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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 meeting the deductible, the plan covers the cost of your prescriptions. If you qualify for the low-income subsidy, your Part D costs are $0. After your total drug costs reach $2000.00, you enter the catastrophic coverage phase and pay nothing for your prescriptions.
Additional Benefits
The PLATINO ADVANCE (HMO D-SNP) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with no copay for emergency and dialysis services. It also provides hearing and vision benefits, covering routine exams and eyewear, and dental services including orthodontics. Additionally, the plan covers ambulance and transportation services, and offers some coverage for home health and home infusion services.
Inpatient Hospital See details
For the PLATINO ADVANCE (HMO D-SNP) plan, Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, along with Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient blood services. Outpatient substance abuse services are partially covered, but individual and group sessions for outpatient substance abuse 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 covered by the PLATINO ADVANCE (HMO D-SNP) plan, but Ground and Air Ambulance Services are not covered. Transportation Services to any health-related location are covered, with 12 one-way trips per year available via taxi, rideshare services, or 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 and no coinsurance, but Worldwide Emergency Transportation is not covered. Worldwide Emergency Services has a maximum plan benefit coverage of $75.00.
Primary Care See details
The PLATINO ADVANCE (HMO D-SNP) plan covers primary care physician services, chiropractic services (with a doctor referral, up to 5 visits per year), occupational therapy, physician specialist services (requiring prior authorization and a doctor referral), podiatry services (with a doctor referral, up to 4 visits per year), physical therapy and speech-language pathology services (requiring authorization), additional telehealth benefits (with a doctor referral), and opioid treatment program services. Mental health specialty services and psychiatric services are partially covered, with individual and group sessions not being 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 benefit, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications are not covered. Health education, alternative therapies (12 visits), nutritional/dietary benefits (12 sessions), remote access technologies, counseling services are covered. Other preventive services including 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 routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids up to a maximum of $300 per year for all types. This plan covers one routine hearing exam per year, and the fitting/evaluation for hearing aids is unlimited. Prescription hearing aids for the inner, outer, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
The PLATINO ADVANCE (HMO D-SNP) plan covers vision services, including eye exams and eyewear. Eyewear has a combined maximum benefit of $300.00 every year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
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, but Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered. Orthodontic services have a maximum plan benefit of $1750 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the PLATINO ADVANCE (HMO D-SNP) plan, including Medicare Part B Insulin Drugs. Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered with no copay and no coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0% to 5% coinsurance and no copay, Prosthetic Devices with 0% to 5% coinsurance and no copay, and Medical Supplies with 0% to 5% coinsurance and no copay. 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 under the PLATINO ADVANCE (HMO D-SNP) plan, but some services are not covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. There is no copay for the covered services.
Home Health Services See details
Home Health Services are covered by the PLATINO ADVANCE (HMO D-SNP) plan with no copay or coinsurance, but Additional Hours of Care and Personal Care Services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered. Prior authorization is required for this benefit.
Other Services See details
The PLATINO ADVANCE (HMO D-SNP) plan covers acupuncture, but only for 12 treatments per year. Other services, including over-the-counter items, meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and many others, are not covered.
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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.
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