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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 2025, 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 4 out of 5 stars in 2025.
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 $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 PMC Premier Platino (HMO D-SNP) plan has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy (LIS), you will pay no copay for your prescriptions. Once you meet your deductible, you will enter the initial coverage phase and pay the costs for drugs in each tier until your total drug costs reach $2000. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The PMC Premier Platino (HMO D-SNP) plan offers a wide range of benefits, including inpatient and outpatient services, and coverage for primary care, preventive services, hearing, vision, dental, and home health services. Many services come with no copay, such as ambulance and transportation services, emergency services, primary care, preventive services, medical equipment, home health services, and skilled nursing facility services, while some services like worldwide urgent coverage have a copay. This plan also provides additional benefits like acupuncture, over-the-counter items, and a meal benefit for chronic illnesses. Vision services include eye exams and eyewear, with a combined annual maximum benefit. Dental services are covered, with a maximum annual benefit, and home infusion bundled services are included.
Inpatient Hospital See details
Inpatient Hospital benefits are covered for the PMC Premier Platino (HMO D-SNP) plan. Inpatient Hospital-Acute and Inpatient Hospital Psychiatric benefits are covered, but Additional Days, Non-Medicare-covered Stay, and Upgrades for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services and observation services, are covered. Ambulatory Surgical Center (ASC) Services are also covered, as are outpatient substance abuse services, though individual and group sessions for outpatient substance abuse, as well as outpatient blood services, are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization and a doctor's referral. The plan does not specify any cost for this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered with no copay or coinsurance, though ground and air ambulance services are not covered. Transportation services to a plan-approved health-related location are covered for 24 one-way trips per year with no copay or coinsurance, utilizing rideshare services, bus/subway, van, or medical transport, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage have no copay or coinsurance. Worldwide Urgent Coverage has a $75 copay, and Worldwide Emergency Transportation is not covered. Worldwide Emergency Services has a maximum plan benefit coverage amount of $500.
Primary Care See details
The PMC Premier Platino (HMO D-SNP) plan covers primary care physician services, chiropractic services (with a $750 annual maximum), occupational therapy services, physician specialist services, podiatry services (with 6 visits per year), other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services; however, individual and group sessions for mental health and psychiatric services are not covered. Occupational therapy and physical therapy services have no copay or coinsurance, but require prior authorization.
Preventive Services See details
The PMC Premier Platino (HMO D-SNP) plan covers Medicare-covered preventive services with no copay, and additional preventive services, including services not usually covered by Medicare, are also covered. Annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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, and telemonitoring services are not covered.
Hearing Services See details
Hearing Services include coverage for Hearing Exams, Fitting/Evaluation for Hearing Aid, and Prescription Hearing Aids (all types). 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 covered by the PMC Premier Platino (HMO D-SNP) plan and include coverage for eye exams and eyewear, with a combined maximum benefit of $600 per year for eyewear. Contact lenses and eyeglasses (lenses and frames) are also covered. Routine eye exams, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, including Medicare dental services, orthodontic services, restorative services, prosthodontics (removable and fixed), and implant services, with prior authorization required, and a maximum plan benefit of $2,000 per year. Adjunctive general services, endodontics, periodontics, maxillofacial prosthetics, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs. This plan does not have a service-specific maximum out-of-pocket cost. Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered under the PMC Premier Platino (HMO D-SNP) plan, but require prior authorization. There is no information about the cost of these services.
Medical Equipment See details
Medical Equipment benefits are covered under the PMC Premier Platino (HMO D-SNP) plan, including Durable Medical Equipment (DME) and Prosthetics/Medical Supplies with no copay or coinsurance, but Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. Diabetic Equipment requires prior authorization.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the PMC Premier 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 PMC Premier Platino (HMO D-SNP) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare coverage and non-Medicare-covered stays are not covered. Prior authorization is required, and there is no copay or coinsurance for covered services.
Other Services See details
The PMC Premier 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, as well as over-the-counter items with a maximum benefit of $200 every month, and a meal benefit for chronic illnesses. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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