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MMM Diamante Platino (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MMM Diamante Platino (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MMM Diamante Platino (HMO D-SNP) in 2025, please refer to our full plan details page.
MMM Diamante Platino (HMO D-SNP) is a HMO D-SNP plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Puerto Rico. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that MMM Diamante Platino (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
MMM Diamante Platino (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about MMM Diamante Platino (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For MMM Diamante Platino (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $20.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The MMM Diamante Platino (HMO D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs as outlined in the plan's formulary. If you qualify for the low-income subsidy (LIS), you will pay $0 for your prescriptions. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The MMM Diamante Platino (HMO D-SNP) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with no copay. The plan also covers ambulance services, emergency services, and many primary care services with no copay, as well as hearing, vision, and dental services. This plan also provides additional benefits such as home health services, medical equipment, and dialysis services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, though additional days, non-Medicare stays, and upgrades for the Acute benefit are not covered. Prior authorization is required for both, and there is no copay or coinsurance.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, observation services, and ambulatory surgical center services, but individual and group sessions for outpatient substance abuse, as well as outpatient blood services are not covered. Prior authorization is required for outpatient hospital services, observation services, and ambulatory surgical center services, while outpatient substance abuse services require prior authorization and a doctor's referral.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization and a doctor referral. There is no information about the cost of this service.
Ambulance and Transportation Services See details
For the MMM Diamante Platino (HMO D-SNP) plan, Ambulance Services are covered with no copay or coinsurance, while Ground and Air Ambulance Services are not covered. Transportation Services to plan-approved health-related locations are covered for up to 24 one-way trips per year, with no copay or coinsurance, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered with no copay or coinsurance, but Worldwide Emergency Transportation is not covered. Worldwide Urgent Coverage has a $75 copay. Worldwide Emergency Services has a maximum benefit coverage amount of $500.
Primary Care See details
The MMM Diamante Platino (HMO D-SNP) plan covers primary care physician services, chiropractic services (with a $750 annual maximum and 6 visits per year), occupational therapy, physician specialist services, podiatry services (6 visits per year), other health care professional services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Mental health and psychiatric services are partially covered, as individual and group sessions are not covered.
Preventive Services See details
Preventive Services include Medicare-covered services with no copay, Health Education, Alternative Therapies (12 visits every three months, up to $100), Nutritional/Dietary Benefit (6 sessions), Additional Sessions of Smoking and Tobacco Cessation Counseling (9 visits), Fitness Benefit (Memory Fitness, up to $100 every three months), Remote Access Technologies, Home and Bathroom Safety Devices and Modifications (up to $100 every three months), Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Annual Physical Exams, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, and Counseling Services are not covered.
Hearing Services See details
Hearing Services are covered by the MMM Diamante Platino (HMO D-SNP) plan. Fitting/Evaluation for Hearing Aids are covered, with a limit of one visit every year. Prescription Hearing Aids (all types) are covered with a maximum of $3,000 every three years. Routine Hearing Exams, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services are partially covered under the MMM Diamante Platino (HMO D-SNP) plan. Eye exams are covered, but routine eye exams are not covered. Contact lenses and eyeglasses (lenses and frames) are covered, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The MMM Diamante Platino (HMO D-SNP) plan covers Medicare Dental Services, Orthodontic Services, Restorative Services, Prosthodontics (removable and fixed), and Implant Services. Adjunctive General Services, Endodontics, Periodontics, Oral and Maxillofacial Surgery, and Orthodontics are not covered. This plan has a maximum benefit of $3,500 per year for orthodontic services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the MMM Diamante Platino (HMO D-SNP) plan, including Medicare Part B Insulin Drugs. Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. There is no information about the cost of services, such as the copay or coinsurance.
Medical Equipment See details
Medical Equipment benefits are covered under MMM Diamante Platino (HMO D-SNP), including Durable Medical Equipment (DME) and Prosthetics/Medical Supplies, with no copay or coinsurance, but Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. Diabetic Equipment benefits are also covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by MMM Diamante Platino (HMO D-SNP), but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered. There is no copay for covered services.
Home Health Services See details
Home Health Services are covered by the MMM Diamante Platino (HMO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the MMM Diamante Platino (HMO D-SNP) plan. Specifically, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare and non-Medicare-covered stays are not covered. Prior authorization is required.
Other Services See details
The MMM Diamante Platino (HMO D-SNP) plan covers acupuncture with a limit of 6 treatments per year, and a maximum benefit coverage amount of $500 per year. Over-the-counter items are covered with a maximum benefit of $100 every three months. The plan also covers a meal benefit for chronic illness and some services are covered. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services are not covered.
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