Appendix K) Information Data Processes and Data Exchange Layout
      MMM Healthcare
      2021
      21-002 MMM HEALTHCARE, LLC (Appendix L) Deliverables
      MMM Healthcare
      2021
      21-002 MMM HEALTHCARE, LLC (Appendix M) Strategic Plan for Health Information Organization (HIO)
      MMM Healthcare
      2021
      21-002 MMM HEALTHCARE, LLC (Appendix N) HIV Drugs Certification
      MMM Healthcare
      2021
      21-002 MMM HEALTHCARE, LLC (Appendix O) Certification Consent for Sterilization
      MMM Healthcare
      2021
      21-002 MMM HEALTHCARE, LLC (Appendix P) ASEM CEertification
      MMM Healthcare
      2021
      21-002 MMM HEALTHCARE, LLC (Appendix Q) Guidelines for Marketing Activities
      MMM Healthcare
      2021
      21-002 MMM HEALTHCARE, LLC (Appendix R) Medicare Part D Appeal Process
      MMM Healthcare
      2021
      22-003 MMM HEALTHCARE, LLC (CONTRACT)
      MMM Healthcare
      2022
      2022-003A MMM HEALTHCARE, LLC.
      MMM Healthcare
      2022
      22-003 MMM HEALTHCARE, LLC (APPENDIX A)
      MMM Healthcare
      2022
      22-003 MMM HEALTHCARE, LLC (APPENDIX B)
      MMM Healthcare
      2022
      22-003 MMM HEALTHCARE, LLC (APPENDIX C-1)
      MMM Healthcare
      2022
      22-003 MMM HEALTHCARE, LLC (APPENDIX C-2)
      MMM Healthcare
      2022
      22-003 MMM HEALTHCARE, LLC (APPENDIX C-3)
      MMM Healthcare
      2022
      22-003 MMM HEALTHCARE, LLC (APPENDIX C-4)
      MMM Healthcare
      2022
      22-003 MMM HEALTHCARE, LLC (APPENDIX C-5)
      MMM Healthcare
      2022
      22-003 MMM HEALTHCARE, LLC (APPENDIX C-6)
      MMM Healthcare
      2022
      22-003 MMM HEALTHCARE, LLC (APPENDIX C-7)
      MMM Healthcare
      2022
      22-003 MMM HEALTHCARE, LLC (APPENDIX C-8)
      MMM Healthcare
      2022
      22-003 MMM HEALTHCARE, LLC (APPENDIX D)
      MMM Healthcare
      2022
      22-003 MMM HEALTHCARE, LLC (APPENDIX E)
      MMM Healthcare
      2022
      22-003 MMM HEALTHCARE, LLC (APPENDIX F)
      MMM Healthcare
      2022
      22-003 MMM HEALTHCARE, LLC (APPENDIX G)
      MMM Healthcare
      2022
      22-003 MMM HEALTHCARE, LLC (APPENDIX G-1)
      MMM Healthcare
      2022
      22-003 MMM HEALTHCARE, LLC (APPENDIX H)
      MMM Healthcare
      2022
      22-003 MMM HEALTHCARE, LLC (APPENDIX I)
      MMM Healthcare
      2022
      22-003 MMM HEALTHCARE, LLC (APPENDIX J)
      MMM Healthcare
      2022
      22-003 MMM HEALTHCARE, LLC (APPENDIX K)
      MMM Healthcare
      2022
      22-003 MMM HEALTHCARE, LLC (APPENDIX L)
      MMM Healthcare
      2022
      22-003 MMM HEALTHCARE, LLC (APPENDIX M)
      MMM Healthcare
      2022
      22-003 MMM HEALTHCARE, LLC (APPENDIX N)
      MMM Healthcare
      2022
      22-003 MMM HEALTHCARE, LLC (APPENDIX O)
      MMM Healthcare
      2022
      22-003 MMM HEALTHCARE, LLC (APPENDIX P)
      MMM Healthcare
      2022
      22-003 MMM HEALTHCARE, LLC (APPENDIX Q)
      MMM Healthcare
      2022
      22-003 MMM HEALTHCARE, LLC (APPENDIX R)
      MMM Healthcare
      2022
      2023-003 MMM HEALTHCARE, LLC.
      MMM Healthcare
      2023
      23-003A MMM HEALTCARE, LLC. (Platino 2023)
      MMM Healthcare
      2023
      APPENDIX A (1) (23) SERVICE AREA
      MMM Healthcare
      2023
      APPENDIX B (1) (23) PREMIUM PAYMENT
      MMM Healthcare
      2023
      APPENDIX C (1) (23) MEDICARE ADVANTAGE PRODUCT PLAN BENEFITS PACKAGE (PBP)
      MMM Healthcare
      2023
      APPENDIX C (2) (23) MEDICAID WRAPAROUND
      MMM Healthcare
      2023
      APPENDIX C (3) (23) SERVICES PROVIDED BY THE DEPARTMENT OF HEALTH
      MMM Healthcare
      2023
      APPENDIX C (4) (23) BID SUMMARY OF BENEFITS (SB)
      MMM Healthcare
      2023
      APPENDIX C (5) (23) COORDINATED CARE MODEL NORM (2022)
      MMM Healthcare
      2023
      APPENDIX C (6) (23) CO-PAYMENTS CERTIFICATION
      MMM Healthcare
      2023
      APPENDIX C (7) (23) BENEFITS NOT-COVERED BY WRAP AROUND SUPPLEMENTARY BENEFITS PART C
      MMM Healthcare
      2023
      APPENDIX C (8) (23) CERTIFICACION ADDED VALUE SERVICES
      MMM Healthcare
      2023
      APPENDIX D (23) ACTUARIAL CERTIFICATION
      MMM Healthcare
      2023
      APPENDIX E (23) CMS CONTRACT 2022
      MMM Healthcare
      2023
      APPENDIX F (23) GUIDELINES FOR THE PROCESSING OF MEDICARE PLATINO ENROLLMENT AND DISENROLLMENT
      MMM Healthcare
      2023
      APPENDIX G-1 (23) GUIDELINES FOR THE DEVELOPMENT OF PROGRAM INTEGRITY PLAN
      MMM Healthcare
      2023
      APPENDIX G (23) BUSINESS ASSOCIATE AGREEMENT
      MMM Healthcare
      2023
      APPENDIX H (23) SWORN STATEMENTS
      MMM Healthcare
      2023
      APPENDIX I (23) FINANCIAL CERTIFICATION
      MMM Healthcare
      2023
      APPENDIX J (23) RELEVANT PUERTO RICO AND FEDERAL LAWS AND REGULATION
      MMM Healthcare
      2023
      HIGLIGTH

      Quejas o Querellas

      Para comenzar un proceso de queja o querella debe comunicarse directamente con la compañía aseguradora seleccionada por usted a la línea de Servicios al Asegurado localizado en la parte de atrás de su tarjeta.

      ‍
      De no estar conforme con la resolución a su queja o querella, podrá comunicarse con ASES en calidad de foro apelativo al número 1-800-981-2737.

        Derechos y Responsabilidades

        Estos son tus derechos:

        Tienes el derecho a exigir que se te mantenga informado y recibir información sobre:

        -Tu plan de salud

        -Facilidades de salud

        -Profesionales de la salud

        -Servicios de salud cubiertos

        -Acceso a los servicios

        ‍

        A ser tratado con respeto y con la debida consideración a tu dignidad y privacidad.

        ‍

        Seleccionar libremente tu Grupo Médico Primario, tu Médico Primario, laboratorio, Rayos-X, Farmacia, Especialistas y Sub-especialistas dentro de la Red Preferida.

        ‍

        Comunicarte con tu Médico Primario, Especialista o Sub-especialista libremente y en estricta confidencialidad.

        ‍

        Recibir servicios de emergencias libremente las veinticuatro (24) horas del día, los siete (7) días de la semana.

        ‍

        Recibir información sobre alternativas y opciones de tratamiento disponibles y que te sean presentadas de manera apropiada a tu condición y capacidad para entender.

        ‍

        Participar en decisiones relacionadas con tu cuidado de la salud, incluyendo el derecho a rehusarte a recibir tratamiento.

        ‍

        Manifestar con directrices anticipadas ya sea verbalmente o por escrito, tu deseo en cuanto a los servicios y tratamiento que quieras te provean o no te provean en caso de quedar incapacitado para poder tomar dichas decisiones.

        ‍

        Estar libre de cualquier forma de restricción o reclusión utilizada como medio de limitación, disciplina, conveniencia o represalia.

        ‍

        Recibir copias de tus expedientes médicos a bajo costo.

        ‍

        Recibir servicios de la más alta calidad.

        ‍

        A la continuidad de servicios de salud.

        ‍

        Al acceso adecuado a los servicios de salud.

        ‍

        Radicar querellas y apelaciones, cuando entiendas que se han violado tus derechos por negación, limitación o cobro indebido de servicios.

        ‍

        No permitir ser discriminado por ninguna razón.
        ‍

        Estas son tus responsabilidades:

        Informarte sobre la Cubierta de MI Salud, sus límites y exclusiones.

        ‍

        Ofrecer a tu médico toda información relacionada con tu salud.

        ‍

        Informar a tu médico cualquier cambio en tu salud.

        ‍

        Seguir el tratamiento médico según recomendado por tu Médico Primario, Especialista o Sub-especialista.

        ‍

        Informarle a tu médico cuando no entiendas alguna instrucción o no comprendas claramente lo que te están informando.

        ‍

        Informarle a tu médico cuando exista alguna razón por la cual no puedas cumplir con el tratamiento recomendado.

        ‍

        Reconocer cuando tengas que realizar cambios en tu estilo de vida en beneficio de tu salud.

        ‍

        Participar de toda decisión relacionada con el cuidado de tu salud.

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