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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 $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs, until your total drug costs reach $2000, at which point you will enter the next coverage phase. If you qualify for the low-income subsidy (LIS), also known as "Extra Help", your Part D costs will be $0. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for your Medicare Part D covered drugs.
Additional Benefits
The PLATINO ADVANCE (HMO D-SNP) plan offers a range of benefits with varying cost structures. Emergency Services and Dialysis Services have no copay, while many outpatient services, hearing, vision, and dental services are covered with a copay. The plan also covers services like home health and skilled nursing facility, but may have limitations on additional days or services not covered by Medicare.
Inpatient Hospital See details
Inpatient Hospital benefits for the PLATINO ADVANCE (HMO D-SNP) plan include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with the Inpatient Hospital-Acute including enhanced benefits and additional days. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient blood services, are covered by the PLATINO ADVANCE (HMO D-SNP) plan, with prior authorization required for outpatient hospital services, observation services, and ASC services. Outpatient Substance Abuse Services are partially covered, with individual and group sessions not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the PLATINO ADVANCE (HMO D-SNP) plan, but requires prior authorization. There is no information about the cost of the service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, but ground and air ambulance services are not covered. Transportation Services to any health-related location are covered for up to 12 one-way trips per year using a 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. Worldwide Emergency Transportation is not covered.
Primary Care See details
The PLATINO ADVANCE (HMO D-SNP) plan covers primary care, chiropractic, occupational therapy, physician specialist, podiatry, other healthcare professional, psychiatric, physical therapy, speech-language pathology, additional telehealth, and opioid treatment program services. Chiropractic services include routine chiropractic care with up to 5 visits per year, and podiatry services cover routine foot care with up to 4 visits per year. Mental health specialty services and psychiatric services do not cover individual or group sessions. Occupational Therapy Services and Physical Therapy and Speech-Language Pathology Services have no copay or coinsurance.
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. Additional preventive services include health education, alternative therapies (12 visits), nutritional/dietary benefit (12 visits), remote access technologies, counseling services (individual sessions, 20 minutes), glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit.
Hearing Services See details
Hearing services include coverage for hearing exams, with no copay, and routine hearing exams once per year. This plan also covers fitting/evaluation for hearing aids with no copay, as well as prescription hearing aids up to $300 per year. Prescription hearing aids for the inner ear, outer ear, and over-the-ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The PLATINO ADVANCE (HMO D-SNP) plan covers vision services, including routine eye exams and other eye exam services, with one visit per year. The plan also covers eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum benefit of $300 every year.
Dental Services See details
The PLATINO ADVANCE (HMO D-SNP) plan covers a variety of dental services, including Medicare Dental Services, Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery, with a maximum benefit of $1,750 per year, but does not cover Maxillofacial Prosthetics, Implant Services, or Orthodontics. Some services require prior authorization.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the PLATINO ADVANCE (HMO D-SNP) plan, with prior authorization required. Insulin and Medicare Part B Insulin Drugs are covered, while Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered with this plan. There is no copay or coinsurance for this benefit.
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, 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 covered by the PLATINO ADVANCE (HMO D-SNP) plan, but the plan does not cover 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 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 the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered stays, and non-Medicare-covered stays, are not covered. Prior authorization is required.
Other Services See details
Other Services include acupuncture, which is limited to 12 treatments per year. 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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