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Platino Enlace (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Platino Enlace (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 Enlace (HMO D-SNP) in 2025, please refer to our full plan details page.
Platino Enlace (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 Enlace (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 Enlace (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 Enlace (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 Enlace (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 $15.00. 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 Enlace (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 your prescriptions. After the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you will enter the next coverage phase. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Platino Enlace (HMO D-SNP) plan offers a variety of health benefits, including coverage for inpatient and outpatient services, emergency services, primary care, preventive services, vision, dental, and home health services. Many services have no copay, such as ambulance services, emergency services, and dialysis services. This plan also includes additional benefits like hearing services, with coverage for routine exams and hearing aids up to $500 per year, and medical equipment. The plan also covers acupuncture, with a limit of 12 treatments per year, and over-the-counter (OTC) items up to $175.00 per month.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered by the Platino Enlace (HMO D-SNP) plan. 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, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services, are covered. Outpatient Substance Abuse Services are partially covered, with individual and group sessions not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. There is no information about the cost of this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Platino Enlace (HMO D-SNP) plan. All Ambulance Services are covered with no copay and no coinsurance, but Ground Ambulance Services and Air Ambulance Services are not covered. Transportation Services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Platino Enlace (HMO D-SNP) plan with no copay and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic services, podiatry services, and additional telehealth benefits require a doctor referral. Mental Health Specialty Services does not cover individual or group sessions. Individual and group sessions for psychiatric services are also not covered. Physical therapy and speech-language pathology services and occupational therapy services have no copay or coinsurance but require prior authorization. Routine Chiropractic Care is limited to 5 visits per year.
Preventive Services See details
The Platino Enlace (HMO D-SNP) plan's preventive services include coverage for Medicare-covered preventive services with no copay, as well as additional services. Some of these additional services, such as Health Education, Counseling Services, and Alternative Therapies, are covered. However, other services, including Annual Physical Exams and In-Home Safety Assessments, are not covered.
Hearing Services See details
Hearing services for Platino Enlace (HMO D-SNP) include routine hearing exams and fitting/evaluation for hearing aids, each covered for one visit per year. Prescription hearing aids are covered up to a maximum of $500 per year, while inner ear, outer ear, and over-the-ear prescription hearing aids, as well as OTC hearing aids, are not covered.
Vision Services See details
The Platino Enlace (HMO D-SNP) plan covers vision services, including routine eye exams with no deductible, and other eye exam services, with one visit allowed every year. Eyewear is covered with a combined maximum benefit of $200 per year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The Platino Enlace (HMO D-SNP) plan covers a variety of dental services, including Medicare Dental Services, Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Platino Enlace (HMO D-SNP) plan, including Medicare Part B Insulin Drugs, but Medicare Part B Chemotherapy/Radiation Drugs are not covered. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Platino Enlace (HMO D-SNP) plan. There is no copay or coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered by the Platino Enlace (HMO D-SNP) plan, including Durable Medical Equipment (DME) with a coinsurance between 0% and 5%, and Prosthetics/Medical Supplies with a coinsurance between 0% and 5%. 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 are technically covered, but none of the sub-services are covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. There is no copay for these services.
Home Health Services See details
Home Health Services are covered by the Platino Enlace (HMO D-SNP) plan, with no copay or coinsurance, though authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required.
Other Services See details
The Platino Enlace (HMO D-SNP) plan covers acupuncture with a limit of 12 treatments per year, and it does not have a maximum plan benefit coverage amount. This plan also covers over-the-counter (OTC) items, including nicotine replacement therapy and Naloxone, up to a maximum of $175.00 per month. Other services such as meal benefits, case management, and home and community-based services are not covered.
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