Medicare Plan Lookup Official CMS data · Contract Year 2027
CMS 2027 data

2027 Medicare plan code

H5774-829

Medicare Plan

Employer BD17 (HMO) · Triple S Advantage · HMO · Puerto Rico

Full CMS plan ID: H5774-829-000

H5774-829-000 is the full CMS identifier for the H5774-829 Medicare plan. Common searches include H5774 829 and H5774829.

2027

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2027 plan record

Employer BD17 (HMO)

H5774-829-000 Puerto Rico HMO Employer-only

At-a-glance

Quick view

01

In-network

Inpatient hospital

Medicare-defined coinsurance cost sharing applies (in-network, tier 1).

Out-of-network

Not separately reported

Point of service

Not separately reported

02

Emergency transport

Ambulance

Ground · in-network20% coinsurance
Air · in-network20% coinsurance
03

Emergency services

Emergency room

20% coinsurance

Waived if admitted within 3 days

04

Medical maximum

Maximum out-of-pocket

In-network$9,850
Combined in + outNot reported
05

Skilled care at home

Home health

In-network0% coinsurance
Out-of-networkNot separately reported
06

Monthly cost

Premium & giveback

Part C premiumNot reported
Consolidated C + DNot reported

CMS reports a Part B premium reduction of $100 per month.

Plan details

All plan benefits

Medical care3 benefits

Primary care physician

In-networkPrimary Care Physician Services: 20% coinsurance
Out-of-networkNot separately reported

Specialist

In-networkPhysician Specialist Services: 20% coinsurance
Out-of-networkNot separately reported

Preventive care

In-networkAnnual Physical Exam: Not applicable; Kidney Disease Education Services: 20% coinsurance; Glaucoma Screening: 20% coinsurance; Diabetes Self-Management Training: 20% coinsurance; Digital Rectal Exams: 20% coinsurance; EKG following Welcome Visit: 20% coinsurance
Out-of-networkNot separately reported
Diagnostics & imaging4 benefits

Diagnostic procedures & tests

In-networkDiagnostic Procedures/Tests: 20% coinsurance
Out-of-networkNot separately reported

Laboratory services

In-networkLab Services: 0% coinsurance
Out-of-networkNot separately reported

X-rays & standard imaging

In-networkOutpatient X-Ray Services: 20% coinsurance
Out-of-networkNot separately reported

MRI, CT & PET imaging

In-networkDiagnostic Radiological Services: 20% coinsurance
Out-of-networkNot separately reported
Urgent & hospital care6 benefits

Urgent care

In-networkUrgently Needed Services: 20% coinsurance
Out-of-networkNot separately reported

Emergency room

In-network20% coinsurance
Out-of-networkNot separately reported

Ground ambulance

In-network20% coinsurance
Out-of-networkNot separately reported

Air ambulance

In-network20% coinsurance
Out-of-networkNot separately reported

Outpatient hospital

In-networkOutpatient Hospital Services: 20% coinsurance; Observation Services: 20% coinsurance
Out-of-networkNot separately reported

Outpatient surgery / ASC

In-networkAmbulatory Surgical Center (ASC) Services: 20% coinsurance
Out-of-networkNot separately reported
Recovery & therapy5 benefits

Home health

In-network0% coinsurance
Out-of-networkNot separately reported

Skilled nursing facility

In-networkSkilled nursing facility: Tier 1: Medicare-defined coinsurance cost sharing applies (in-network, tier 1).
Out-of-networkNot separately reported

Cardiac & pulmonary rehabilitation

In-networkCardiac Rehabilitation Services: 20% coinsurance; Intensive Cardiac Rehabilitation Services: 20% coinsurance; Pulmonary Rehabilitation Services: 20% coinsurance; SET for PAD Services: 20% coinsurance; 3-1(NMC): Not applicable; 3-2(NMC): Not applicable; 3-3(NMC): Not applicable; 3-4(NMC): Not applicable
Out-of-networkNot separately reported

Occupational therapy

In-networkOccupational Therapy Services: 20% coinsurance
Out-of-networkNot separately reported

Physical & speech therapy

In-networkPhysical Therapy and Speech-Language Pathology Services: 20% coinsurance
Out-of-networkNot separately reported
Behavioral health2 benefits

Mental health services

In-networkPartial Hospitalization Program: 20% coinsurance; Individual Sessions for Mental Health Specialty Services: 20% coinsurance; Group Sessions for Mental Health Specialty Services: 20% coinsurance; Individual Sessions for Psychiatric Services: 20% coinsurance; Group Sessions for Psychiatric Services: 20% coinsurance; Inpatient psychiatric hospital: Tier 1: Medicare-defined coinsurance cost sharing applies (in-network, tier 1).
Out-of-networkNot separately reported

Substance use treatment

In-networkIntensive Outpatient Program Services: 20% coinsurance; Individual Sessions for Outpatient Substance Abuse: 20% coinsurance; Group Sessions for Outpatient Substance Abuse: 20% coinsurance
Out-of-networkNot separately reported
Specialty care2 benefits

Podiatry

In-networkPodiatry Services: 20% coinsurance; 7f(NMC): Not applicable
Out-of-networkNot separately reported

Chiropractic

In-networkChiropractic Services: 20% coinsurance
Out-of-networkNot separately reported
Supplemental benefits7 benefits

Dental

In-networkMedicare Dental Services: 20% coinsurance
Out-of-networkNot separately reported

Vision

In-networkEye Exams: 20% coinsurance; Routine Eye Exams: Not applicable; Other Eye Exam Services: Not applicable; Eyewear: 20% coinsurance; Contact Lenses: Not applicable; Eyeglasses (lenses and frames): Not applicable; Eyeglass lenses: Not applicable; Eyeglass frames: Not applicable; Upgrades: Not applicable
Out-of-networkNot separately reported

Hearing

In-networkHearing Exams: 20% coinsurance; Routine Hearing Exams: Not applicable; Fitting/Evaluation for Hearing Aid: Not applicable; Prescription Hearing Aids (all types): Not applicable; Prescription Hearing Aids - Inner Ear: Not applicable; Prescription Hearing Aids - Outer Ear: Not applicable; Prescription Hearing Aids - Over the Ear: Not applicable
Out-of-networkNot separately reported

Transportation

Not applicable
In-network10b(NMC): Not applicable
Out-of-networkNot separately reported

Fitness & wellness

Not applicable
In-networkFitness Benefit: Not applicable
Out-of-networkNot separately reported

Over-the-counter allowance

Not applicable
In-networkOver-the-Counter (OTC) Items: Not applicable
Out-of-networkNot separately reported

Meals

Not applicable
In-networkMeal Benefit: Not applicable
Out-of-networkNot separately reported
Plan costs & rulesCoverage overview

Premium & Part B giveback

Part C premium not reported · CMS reports a Part B premium reduction of $100 per month.

Maximum out-of-pocket (MOOP)

In-network$9,850
Combined in + outNot reported

Medical deductibles

In-networkNot reported
Out-of-networkNot reported

Annual health deductible

Not separately reported

Combined network deductible

Not separately reported

Part D premium

Not reported

Network & referrals

HMO · Referrals: Not required · Out-of-network coverage: Not reported

Prescription drugs0 tiers

Part D deductible

Plan-specific drug deductible not published

Using this plan

Understand H5774-829-000

Plain-language context built from this plan’s 2027 CMS record. It is a guide to the reported benefits, not a personalized cost estimate.

Plan at a glance

A quick read on this plan

Employer BD17 (HMO) is a 2027 HMO offered by Triple S Advantage in Puerto Rico. The plan record does not require referrals.

Common benefit costs

What you may pay

These are individual in-network benefit amounts. A real visit may involve more than one separately billed service.

Routine care

Primary care physician
Primary Care Physician Services: 20% coinsurance
Specialist
Physician Specialist Services: 20% coinsurance
Laboratory services
Lab Services: 0% coinsurance

Separate visits or services; costs are not added together.

Tests & outpatient care

Diagnostic procedures & tests
Diagnostic Procedures/Tests: 20% coinsurance
MRI, CT & PET imaging
Diagnostic Radiological Services: 20% coinsurance
Outpatient hospital
Outpatient Hospital Services: 20% coinsurance; Observation Services: 20% coinsurance

The service setting and billing details can change what you pay.

Emergency & hospital care

Emergency room
20% coinsurance

Actual costs depend on the care received and plan rules.

Helpful context

Terms worth knowing

Maximum out-of-pocket (MOOP)

This is the most you generally pay during the plan year for covered Part A and Part B medical services under the applicable network limit. Premiums and prescription drug costs generally do not count toward it.

Part B premium reduction (“giveback”)

A giveback may reduce the amount you pay toward Medicare Part B; it is not usually paid to you as cash. The CMS record notes: CMS reports a Part B premium reduction of $100 per month.

Availability

Who can enroll

Service area
Puerto Rico (PR)
Plan type
HMO
Contract / plan
H5774-829
Coverage year
2027

Enrollment is limited to people eligible through the sponsoring employer or group. Confirm eligibility and the exact service area with the plan before enrolling.

Supplemental coverage

Extra benefits reported

Availability is summarized here; allowances, frequency limits, networks, and prior-authorization rules may apply.

DentalMedicare Dental Services: 20% coinsurance
VisionEye Exams: 20% coinsurance; Routine Eye Exams: Not applicable; Other Eye Exam Services: Not applicable; Eyewear: 20% coinsurance; Contact Lenses: Not applicable; Eyeglasses (lenses and frames): Not applicable; Eyeglass lenses: Not applicable; Eyeglass frames: Not applicable; Upgrades: Not applicable
HearingHearing Exams: 20% coinsurance; Routine Hearing Exams: Not applicable; Fitting/Evaluation for Hearing Aid: Not applicable; Prescription Hearing Aids (all types): Not applicable; Prescription Hearing Aids - Inner Ear: Not applicable; Prescription Hearing Aids - Outer Ear: Not applicable; Prescription Hearing Aids - Over the Ear: Not applicable

Plan-specific answers

Frequently asked questions

Where is H5774-829-000 available?

Employer BD17 (HMO) is listed for Puerto Rico (PR). Enrollment is limited to people eligible through the sponsoring employer or group.

What is the in-network maximum out-of-pocket limit for H5774-829-000?

The 2027 CMS record lists an in-network medical maximum out-of-pocket limit of $9,850. Prescription drug spending generally does not count toward this medical limit.

What does an emergency room visit cost on H5774-829-000?

The plan record lists 20% coinsurance, waived when an admission meets the plan's stated timing rule.

Does H5774-829-000 report extra benefits?

Yes. CMS reports dental, vision, hearing. See the detailed benefit rows and official plan documents for limits and conditions.

Source trail

Official CMS, Contract Year 2027

Plan identity and benefits come from CMS PBP data. Benefits and drug cost sharing come from the approved annual PBP tabular extract and its CMS dictionary. Premiums and drug deductibles are cross-checked with the annual Landscape. Geography comes from annual PlanArea and PlanRegionArea records, including exact segments and partial-county or employer/group qualifiers. Quick-reference values should be confirmed in current official plan documents.

PBP benefits ↗ Landscape data ↗ County service area ↗

Plan context

Where H5774-829-000 fits

Full CMS plan ID
H5774-829-000
Contract
H5774
Base plan code
H5774-829
Segment
000
Carrier
Triple S Advantage
Plan type
HMO
Service area
Puerto Rico (PR)

County/service-area foundation

CMS service-area entries

Service areas come from the annual CMS PlanArea and PlanRegionArea tables for this exact contract, plan, and segment. Partial-county and employer/group qualifiers remain part of the coverage area. Regional PPO county entries use the matching annual Landscape expansion of the CMS region.

  • Adjuntas, PR
  • Aguada, PR
  • Aguadilla, PR
  • Aguas Buenas, PR
  • Aibonito, PR
  • Anasco, PR
  • Arecibo, PR
  • Arroyo, PR
  • Barceloneta, PR
  • Barranquitas, PR
  • Bayamon, PR
  • Cabo Rojo, PR

66 additional service-area entries are retained in the data record.

Exact county navigation

These links are limited to named counties tied to this exact medical plan segment. Partial-county entries remain labeled for verification.

Show 78 county links
Puerto Rico

Same CMS contract

H5774-022-000 Contigo Plus (HMO C-SNP) Puerto Rico · HMO H5774-035-000 Platino Enlace (HMO D-SNP) Puerto Rico · HMO H5774-038-000 Enlace Plus (HMO) Puerto Rico · HMO H5774-041-001 PLATINO ADVANCE (HMO D-SNP) Region 1 · HMO H5774-041-002 PLATINO ADVANCE (HMO D-SNP) Region 2 · HMO H5774-041-003 PLATINO ADVANCE (HMO D-SNP) Region 3 · HMO H5774-043-001 PLATINO PLUS (HMO D-SNP) Region 1 · HMO H5774-043-002 PLATINO PLUS (HMO D-SNP) Region 2 · HMO

About this code

What H5774-829-000 identifies

H5774-829-000 is a Contract Year 2027 Medicare plan segment code. Searches written as H5774-829, H5774 829, or the compact full CMS ID H5774829000 refer to this plan or its base plan code.

Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.