Contigo Plus (HMO C-SNP) H5774-022 • 2027 • Naguabo Municipio, PR
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $4200.00In-network
- Part B Giveback
- −$70.00 reduction
- Prescription Coverage
- Enhanced, $0.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Naguabo Municipio, PR
- Local Enrollment
- 17 beneficiaries in Naguabo Municipio
Introduction
Contigo Plus is a Medicare Advantage Chronic Condition Special Needs Plan (C-SNP) offered by Triple S Advantage. The plan uses a Health Maintenance Organization (HMO) provider network and includes Medicare Part D prescription drug coverage. For the 2027 plan year, it has a $0.00 monthly premium, $0.00 medical deductible, and $4200.00 in-network maximum out-of-pocket. CMS Plan ID H5774-022 identifies this plan. The 2027 Part D prescription drug deductible is $0.00.
You must live in Naguabo Municipio, Puerto Rico to enroll in this plan. CMS reports 17 beneficiaries enrolled in this plan in Naguabo Municipio. For assistance with this plan, new members can call (833)221-2234 (TTY (866)620-2520).
Eligibility
Contigo Plus is a Medicare C-SNP plan for individuals with specific chronic or disabling conditions.
- Special Needs Plan Type
- Chronic Condition Special Needs Plan (C-SNP)
- Medicare Requirement
- Must have Medicare Part A and Part B
- Special Needs Requirement
- This plan is for individuals with cardiovascular disorders, chronic heart failure, and/or diabetes mellitus.
- Service Area Requirement
- Must live in the plan's service area
- Prescription Drug Coverage
- Medicare Part D prescription drug coverage is included.
Compare Similar Plans in Naguabo Municipio
Compare this plan with the two most-enrolled HMO C-SNP plans available in Naguabo Municipio, Puerto Rico. Enrollment is based on CMS local enrollment data.
| Plan Detail | Contigo Plus | MCS Classicare Primero | MMM Supremo |
|---|---|---|---|
| CMS Plan ID | H5774-022-0 |
H5577-038-0 |
H4003-009-0 |
| Local Enrollment | 17 | 136 | 15 |
| Monthly Premium | $0.00 | $0.00 | $0.00 |
| Medical Deductible | $0.00 | $0.00 | $0.00 |
| Maximum Out-of-Pocket | $4,200.00 | $3,400.00 | $3,250.00 |
| Part B Giveback | −$70.00 reduction | −$31.00 reduction | −$25.00 reduction |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | $0-$3 copay | $0 copay | $0 copay |
| Part D Deductible | $0.00 | $0.00 | $0.00 |
| CMS Star Rating | Not yet rated | Not yet rated | Not yet rated |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0 copay | $0 copay | $0 copay |
| Hearing | $0 copay | $0 copay | $0 copay |
Plan Benefits
Contigo Plus has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H5774-022.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H5774-022-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
- Specialist
- In-network: $0-$3 copay
Preventive and Wellness Services
- Annual wellness exam
- Not covered
- Telehealth benefit
- In-network: $0-$3 copay
- Routine chiropractic
- In-network: $0-$5 copay
- Fitness benefits
- Coming soon
- Health education
- In-network: $0 copay
- Counseling services
- In-network: $0 copay
- Over-the-counter drug benefits
- In-network: $0 copay
- Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: $0-$25 copay
- Lab services
- In-network: 0%-15% coinsurance
- Outpatient x-rays
- In-network: $0 copay
- Diagnostic tests and procedures
- In-network: 0%-15% coinsurance
Emergency and Urgent Care Services
- Emergency room care
- $50 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $0 copay
- Inpatient hospital care
- Tier 1
$0 per stay
Tier 2
$50 per stay - Skilled Nursing Facility
- $0 copay
- Ground ambulance
- In-network: $0 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $0 copay
- Outpatient group therapy
- In-network: $0 copay
- Inpatient psychiatric hospital care
- Tier 1
$0 per stay
Tier 2
$50 per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $0 copay
- Occupational therapy
- In-network: $5 copay
Medical Equipment and Supplies
- Diabetes supplies
- In-network: $0 copay
- Durable medical equipment
- In-network: 0%-10% coinsurance
- Prosthetics
- In-network: 0%-10% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0%-20% coinsurance
- Other Part B drugs (Medicare-covered)
- In-network: 0%-20% coinsurance
Dental Services
- Oral exam
- In-network: $0 copay
- Dental x-rays
- In-network: $0 copay
- Cleaning
- In-network: $0 copay
- Periodontics
- In-network: $0 copay
- Endodontics
- In-network: $0 copay
- Restorative services
- In-network: $0 copay
- Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- In-network: $0 copay
Vision Services
- Routine eye exam
- In-network: $0 copay
- Contact lenses
- In-network: $0 copay
- Eyeglass frames only
- In-network: $0 copay
- Eyeglass lenses only
- In-network: $0 copay
- Eyeglasses (frames & lenses)
- In-network: $0 copay
- Upgrades
- In-network: $0 copay
Hearing Services
- Hearing exam
- In-network: $0 copay
- Fitting/evaluation
- In-network: $0 copay
- Prescription hearing aids
- In-network: $0 copay
- OTC hearing aids
- Not covered
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- Not covered
- Personal emergency response system
- Coming soon
- Weight management programs
- Not covered
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- In-network: $0 copay
- Massage therapy
- Not covered
- Home/bathroom safety devices
- In-network: $0 copay
Certain preventive services are covered 100% by Contigo Plus as a Part B benefit.
Prescription Drug Coverage
Contigo Plus includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $0.00 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | Not Applicable |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $0.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Triple S Advantage starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Contigo Plus may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | $0.00 copay |
| Generic | $0.00 copay | $0.00 copay |
| Preferred Brand | $0.00 copay | $0.00 copay |
| Non-Preferred Brand | $10.00 copay | $10.00 copay |
| Specialty Tier | 33% coinsurance | 33% coinsurance |
| Select Care Drugs | $0.00 copay | $0.00 copay |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H5774)
CMS star ratings reflect how well a Medicare plan performs across key quality measures, such as managing chronic conditions, member satisfaction, and customer service. Ratings range from 1 to 5 stars and are updated each year by Medicare.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for Triple S Advantage
- Website
- Triple S Advantage Plan Page
- Providers
- Triple S Advantage Providers Page
- Formulary
- Triple S Advantage Formulary Page
- Pharmacy
- Triple S Advantage Pharmacy Page
- New Member Health Plan Help
- (833)221-2234
- New Member Health Plan TTY
- (866)620-2520
- New Member Part D Help
- (833)221-2234
- New Member Part D TTY Users
- (866)620-2520
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Triple S Advantage (official source) | http://www.sssadvantage.com | October 4, 2026 |
| CMS.gov | Chronic Condition Special Needs Plans (C-SNPs) | April 28, 2026 |
| CMS.gov | Medicare Advantage Plan Fact Sheet | April 28, 2026 |
| Medicare.gov | Joining a plan | April 28, 2026 |
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