A non-government entity
Brillante (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Brillante (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Brillante (HMO-POS) in 2026, please refer to our full plan details page.
Brillante (HMO-POS) is a HMO-POS 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 4.5 out of 5 stars in 2026.
It's important to know that Brillante (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Brillante (HMO-POS).
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 Brillante (HMO-POS), 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4200.00 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 Brillante (HMO-POS) Medicare plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 (Preferred Generic), Tier 2 (Generic), and Tier 6 (Select Care Drugs), there is no copay for a 1-month or 3-month supply when using a preferred pharmacy or standard mail order. If you choose a standard pharmacy, these tiers carry low copays ranging from $3 to $10 for a 1-month supply. Brand-name and specialty medications under this plan have structured cost-sharing depending on your pharmacy choice. Tier 3 (Preferred Brand) drugs cost $25 at preferred pharmacies and $45 at standard pharmacies for a 1-month supply, while Tier 4 (Non-Preferred Brand) drugs require a $40 or $60 copay respectively. High-cost Tier 5 (Specialty) drugs require a 33% coinsurance across all pharmacy options.
Additional Benefits
The Brillante (HMO-POS) plan offers comprehensive medical coverage with minimal out-of-pocket costs, featuring no copays and no coinsurance for primary care, preventive services, and home health care. Specialist visits and outpatient hospital services are highly affordable, requiring only low copays ranging from no copay up to $50 with no coinsurance. Inpatient hospital stays are covered with a simple $50 copay per admission, while emergency room visits carry a $50 copay that is waived if you are admitted. This plan also provides robust routine benefits, including dental, vision, and hearing services with no copays or coinsurance, subject to generous annual maximum allowances. Additionally, members can take advantage of up to 20 free one-way transportation trips per year and a $25 quarterly allowance for over-the-counter items with no copay. Essential medical needs like diagnostic testing and skilled nursing facility care are also covered with no copays and no coinsurance.
Inpatient Hospital See details
Brillante (HMO-POS) covers inpatient acute hospital stays with a $50 copay per admission and no coinsurance, while inpatient psychiatric stays are covered with no copay and no coinsurance. Unlimited additional days are covered for acute stays, but upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Brillante (HMO-POS) covers outpatient hospital services with a $25 to $50 copay and ambulatory surgical center services with a $25 copay, both featuring no coinsurance. Outpatient blood services are covered with no copay, deductible, or coinsurance, and while some outpatient substance abuse services are covered with no copay or coinsurance, individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization is covered by Brillante (HMO-POS) with no copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Brillante (HMO-POS) partially covers ambulance and transportation services, requiring prior authorization for these benefits. Ground and air ambulance services require a $65 copay and no coinsurance, while up to 20 yearly one-way transportation trips to any health-related location are covered with no copay and no coinsurance, though transportation to plan-approved health-related locations is not covered.
Emergency Services See details
Emergency services are covered by Brillante (HMO-POS) with a $50 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services have no copay and no coinsurance, while worldwide emergency and urgent care are partially covered with no copay or coinsurance up to a $75 maximum benefit, excluding worldwide emergency transportation.
Primary Care See details
Brillante (HMO-POS) covers primary care, occupational and physical therapy, podiatry, and opioid treatment with no copay and no coinsurance, while specialist and telehealth services require a $0 to $15 copay and no coinsurance. Chiropractic care is partially covered with a $0 to $5 copay and no coinsurance for up to 5 routine visits annually, but other chiropractic services are not covered. For mental health and psychiatric specialty services, some services are covered, but individual and group sessions are not covered.
Preventive Services See details
Preventive services are covered by Brillante (HMO-POS) with no copay and no coinsurance, though this benefit is only partially covered. Covered services include Medicare-approved preventive care and alternative therapies, while annual physical exams, fitness benefits, and in-home safety assessments are not covered.
Hearing Services See details
Brillante (HMO-POS) covers annual routine hearing exams and fitting evaluations with no copay, no coinsurance, and no deductible. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,250 annual maximum, though inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision services are covered by Brillante (HMO-POS) with no copay, no coinsurance, and no deductible for annual routine eye exams and eyewear exams. Eyewear, including contacts and eyeglasses, is also covered with no copay or coinsurance up to a $300 yearly maximum benefit.
Dental Services See details
Brillante (HMO-POS) dental services are partially covered with no copay and no coinsurance for all covered preventive and comprehensive treatments, though a $2,000 annual maximum applies to comprehensive care. Implant services, maxillofacial prosthetics, and orthodontics are not covered, and prior authorization is required for certain services.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Brillante (HMO-POS) with no copay, though prior authorization and step therapy are required. Medicare Part B insulin is covered with no copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Brillante (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Brillante (HMO-POS) covers medical equipment with no copay, featuring coinsurance ranging from no coinsurance up to 10% for durable medical equipment and medical supplies, and up to 20% for prosthetics. For diabetic equipment, some services are covered with no copay and no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by Brillante (HMO-POS), offering covered diagnostic procedures, lab services, and diagnostic radiological services with no copay and no coinsurance, subject to prior authorization. Therapeutic radiological services and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered by Brillante (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Brillante (HMO-POS) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD services are all not covered.
Skilled Nursing Facility (SNF) See details
Brillante (HMO-POS) covers Skilled Nursing Facility (SNF) services per admission with no copay and no coinsurance, although prior authorization and a prior three-day inpatient hospital stay are required. Additional days beyond Medicare-covered SNF stays are not covered.
Other Services See details
Other services are partially covered by Brillante (HMO-POS) with no copay and no coinsurance, including up to 12 acupuncture treatments per year and a $25 quarterly allowance for over-the-counter items. Meal benefits and other additional services are not covered under this plan.
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