A non-government entity
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:
Sign up for PLATINO ADVANCE (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The PLATINO ADVANCE (HMO D-SNP) prescription drug coverage includes an annual drug deductible of $615. This means you will pay the full cost of your covered medications up to this amount before your plan benefits kick in. Specific drug tier details, such as copays and coinsurance for generic or brand-name drugs, are not available for this plan. For complete formulary information and to see how your specific medications are covered under this deductible, please contact the plan provider directly.
Additional Benefits
The PLATINO ADVANCE (HMO D-SNP) plan offers comprehensive medical coverage with no copays, no deductibles, and no coinsurance for most primary care, specialist visits, inpatient hospital stays, and outpatient services. Members also benefit from no-cost emergency services, dialysis, home health care, and up to 12 one-way transportation trips per year to health-related locations. For supplemental care, the plan provides vision coverage with no copay and a $300 annual eyewear allowance, alongside hearing services that include routine exams and up to a $325 annual hearing aid benefit. Dental care is covered with no copay up to a $1,200 annual limit, and durable medical equipment is available with no copay, though certain medical supplies and over-the-counter items are not covered.
Inpatient Hospital See details
PLATINO ADVANCE (HMO D-SNP) covers inpatient hospital services, including acute and psychiatric stays, with no copay and no coinsurance. This benefit is partially covered as upgrades, non-Medicare-covered stays, and additional days for psychiatric stays are not covered.
Outpatient Services See details
Outpatient services are covered by PLATINO ADVANCE (HMO D-SNP) with no copay and no coinsurance for outpatient hospital, ambulatory surgical center, and blood services. For outpatient substance abuse, some services are covered but individual and group sessions are not covered.
Partial Hospitalization See details
PLATINO ADVANCE (HMO D-SNP) covers partial hospitalization benefits with no copay and no coinsurance, though prior authorization is required for certain services.
Ambulance and Transportation Services See details
PLATINO ADVANCE (HMO D-SNP) offers ambulance and transportation benefits with no copay and no coinsurance, although some ambulance services are covered but ground and air ambulance services are not covered. Transportation services are partially covered, providing up to 12 yearly one-way trips to any health-related location via taxi, rideshare, or medical transport, while plan-approved health-related locations are not covered.
Emergency Services See details
PLATINO ADVANCE (HMO D-SNP) covers emergency and urgently needed services with no copay and no coinsurance. Worldwide emergency and urgent services are partially covered with no copay and no coinsurance up to a $75 maximum, though worldwide emergency transportation is not covered.
Primary Care See details
PLATINO ADVANCE (HMO D-SNP) covers primary care, specialist, therapy, podiatry, and telehealth services with no copay and no coinsurance. Chiropractic care is partially covered with no copay and no coinsurance, but other chiropractic services are not covered. For mental health and psychiatric benefits, some services are covered with no copay and no coinsurance, but individual and group sessions are not covered.
Preventive Services See details
PLATINO ADVANCE (HMO D-SNP) partially covers preventive services with no copay and no coinsurance for covered care such as kidney disease education, counseling, and diabetes self-management. However, several services are not covered under this plan, including annual physical exams, fitness benefits, weight management programs, and in-home safety assessments.
Hearing Services See details
PLATINO ADVANCE (HMO D-SNP) hearing services are covered with no copay and no coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $325 annual limit, while OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
PLATINO ADVANCE (HMO D-SNP) covers vision services with no copays, no coinsurance, and no deductibles for both eye exams and eyewear. This benefit includes one routine eye exam and one eyewear exam per year, as well as a $300 annual allowance for contact lenses, eyeglasses, frames, and upgrades.
Dental Services See details
PLATINO ADVANCE (HMO D-SNP) offers partially covered dental services with no copay and no coinsurance up to a $1,200 annual limit for covered benefits like restorative, endodontics, periodontics, prosthodontics, and oral surgery. Diagnostic and preventive services (including oral exams, cleanings, x-rays, and fluoride), implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
PLATINO ADVANCE (HMO D-SNP) partially covers home infusion bundled services with no copay and no coinsurance, though prior authorization and step therapy are required. While Part D home infusion drugs and Part B insulin are covered at no cost, Medicare Part B chemotherapy, radiation, and other Part B drugs are not covered under this benefit.
Dialysis Services See details
Dialysis Services are covered by PLATINO ADVANCE (HMO D-SNP) with no copay and no coinsurance. This benefit ensures that eligible members can receive necessary dialysis treatments without any additional copayment or coinsurance costs.
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, and prosthetic devices with no copay and 0% to 5% coinsurance. Medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered under this plan, and prior authorization is required for covered items.
Diagnostic and Radiological Services See details
Diagnostic and Radiological 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, diagnostic procedures and tests, lab services, diagnostic and therapeutic radiological services, and outpatient X-ray services are not covered.
Home Health Services See details
PLATINO ADVANCE (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
PLATINO ADVANCE (HMO D-SNP) covers Cardiac Rehabilitation Services with no copay and no coinsurance, subject to prior authorization, though only some services are covered as Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are partially covered by PLATINO ADVANCE (HMO D-SNP) with no copay and no coinsurance, though prior authorization and a prior three-day inpatient hospital stay are required. Additional days beyond the Medicare-covered limit are not covered, and there is no cost-sharing on the day of discharge.
Other Services See details
PLATINO ADVANCE (HMO D-SNP) partially covers other services, offering 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 under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved