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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 2026, 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 4.5 out of 5 stars in 2026.
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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 ADVANCE (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. This deductible is the amount you must pay out-of-pocket for your covered medications before the plan begins to pay its share of the costs. Specific details regarding drug coverage tiers, copayments, and coinsurance are currently unavailable for this plan. To determine your exact out-of-pocket costs for specific prescriptions, it is recommended to consult the plan's formulary or contact the provider directly.
Additional Benefits
The PLATINO ADVANCE (HMO D-SNP) Medicare plan offers comprehensive medical coverage with no copay and no coinsurance for most essential services. This includes inpatient and outpatient hospital stays, primary and specialist care, preventive services, and home health care. Additionally, members can access skilled nursing facility care, emergency services, and dialysis without worrying about copays or coinsurance. For specialty care, the plan provides partial coverage for vision, dental, and hearing services with no copay or coinsurance, though annual spending limits apply, such as a $300 vision allowance and a $1,200 dental limit. Vision benefits also feature no deductible, while other perks like up to 12 one-way transportation trips and acupuncture treatments are included with no copay. However, some common benefits like over-the-counter items, meals, and routine dental cleanings are not covered under this plan.
Inpatient Hospital See details
PLATINO ADVANCE (HMO D-SNP) covers inpatient hospital acute and psychiatric stays with no copay and no coinsurance. The benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional days for psychiatric care are not covered.
Outpatient Services See details
PLATINO ADVANCE (HMO D-SNP) covers outpatient hospital, ambulatory surgical center, and blood services with no copay and no coinsurance. For outpatient substance abuse, some services are covered but individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization is covered under the PLATINO ADVANCE (HMO D-SNP) plan with no copay and no coinsurance, though prior authorization is required for these services.
Ambulance and Transportation Services See details
PLATINO ADVANCE (HMO D-SNP) offers transportation services with no copay and no coinsurance for up to 12 one-way trips per year to health-related locations via taxi, rideshare, or medical transport. While ambulance services are technically covered with no copay and no coinsurance, ground and air ambulance services are not covered.
Emergency Services See details
Emergency services under PLATINO ADVANCE (HMO D-SNP) are covered with no copay and no coinsurance for emergency and urgently needed services. Worldwide emergency and urgent care are also covered with no copay or coinsurance up to a $75 maximum limit, though this benefit is partially covered as worldwide emergency transportation is not covered.
Primary Care See details
PLATINO ADVANCE (HMO D-SNP) offers primary care, specialist visits, therapy, and telehealth services with no copay and no coinsurance. Chiropractic care is partially covered with no copay or coinsurance for up to 5 routine visits per year (other chiropractic services are not covered), and while some psychiatric and mental health services are covered, individual and group sessions are not.
Preventive Services See details
Preventive services are partially covered under the PLATINO ADVANCE (HMO D-SNP) plan with no copay and no coinsurance. Covered benefits include Medicare-covered preventive services, kidney disease education, alternative therapies, and nutritional counseling, while annual physical exams, fitness benefits, weight management programs, therapeutic massage, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by PLATINO ADVANCE (HMO D-SNP), offering no copay and no coinsurance for one routine hearing exam and one fitting evaluation annually. Prescription hearing aids are covered up to a $325 annual limit with no copay and no coinsurance, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
PLATINO ADVANCE (HMO D-SNP) covers vision services with no copay, no coinsurance, and no deductible, including one routine eye exam and one eyewear exam per year. Covered eyewear, including contact lenses, eyeglasses, and upgrades, also features no copay, no coinsurance, and no deductible, up to a combined maximum benefit of $300 annually.
Dental Services See details
PLATINO ADVANCE (HMO D-SNP) dental services are partially covered, offering Medicare-covered and select comprehensive services with no copay and no coinsurance up to a $1,200 yearly limit, subject to prior authorization. Preventive services like oral exams, cleanings, x-rays, and fluoride are not covered, nor are implants, orthodontics, or maxillofacial prosthetics.
Home Infusion bundled Services See details
PLATINO ADVANCE (HMO D-SNP) partially covers Home Infusion bundled Services with no copay and no coinsurance, although prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs are covered, but Medicare Part B chemotherapy or radiation drugs and other Part B drugs are not covered.
Dialysis Services See details
Dialysis Services are covered by PLATINO ADVANCE (HMO D-SNP) with no copay and no coinsurance.
Medical Equipment See details
PLATINO ADVANCE (HMO D-SNP) partially covers medical equipment, offering durable medical equipment and diabetic equipment with no copay and no coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered. Prosthetic devices are covered with no copay and 0% to 5% coinsurance, while medical supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the PLATINO ADVANCE (HMO D-SNP) plan 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
Home Health Services are covered under the PLATINO ADVANCE (HMO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by PLATINO ADVANCE (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. While some services are covered, the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
PLATINO ADVANCE (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance per stay, requiring prior authorization and a prior three-day inpatient hospital stay. Additional days beyond Medicare-covered limits are not covered, and no cost-sharing is charged on the day of discharge.
Other Services See details
PLATINO ADVANCE (HMO D-SNP) offers partial coverage for other services, providing acupuncture with no copay and no coinsurance for up to 12 treatments per year. Over-the-counter (OTC) items and meal benefits are not covered.
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