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HOW PLAN VITAL WORKS WITH MEDICARE

 If you have Medicare, your Plan Vital coverage works in a different way. Medicare is health insurance for people who are age 65 and older, and for some people of any age who Social Security says are disabled. People with end stage renal disease can have Medicare too.

These are the different parts of Medicare:

  • Part A is for hospital stays, skilled nursing facility care, home health care, and hospice care and hospice care.
  • Part B is for your doctor’s services and outpatient care.
  • Part D is for prescription drugs.

There are also other ways to have Medicare. These are called Medicare Health Plans (these plans are sometimes called Medicare Part C). These plans put all of the parts A, B, and D together for you in one plan.

To learn more about Medicare, call them at 1-800-633-4227. It’s a free call.

If you have Medicare, your Plan Vital coverage works differently:

  • Your Medicare is your first (primary) insurance. Hospitals, doctors and other health care providers will bill Medicare first.
  • Your Vital is your second (secondary) insurance. After your providers bill Medicare, they will also bill Vital.

If you have Medicare Part A:

  • Plan Vital will pay once you have reached the limit of what Medicare pays for.
  • Plan Vital will not pay for your Part A deductibles.
  • You will pay a copay for services depending on what type of Plan Vital you have. See the copay chart for more information.

If you have Medicare Part A and Part B:

  • Plan Vital will pay for your pharmacy and dental services.
  • Plan Vital will not pay for your Part A deductibles.
  • Plan Vital will pay for your Part B Deductibles and Copayments.

If you have Medicare Part C:

  • You have the option to choose a Platino Plan, which will cover services your Medicare health plan does not cover.

If you have other health insurance, your other insurance is your first (primary) insurance. Hospitals, doctors, and other health care providers will bill your other insurance first. Your Plan Vital is your second (secondary) insurance. After your providers contracted bill your other insurance, they will bill Plan Vital.

If you have other health insurance, you must let Triple-S Salud and Medicaid Program know. Call Medicaid Program and Triple-S at 1-800-981-1352; TTY / TDD users should call 1-855-295-4040 to let them know.

When you go to your health care visits, bring your Plan Vital ID card and your ID cards for your other insurance.

If you are a public employee or a retiree from the Government of Puerto Rico, you can choose Plan Vital as your health insurance. Your employer will pay ASES, and you will pay the difference, if any.

You can also visit your local Medicaid Office to see if you are eligible for Plan Vital for other reasons. If you are eligible for Plan Vital for other reasons, you will not have to pay the difference, if any. If you and your husband (or wife) are public employees or retirees from the Government of Puerto Rico, you can apply together for Plan Vital. This is called “joint enrollment.”

If at any time you lose eligibility for Plan Vital, you can sign up for Plan Vital in the ELA Puro group. That way, you can continue getting your Plan Vital benefits until you can get insurance through your job. You do not have to continue as ELA Puro. It is your choice!

If you get other health insurance from your job, you have to cancel your Plan Vital benefits before you sign up for the other health insurance. Visit your local Medicaid office to cancel your Plan Vital benefits. The change will be effective the first day of the next month after you cancel your benefits. If you do not cancel your benefits, you will have to pay for part of the cost of the premium for the new insurance you affiliate with.

The members of the Police Department of Puerto Rico, their spouses and children may also enroll in Plan Vital. The Police Department of Puerto Rico will pay.

If you are a member of the Police Department of Puerto Rico, you must visit your local Medicaid Office to sign up for Plan Vital.

If a member of the Police Department of Puerto Rico dies, his/her widow can continue to get Plan Vital benefits until he/she remarries. Children can continue to get Plan Vital benefits up to the age of 26.

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By clicking this link, you are leaving the website of Vital. If you need further assistance you may contact the Vital Call Center at 787-775-1352. (TTY users should call 1-855-295-4040).

Hours are from 7:00 a.m. to 7:00 p.m., 7 days a week.

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