The player controls either Sonic the Hedgehog or Miles "Tails" Prower as they venture to protect the powerful Chaos Emeralds from Doctor Robotnik, Knuckles the Echidna, and series newcomer Nack the Weasel.

[2] The story follows Sonic the Hedgehog and Tails in their efforts to stop the powerful Chaos Emeralds from being acquired by Doctor Robotnik, who has tricked Knuckles the Echidna into aiding him.

[16] Critics felt Triple Trouble was fun but too similar to previous Sonic games, and thought the series was beginning to stagnate.

[20] Leadbetter and Sushi-X of Electronic Gaming Monthly appreciated the levels for their large size and found that they invited exploration.

[17][20][6] Many critics felt the game's levels were sparsely populated with enemies, making it too short and easy to complete.

[3][12][20][6] Computer and Video Games and Mean Machines Sega believed this lack of challenge harmed its long term value to players.

[22] Ryan Davis of GameSpot believed it did a better job capturing classic Sonic gameplay than other games on the system, due to it being a later release and thus more technically competent.

[2] Corbie Dillard of Nintendo Life agreed, writing that Sega had made a strong attempt to capture classic Mega Drive Sonic gameplay on the Game Gear, and believed Triple Trouble was "probably the closest thing gamers could get to the overall style of play of the 16-bit titles on a handheld".

[8] Sean Madson of Diehard GameFan appreciated the 3DS release for adding different resolutions, button configurations, and save state support.

[5] In August 2022, an unofficial fan remake titled Sonic Triple Trouble 16-Bit, by indie developer Noah Copeland, was released for Windows via Game Jolt,[23] with Android and macOS ports later following.

Copeland was inspired to remake Triple Trouble after playing it and thinking it was a "good classic Sonic game buried under 8-bit limitations".

[25] The remake received overwhelmingly positive reception from critics - Stuart Gipp of TechRadar called it a "world-class fangame" that vastly improved on the original, praising its "joyous set pieces" and "masterful compositions".