Plan year 2027 · Medicare AdvantageCMS files of Sept. 22 and Oct. 1, 2026

Óptimo Plus, 2027

H4005Contract004Plan

PPO · 78 counties in Puerto Rico

Run by Triple S Advantage, Inc. (contract H4005), sold as Triple-S Advantage, owned by Guidewell Mutual Holding Corporation

Renews for 2027

2026 star rating, contract H4005: 3.5 of 5

Óptimo Plus (H4005-004) costs $0 a month in 2027, the same as in 2026, with an in-network out-of-pocket limit of $7,151 ($6,751 in 2026).

What changes from 2026 to 2027?

The changed lines are marked and come first. In-network amounts; members keep paying the Part B premium unless the plan reduces it.
What you pay or get	2026	2027	Change
In-network out-of-pocket limit	$6,751	$7,151	up $400
Hearing aids, yearly limit for both ears	$200 a year	$66.67 a year	down $133.33
20 lines do not change
Monthly premium	$0	$0	no change
Drug deductible	$0	$0	no change
Part B premium reduction, monthly	none	none	no change
Primary care visit	$0 copay	$0 copay	no change
Specialist visit	$0 copay	$0 copay	no change
Emergency room	$50 copay	$50 copay	no change
Medical deductible, in network	none	none	no change
Hospital stay, in network	$0 a stay	$0 a stay	no change
Skilled nursing facility, in network	$0 a stay	$0 a stay	no change
Ground ambulance, in network	$0 copay	$0 copay	no change
Comprehensive dental, yearly limit	$1,000 a year	$1,000 a year	no change
Eyewear, yearly limit	$200 a year	$200 a year	no change
Over-the-counter items, yearly	not offered	not offered	no change
Counties served	78	78	no change
Drug tier 1, preferred generic	$8	$8	no change
Drug tier 2, generic	$20	$20	no change
Drug tier 3, preferred brand	$45	$45	no change
Drug tier 4, non-preferred brand	$75	$75	no change
Drug tier 5, specialty tier	33% of the cost	33% of the cost	no change
Drug tier 6, select care drugs	$3	$3	no change

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS plan benefit package files, 2027 and 2026; CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026). Plan details can change during the year; confirm on Medicare Plan Finder.

What will prescriptions cost?

Your share for a 30-day supply at a retail pharmacy, as filed with CMS; tiers whose share changes are marked. The plan charges less at its preferred pharmacies
Tier	What the tier holds	2026, standard pharmacy	2027, standard pharmacy	2027, preferred pharmacy
Tier 1	Preferred Generic	$8	$8	$0
Tier 2	Generic	$20	$20	$0
Tier 3	Preferred Brand	$45	$45	$30
Tier 4	Non-Preferred Brand	$75	$75	$50
Tier 5	Specialty Tier	33% of the cost	33% of the cost	33% of the cost
Tier 6	Select Care Drugs	$3	$3	$0

Source: CMS plan benefit package files, 2027 and 2026. Insulin is capped at $35 a month by law. A drug's tier is set by the plan's formulary.

How does it compare with plans sold where it is?

In the counties it serves, 24 plans open to everyone are sold for 2027, this one included. Against the others, 23 plans have a lower out-of-pocket limit. On the premium, 23 the same.

Out-of-pocket limits of the 24 plans open to everyone

$0 to under $2,0000 plans

$2,000 to under $4,00020 plans

$4,000 to under $6,0003 plans

$6,000 to $8,000 (this plan)1 plan

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).

Where is it sold, and what does it cost there?

The premium and the out-of-pocket limit are the same in all 78 counties: $0 a month and $7,151.

Puerto Rico

Adjuntas Aguada Aguadilla Aguas Buenas Aibonito Anasco Arecibo Arroyo Barceloneta Barranquitas Bayamon Cabo Rojo Caguas Camuy Canovanas Carolina Catano Cayey Ceiba Ciales Cidra Coamo Comerio Corozal Culebra Dorado Fajardo Florida Guanica Guayama Guayanilla Guaynabo Gurabo Hatillo Hormigueros Humacao Isabela Jayuya Juana Diaz Juncos Lajas Lares Las Marias Las Piedras Loiza Luquillo Manati Maricao Maunabo Mayaguez Moca Morovis Naguabo Naranjito Orocovis Patillas Penuelas Ponce Quebradillas Rincon Rio Grande Sabana Grande Salinas San German San Juan San Lorenzo San Sebastian Santa Isabel Toa Alta Toa Baja Trujillo Alto Utuado Vega Alta Vega Baja Vieques Villalba Yabucoa Yauco

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).

Who runs this plan?

Plan ID: H4005-004
Legal name of the contract: Triple S Advantage, Inc.
Sold as: Triple-S Advantage
Parent company: Guidewell Mutual Holding Corporation
Plan type: PPO
2026 star rating of the contract: 3.5 of 5 overall; health plan 3.5 of 5, drug plan 4.5 of 5
Members, September 2026: 2,690
Plan website, as filed with CMS: www.sssadvantage.com

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS 2026 Star Ratings (October 2025); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11). CMS publishes the 2027 Star Ratings in October 2026.

What else should you check?

Other 2027 plans in San Juan, PRWhere most of its members live; premiums and limits side by side
Every Triple-S Advantage plan for 2027Its contracts, counties and plans that end
Is your prescription covered?Coverage share and tier for 2,259 drugs

Data, not advice. These are the plan's filed amounts, not a quote for you; confirm on Medicare Plan Finder or call the plan before you enroll.