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PLATINO ADVANCE (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PLATINO ADVANCE (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 ADVANCE (HMO D-SNP) in 2025, please refer to our full plan details page.
PLATINO ADVANCE (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 ADVANCE (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 ADVANCE (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 ADVANCE (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 ADVANCE (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 $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 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 ADVANCE (HMO D-SNP) plan has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy (LIS), your cost for Part D drugs is $0. After you meet your deductible, you will enter the initial coverage phase, where 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 costs, you enter the catastrophic coverage phase and will pay nothing for Part D covered drugs.
Additional Benefits
The PLATINO ADVANCE (HMO D-SNP) plan provides comprehensive coverage, including inpatient and outpatient services, with no copay for emergency, ambulance, and transportation services. The plan also offers coverage for primary care, preventive services, hearing, vision, dental, home infusion, dialysis, and medical equipment. While some benefits may require prior authorization, the plan aims to provide a wide range of healthcare services with various cost-sharing structures, including coinsurance for medical equipment and a maximum annual benefit for dental services.
Inpatient Hospital See details
The PLATINO ADVANCE (HMO D-SNP) plan covers Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, but does not specify the cost sharing. Additional Days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services. Outpatient substance abuse services are covered, but individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization is covered by the PLATINO ADVANCE (HMO D-SNP) plan, but requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by PLATINO ADVANCE (HMO D-SNP). All Ambulance Services are covered with no copay or coinsurance, but Ground and Air Ambulance Services are not covered. Transportation Services to any health-related location are covered for up to 12 one-way trips per year with no copay or coinsurance, and can include taxi, rideshare services, and medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the PLATINO ADVANCE (HMO D-SNP) plan, with no copay or coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The PLATINO ADVANCE (HMO D-SNP) plan covers primary care physician services, chiropractic services (with a doctor referral), occupational therapy, physician specialist services (with prior authorization and a doctor referral), podiatry services (with a doctor referral), other health care professional services (with prior authorization and a doctor referral), psychiatric services, physical therapy, speech-language pathology services (with prior authorization), additional telehealth benefits (with a doctor referral), and opioid treatment program services. Individual and group sessions for Mental Health Specialty Services and Psychiatric Services are not covered. Routine Chiropractic Care is covered for 5 visits per year.
Preventive Services See details
Preventive Services are covered, with some services not covered, including 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, Enhanced Disease Management, Telemonitoring Services, and Home and Bathroom Safety Devices and Modifications. Health Education, Alternative Therapies (up to 12 visits), Nutritional/Dietary Benefit (up to 12 sessions), Counseling Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered.
Hearing Services See details
Hearing services include coverage for hearing exams, routine hearing exams, and fitting/evaluation for hearing aids, with no copay or coinsurance. Prescription hearing aids are covered up to a maximum of $300 per year, but prescription hearing aids for the inner, outer, or over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The PLATINO ADVANCE (HMO D-SNP) plan covers vision services, including routine eye exams with one visit per year, and other eye exam services with one visit per year. Eyewear benefits are covered, with a combined maximum benefit of $300 per year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental services are covered, with a maximum plan benefit of $1,750 per year. The plan covers Medicare Dental Services, Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery, but not Maxillofacial Prosthetics, Implant Services, or Orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the PLATINO ADVANCE (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 this benefit.
Dialysis Services See details
Dialysis Services are covered with this plan. There is no copay or coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0% to 5% coinsurance and no copay, Prosthetics/Medical Supplies with 0% to 5% coinsurance and no copay, and Diabetic Equipment. 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 covered by the PLATINO ADVANCE (HMO D-SNP) plan, but no services are covered. There is no copay for these services.
Home Health Services See details
Home Health Services are covered by the PLATINO ADVANCE (HMO D-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
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 Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but additional days beyond Medicare coverage and non-Medicare-covered stays are not covered. Prior authorization is required.
Other Services See details
Other Services includes acupuncture, which is limited to 12 treatments per year, but the other services are not covered.
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