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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 deductible of $590.00. After the deductible is met, the plan provides drug coverage. If you qualify for the low-income subsidy (LIS), you will have no copay for Part D drugs. After your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The PLATINO ADVANCE (HMO D-SNP) plan offers a wide range of benefits, including coverage for inpatient and outpatient services, ambulance and transportation, emergency services, and primary care. There is no copay for ambulance services, emergency services, and transportation services, and also for home health services. The plan also covers hearing services, vision services, and dental services, with specific limits and exclusions for each. Other key benefits include coverage for partial hospitalization, home infusion, dialysis, medical equipment, and skilled nursing facility services. However, it's important to note that diagnostic and radiological services, as well as cardiac rehabilitation services, are not covered. The plan also provides coverage for acupuncture, limited to 12 treatments per year.
Inpatient Hospital See details
Inpatient Hospital benefits with PLATINO ADVANCE (HMO D-SNP) include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. 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 are covered, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient blood services. Outpatient substance abuse services are partially covered, as individual and group sessions for outpatient substance abuse are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the PLATINO ADVANCE (HMO D-SNP) plan, but requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered. 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 with no copay or coinsurance, with up to 12 one-way trips per year via taxi, rideshare services, or medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage are covered with no copay and no coinsurance, while Worldwide Emergency Transportation is not covered. Worldwide Emergency Services has a maximum plan benefit coverage of $75.
Primary Care See details
The PLATINO ADVANCE (HMO D-SNP) plan covers 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. Chiropractic Services offers 5 visits per year, and Podiatry Services offers 4 visits per year. Mental Health Specialty Services, including individual and group sessions, are not covered. Individual and group sessions for Psychiatric Services are also not covered.
Preventive Services See details
Preventive Services are covered, but 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 benefits, enhanced disease management, telemonitoring services, and home and bathroom safety devices and modifications are not covered. The plan covers Health Education, Alternative Therapies (12 visits), Nutritional/Dietary Benefits (12 visits), Counseling Services, Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing Services include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. The plan covers one routine hearing exam per year, and fitting/evaluation for hearing aids with no copay or coinsurance. Prescription hearing aids are covered up to a maximum of $300 per year. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered, nor are OTC hearing aids.
Vision Services See details
The PLATINO ADVANCE (HMO D-SNP) plan covers vision services, including eye exams and eyewear. Eyewear has a combined maximum plan benefit coverage of $300.00 every year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are unlimited.
Dental Services See details
The PLATINO ADVANCE (HMO D-SNP) plan covers 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 ADVANCE (HMO D-SNP) plan, including Medicare Part B Insulin Drugs. However, Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered with this plan.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 0% to 5% coinsurance and no copay, Prosthetics/Medical Supplies with a coinsurance for Medicare-covered items 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 not covered by the PLATINO ADVANCE (HMO D-SNP) plan. All diagnostic and radiological services, including diagnostic procedures/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 by the PLATINO ADVANCE (HMO D-SNP) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but not in practice. None of the sub-services, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the PLATINO ADVANCE (HMO D-SNP) plan, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required for this benefit.
Other Services See details
Other Services include acupuncture, which is limited to 12 treatments per year, while over-the-counter items, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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