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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 2025, 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 out of 5 stars in 2025.
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 $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 no drug deductible. Your prescription medication coverage will start immediately.
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 Brillante (HMO-POS) plan has an "Enhanced Alternative" drug benefit type with no deductible. In the initial coverage phase, you'll pay no copay for preferred generic drugs at a preferred pharmacy, $10 for standard generic drugs, and $40 for preferred brand drugs. For non-preferred drugs, you'll pay 33% coinsurance. For specialty tier drugs, you'll have no copay at a preferred pharmacy and a $3 copay at a standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, your premium may be reduced.
Additional Benefits
The Brillante (HMO-POS) plan offers a range of benefits, including inpatient hospital stays with a $50 copay per admission, outpatient services with varying copays, and emergency services with a $50 copay. The plan also covers ambulance services, offering ground and air ambulance with a $65 copay, and transportation services for up to 20 one-way trips per year. This plan provides coverage for primary care, specialist visits, mental health, and other services like podiatry and chiropractic care, with copays ranging from $0 to $15. It also includes preventive services with no copay, hearing and vision coverage, and dental services with prior authorization required for some services. Additionally, the plan covers home infusion services, dialysis, medical equipment, and diagnostic services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. The Inpatient Hospital-Acute benefit has a copay of $50 per admission or stay, and the Additional Days and Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. For outpatient hospital services, the copay is $25-$50, and for ambulatory surgical center services, the copay is $25. Individual and group sessions for outpatient substance abuse have a $5 copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Brillante (HMO-POS) plan, but requires prior authorization. The plan does not provide any additional information about the cost of this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Brillante (HMO-POS) plan. Ground and air ambulance services have a $65 copay, and transportation services to any health-related location are covered for up to 20 one-way trips per year.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered under the Brillante (HMO-POS) plan. Emergency Services have a $50 copay and no coinsurance, while Urgently Needed Services have no copay and no coinsurance. Worldwide Emergency Services are covered, but have a maximum benefit coverage amount of $75. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Brillante (HMO-POS) plan covers primary care physician services, chiropractic services with a $5 copay, occupational therapy services with no copay or coinsurance, physician specialist services with a $5-$15 copay, mental health specialty services with a $5 copay for individual and group sessions, podiatry services, other health care professional services with a $5-$15 copay, psychiatric services with a $5 copay for individual and group sessions, physical therapy and speech-language pathology services with no copay or coinsurance, additional telehealth benefits with a $0-$15 copay, and opioid treatment program services with no copay. Routine chiropractic care is limited to 5 visits per year.
Preventive Services See details
Preventive Services are covered by the Brillante (HMO-POS) plan, with no copay for Medicare-covered preventive services. 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 Benefit, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications are not covered. Alternative Therapies, Nutritional/Dietary Benefit, Counseling Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered.
Hearing Services See details
The Brillante (HMO-POS) plan covers hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, with 1 visit per year for each service. Prescription hearing aids are covered up to a maximum of $1500 every year, however, inner ear, outer ear, and over the ear hearing aids are not covered, and neither are OTC hearing aids.
Vision Services See details
The Brillante (HMO-POS) plan covers vision services, including routine eye exams once per year and other eye exam services once per year. The plan also covers eyewear with a combined maximum benefit of $500 per year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The Brillante (HMO-POS) plan covers various dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, with prior authorization required for some. Orthodontic services have a maximum plan benefit of $2500 per year, and maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Brillante (HMO-POS) plan, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. The coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Brillante (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits for the Brillante (HMO-POS) plan include Durable Medical Equipment (DME) with a coinsurance between 0% and 10%, and Prosthetics/Medical Supplies with a coinsurance for Medicare-covered devices and supplies. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services includes coverage for all diagnostic services with no copay and up to 20% coinsurance, and diagnostic radiological services with a copay up to $75.00. Therapeutic Radiological Services and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Brillante (HMO-POS) 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 not covered by the Brillante (HMO-POS) plan, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. 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 and non-Medicare-covered stays for SNF are not covered. Prior authorization is required.
Other Services See details
The "Brillante (HMO-POS)" plan covers acupuncture with a limit of 12 treatments per year, and it also covers over-the-counter (OTC) items up to $25 every three months, including nicotine replacement therapy and naloxone, but does not cover all drugs on the CMS OTC list. This plan does not cover meal benefits, and other additional services such as 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.
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