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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) Medicare plan has an annual prescription drug deductible of $615. You will need to pay this deductible amount out-of-pocket for your covered medications before your plan benefits begin to pay. Detailed information regarding drug coverage tiers, copayments, and coinsurance is not available for this plan. For specific cost-sharing details and to see which medications are covered, please refer directly to the plan's formulary.
Additional Benefits
The PLATINO ADVANCE (HMO D-SNP) Medicare plan offers comprehensive coverage with no copays and no coinsurance for most major medical services. Members can access inpatient and outpatient hospital stays, primary care, specialist visits, emergency care, and home health services without any out-of-pocket cost-sharing. Additionally, essential services like dialysis, diagnostic tests, and skilled nursing facility care are covered with no copay and no coinsurance. For supplemental care, this plan provides vision benefits with no copay, no coinsurance, and no deductible, alongside a $300 annual allowance for eyewear. Dental and hearing services are also covered with no copay or coinsurance, featuring a $1,200 annual limit for select dental treatments and a $325 annual maximum for prescription hearing aids. While durable medical equipment has no copay or coinsurance, prosthetics may require a minimal coinsurance of 0% to 5%.
Inpatient Hospital See details
PLATINO ADVANCE (HMO D-SNP) covers inpatient hospital acute and psychiatric stays with no copay and no coinsurance, though prior authorization is required for acute care. While unlimited additional days for acute care are covered, upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
PLATINO ADVANCE (HMO D-SNP) outpatient services are covered with no copay and no coinsurance, which includes outpatient hospital care, ambulatory surgical center services, and outpatient blood services. While some outpatient substance abuse services are covered with no copay or coinsurance, individual and group sessions are not covered.
Partial Hospitalization See details
PLATINO ADVANCE (HMO D-SNP) covers partial hospitalization services with no copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
PLATINO ADVANCE (HMO D-SNP) offers partially covered transportation services with no copay and no coinsurance for up to 12 one-way trips per year to any health-related location, though plan-approved health-related locations are excluded. Ambulance services are not covered under this plan.
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 or coinsurance up to a $75.00 maximum, but worldwide emergency transportation is not covered.
Primary Care See details
Primary care and specialist services under PLATINO ADVANCE (HMO D-SNP) are covered with no copay and no coinsurance. Chiropractic care is partially covered with no copay and no coinsurance for up to 5 routine visits yearly, but other chiropractic services are not covered. Some mental health and psychiatric services are covered with no copay and no coinsurance, though individual and group sessions are not covered.
Preventive Services See details
Preventive services are partially covered by PLATINO ADVANCE (HMO D-SNP) with no copay and no coinsurance for covered benefits, which include Medicare-covered preventive services, kidney disease education, counseling, and limited alternative therapies. However, annual physical exams, fitness benefits, in-home support, personal emergency response systems, and in-home safety assessments are not covered.
Hearing Services See details
PLATINO ADVANCE (HMO D-SNP) covers annual routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $325 annual maximum, though inner ear, outer ear, over the ear, and OTC 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 for both eye exams and eyewear. The plan 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 for Medicare-covered dental, restorative, endodontics, periodontics, prosthodontics, and oral surgery up to a $1,200 annual limit. Preventive services (including cleanings and exams), orthodontics, implants, and maxillofacial prosthetics are not covered, and prior authorization is required for covered services.
Home Infusion bundled Services See details
Home infusion bundled services are partially covered by PLATINO ADVANCE (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. While Part D home infusion drugs and Part B insulin are covered with no copay and no coinsurance, Medicare Part B chemotherapy, radiation, and other Part B drugs are not covered.
Dialysis Services See details
Dialysis Services are fully covered by the PLATINO ADVANCE (HMO D-SNP) Medicare plan with no copay and no coinsurance.
Medical Equipment See details
Medical equipment is covered by PLATINO ADVANCE (HMO D-SNP) with no copay and no coinsurance for durable medical equipment. Prosthetics and diabetic equipment are partially covered with no copay, featuring 0% to 5% coinsurance for prosthetics and no coinsurance for diabetic equipment, while medical supplies, diabetic supplies, and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
PLATINO ADVANCE (HMO D-SNP) covers diagnostic and radiological services with no copay and no coinsurance, subject to prior authorization. While some services are covered, diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays 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, though prior authorization is required.
Cardiac Rehabilitation Services See details
PLATINO ADVANCE (HMO D-SNP) covers some cardiac rehabilitation services with no copay and no coinsurance, subject to prior authorization. However, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by PLATINO ADVANCE (HMO D-SNP) with no copay and no coinsurance, though prior authorization and a three-day prior inpatient hospital stay are required. Additional days beyond the standard Medicare-covered limit are not covered, and no cost-sharing is charged on the day of discharge.
Other Services See details
PLATINO ADVANCE (HMO D-SNP) other services benefit partially covers acupuncture with no copay and no coinsurance for up to 12 treatments per year. Over-the-counter (OTC) items, meal benefits, and other supplemental services are not covered under this plan.
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* 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.
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