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Platino Blindao (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Platino Blindao (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Platino Blindao (HMO D-SNP) in 2025, please refer to our full plan details page.
Platino Blindao (HMO D-SNP) is a HMO D-SNP plan offered by Guidewell Mutual Holding Corporation 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 Platino Blindao (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:
Platino Blindao (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 Platino Blindao (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 Platino Blindao (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 $50.00. 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 $3650.00 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 Platino Blindao (HMO D-SNP) plan has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy, you will pay no copay for Part D drugs. After your deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000. Once you reach $2000 in out-of-pocket drug costs, you will pay nothing for Part D covered drugs.
Additional Benefits
The Platino Blindao (HMO D-SNP) plan offers a wide range of benefits with varying cost structures. It covers inpatient and outpatient services, including emergency care with no copay. Additional benefits include coverage for hearing, vision, and dental services. This plan provides coverage for ambulance services with no copay, and transportation to health-related locations up to 14 one-way trips per year. It also includes coverage for primary care, preventive services, and home health services. However, it's important to note that some services may require prior authorization, and certain services, such as some dental, vision, and hearing services, have annual limits.
Inpatient Hospital See details
Inpatient Hospital benefits are covered for Platino Blindao (HMO D-SNP), including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient Services are covered, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services. Outpatient Substance Abuse Services are partially covered, but Individual Sessions and Group Sessions are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Platino Blindao (HMO D-SNP) plan, but requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by the Platino Blindao (HMO D-SNP) plan, with no copay or coinsurance for ambulance services. Ground and air ambulance services are not covered, while transportation services to any health-related location are covered for up to 14 one-way trips per year using taxi, rideshare services, or medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage are covered with no copay and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Platino Blindao (HMO D-SNP) plan covers primary care physician services, chiropractic services (5 visits per year), occupational therapy services (no copay, no coinsurance), physician specialist services (requires prior authorization and referral), podiatry services (4 visits per year), physical therapy and speech-language pathology services (no copay, no coinsurance, requires authorization), additional telehealth benefits, and opioid treatment program services. Mental health specialty services and psychiatric services are partially covered, with individual and group sessions not covered.
Preventive Services See details
Preventive Services are covered by the Platino Blindao (HMO D-SNP) plan, but 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, additional sessions of smoking and tobacco cessation counseling, fitness benefits, enhanced disease management, telemonitoring services, and home and bathroom safety devices and modifications are not covered. The plan covers alternative therapies for 12 visits, counseling services with no copay, and nutritional/dietary benefits for 12 individual sessions.
Hearing Services See details
The Platino Blindao (HMO D-SNP) plan covers hearing exams, routine hearing exams (1 per year), and fitting/evaluation for hearing aids (1 per year). Prescription hearing aids are covered up to $300 per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Platino Blindao (HMO D-SNP) plan covers vision services, including eye exams and eyewear. Eye exams include one routine eye exam and one "Other Eye Exam" per year. Eyewear benefits include contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum benefit of $325 per year.
Dental Services See details
The Platino Blindao (HMO D-SNP) plan covers dental services, with an annual maximum benefit of $1,500. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery are covered, but Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Platino Blindao (HMO D-SNP) plan and require prior authorization. Medicare Part B Insulin Drugs are covered, while Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered by the Platino Blindao (HMO D-SNP) plan. There is no specific cost information provided for this benefit.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0% to 5% coinsurance, and Prosthetics/Medical Supplies with 0% to 5% coinsurance for Medicare-covered items, but Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Platino Blindao (HMO D-SNP) plan, but some services are not covered. There is no copay for these services, but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Platino Blindao (HMO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but not in practice, as Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered SNF services, and non-Medicare-covered SNF stays are not covered. Prior authorization is required.
Other Services See details
The Platino Blindao (HMO D-SNP) plan covers acupuncture with a limit of 12 treatments per year. Other services such as over-the-counter items, meal benefits, and several other services are not covered.
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