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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 2026, 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 4.5 out of 5 stars in 2026.
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 $615.00 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) Medicare Advantage plan features an annual prescription drug deductible of $615. This deductible is the amount you must pay out-of-pocket for your medications before your plan coverage begins to pay. Knowing this deductible amount helps you estimate your initial yearly healthcare expenses and plan your budget. Specific drug tier details, including individual copayments and coinsurance rates for different medication levels, are not available for this plan. To verify if your specific prescriptions are covered and to estimate your ongoing costs, you should consult the plan's official drug list or formulary.
Additional Benefits
The Platino Enlace (HMO D-SNP) plan offers comprehensive medical coverage with no copay and no coinsurance for most core services, including inpatient hospital stays, primary care, specialist visits, and outpatient care. Members also benefit from no copay and no coinsurance for dialysis, home health, and skilled nursing facility care, though prior authorization is required for several services. This plan minimizes out-of-pocket expenses by ensuring there is no deductible for key benefits like routine vision care. Supplemental benefits are also highly accessible, featuring no copay and no coinsurance for dental services up to a $1,500 annual limit and hearing aids up to a $500 annual maximum. Additionally, members can access up to 12 one-way transportation trips per year to health-related destinations and an over-the-counter allowance of up to $175 per month. While many services are covered at no cost, some specific exclusions apply, and prior authorization is necessary for certain dental, medical equipment, and diagnostic services.
Inpatient Hospital See details
Platino Enlace (HMO D-SNP) partially covers inpatient hospital services with no copay and no coinsurance, though prior authorization is required for acute care. While unlimited additional days are covered for acute stays, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Platino Enlace (HMO D-SNP) outpatient services, including outpatient hospital, ambulatory surgical center, and blood services, are covered with no copay and no coinsurance. For outpatient substance abuse services, some services are covered with no copay or coinsurance, but individual and group sessions are not covered.
Partial Hospitalization See details
Platino Enlace (HMO D-SNP) covers partial hospitalization services with no copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Platino Enlace (HMO D-SNP) covers transportation services to any health-related location with no copay and no coinsurance for up to 12 one-way trips per year using taxi, rideshare, or medical transport. For ambulance services, some services are covered with no copay and no coinsurance, but ground and air ambulance services are not covered.
Emergency Services See details
Platino Enlace (HMO D-SNP) partially covers emergency services with no copay and no coinsurance for emergency, urgently needed, and worldwide emergency and urgent care. Worldwide benefits are limited to a maximum of $75, and worldwide emergency transportation is not covered.
Primary Care See details
Platino Enlace (HMO D-SNP) provides primary care, specialist, therapy, and telehealth services with no copay and no coinsurance. Chiropractic care is partially covered, as other chiropractic services are not covered, while mental health and psychiatric benefits cover some services but exclude individual and group sessions. Routine podiatry is also covered for up to four visits per year with no copay and no coinsurance.
Preventive Services See details
Platino Enlace (HMO D-SNP) provides partial coverage for preventive services with no copay and no coinsurance, including Medicare-covered zero-dollar services, counseling, and nutritional benefits. However, several sub-services are not covered under this plan, such as annual physical exams, fitness benefits, weight management programs, therapeutic massages, and in-home safety assessments.
Hearing Services See details
Hearing services are partially covered by Platino Enlace (HMO D-SNP), offering annual routine exams, fitting evaluations, and prescription hearing aids with no copay and no coinsurance. While prescription hearing aids are covered up to a $500 annual maximum, OTC hearing aids and inner ear, outer ear, or over-the-ear prescription hearing aid types are not covered.
Vision Services See details
Platino Enlace (HMO D-SNP) covers vision services with no copay, no coinsurance, and no deductible, including one routine eye exam and one eyewear exam annually. Covered eyewear, such as contact lenses, eyeglasses, frames, and upgrades, is also available with no copay or coinsurance up to a $200 annual maximum allowance.
Dental Services See details
Platino Enlace (HMO D-SNP) dental services are partially covered with no copay and no coinsurance for Medicare-covered dental, restorative, endodontics, periodontics, prosthodontics, and oral surgery, up to a $1,500 annual maximum with prior authorization. Preventive and diagnostic services—including oral exams, cleanings, x-rays, and fluoride—along with implants, orthodontics, and maxillofacial prosthetics, are not covered.
Home Infusion bundled Services See details
Platino Enlace (HMO D-SNP) partially covers home infusion bundled services with no copay and no coinsurance, though prior authorization and step therapy are required. While Medicare Part B insulin drugs are covered with no copay and no coinsurance, Medicare Part B chemotherapy, radiation, and other Part B drugs are not covered.
Dialysis Services See details
Dialysis Services are covered under the Platino Enlace (HMO D-SNP) plan with no copay and no coinsurance.
Medical Equipment See details
Platino Enlace (HMO D-SNP) partially covers medical equipment, offering durable medical equipment and diabetic equipment with no copay, no coinsurance, and prior authorization. Prosthetic devices are covered with no copay and 0% to 5% coinsurance, while medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Platino Enlace (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. While some services are covered, diagnostic procedures and tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient x-ray services are not covered.
Home Health Services See details
Platino Enlace (HMO D-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to receive this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Platino Enlace (HMO D-SNP) with no copay and no coinsurance, subject to prior authorization. Although some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Platino Enlace (HMO D-SNP) covers Skilled Nursing Facility (SNF) services per admission with no copay and no coinsurance, though prior authorization and a prior three-day inpatient hospital stay are required. Additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Platino Enlace (HMO D-SNP) covers acupuncture and over-the-counter (OTC) items with no copay and no coinsurance, while meal benefits are not covered. Acupuncture is limited to 12 treatments per year, and the OTC benefit provides up to $175 per month for select health products.
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