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PMC Premier Platino (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PMC Premier 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 PMC Premier Platino (HMO D-SNP) in 2026, please refer to our full plan details page.
PMC Premier 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 5 out of 5 stars in 2026.
It's important to know that PMC Premier 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:
PMC Premier 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 PMC Premier 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 PMC Premier 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 $35.00. 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 $615.00 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 PMC Premier Platino (HMO D-SNP) Medicare plan features an annual prescription drug deductible of $615. This deductible represents the amount you must pay out-of-pocket for your medications before your coverage begins to pay. Specific details regarding drug tier copayments and coinsurance are not available for this plan. To determine your exact costs for individual prescriptions, it is best to consult the plan's comprehensive formulary or contact the provider directly.
Additional Benefits
The PMC Premier Platino (HMO D-SNP) plan offers highly accessible coverage with no copay and no coinsurance for most medical services, including inpatient and outpatient hospital stays, primary and specialist care, and skilled nursing facility care. Members also enjoy no-cost benefits for home health care, dialysis, durable medical equipment, and up to 24 one-way transportation trips per year to approved health locations. Emergency and urgent care are covered with no copay, though worldwide emergency services require a $75 copay. Additionally, the plan provides robust allowances for dental, vision, and hearing services, featuring a $2,000 annual limit for restorative dental care, a $600 annual limit for vision hardware, and up to $2,500 every three years for prescription hearing aids. Benefits like acupuncture, chronic illness meals, and over-the-counter items are also covered with no copay, though ambulance services and cardiac rehabilitation are excluded from the plan.
Inpatient Hospital See details
Inpatient hospital services are partially covered by PMC Premier Platino (HMO D-SNP) with no copay and no coinsurance for acute and psychiatric stays, though prior authorization is required. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
PMC Premier Platino (HMO D-SNP) covers outpatient hospital, ambulatory surgical center, and blood services with no copay and no coinsurance. For outpatient substance abuse, some services are covered but individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization is covered by PMC Premier Platino (HMO D-SNP) with no copay and no coinsurance, though prior authorization and a referral are required.
Ambulance and Transportation Services See details
PMC Premier Platino (HMO D-SNP) provides transportation services to plan-approved health-related locations with no copay and no coinsurance, covering up to 24 one-way trips per year with prior authorization. Ambulance services, including both ground and air transportation, are not covered under this plan.
Emergency Services See details
PMC Premier Platino (HMO D-SNP) covers emergency and urgently needed services with no copay and no coinsurance. Worldwide emergency and urgent care are partially covered with a $75 copay, no coinsurance, and a $500 maximum limit, but worldwide emergency transportation is not covered.
Primary Care See details
PMC Premier Platino (HMO D-SNP) covers primary care, specialist, therapy, podiatry, telehealth, and opioid treatment services with no copay and no coinsurance. Chiropractic services are partially covered with no copay and no coinsurance, but other chiropractic services are not covered. For psychiatric and mental health specialty services, some services are covered, but individual and group sessions are not covered.
Preventive Services See details
Preventive services are partially covered by PMC Premier Platino (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required for some benefits. Covered services include health education, alternative therapies, and nutritional benefits, while annual physical exams, therapeutic massages, in-home safety assessments, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are partially covered by PMC Premier Platino (HMO D-SNP) with no copay or coinsurance, requiring prior authorization for covered services. This benefit includes one annual fitting evaluation and up to $2,500 every three years for prescription hearing aids, but does not cover routine hearing exams, OTC hearing aids, or inner, outer, and over-the-ear prescription hearing aid types.
Vision Services See details
PMC Premier Platino (HMO D-SNP) offers partially covered vision services with no copay and no coinsurance, though prior authorization is required. Covered benefits include contact lenses and eyeglasses (lenses and frames) up to a $600 annual maximum, while routine eye exams, other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered under PMC Premier Platino (HMO D-SNP), which offers Medicare dental, restorative, implants, and prosthodontics with no copay and no coinsurance, up to a $2,000 annual maximum with prior authorization. Preventive care (including exams, cleanings, and x-rays), endodontics, periodontics, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are partially covered by PMC Premier Platino (HMO D-SNP) with no copay and no coinsurance, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs are covered, but Medicare Part B chemotherapy/radiation drugs and other Medicare Part B drugs are not covered.
Dialysis Services See details
Dialysis Services are covered under the PMC Premier Platino (HMO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Medical Equipment See details
PMC Premier Platino (HMO D-SNP) covers Durable Medical Equipment (DME) with no copay and no coinsurance, subject to prior authorization. For prosthetics, medical supplies, and diabetic equipment, some services are covered with no copay and no coinsurance, but prosthetic devices, medical supplies, diabetic supplies, and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
PMC Premier Platino (HMO D-SNP) covers diagnostic and radiological services with no copay and no coinsurance, although prior authorization is required. While some services are covered, diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient x-rays are not covered.
Home Health Services See details
Home Health Services are covered by PMC Premier Platino (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under PMC Premier Platino (HMO D-SNP) because none of the individual sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are covered by the plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by PMC Premier Platino (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. While the plan does not require a prior three-day inpatient hospital stay, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
PMC Premier Platino (HMO D-SNP) covers acupuncture, chronic illness meals, and over-the-counter (OTC) items with no copay and no coinsurance. OTC items are partially covered, as the plan does not cover Naloxone or all drugs on the CMS OTC list.
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