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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 features an annual prescription drug deductible of $615. This deductible represents the amount you must pay out-of-pocket for your medications before your plan coverage begins. Specific details regarding drug coverage tiers, copays, and coinsurance are not available for this plan. Knowing the annual deductible is a key factor in determining if this plan fits your prescription medication budget.
Additional Benefits
The PLATINO ADVANCE (HMO D-SNP) plan offers comprehensive medical coverage with virtually no out-of-pocket costs for its members. Beneficiaries enjoy no copays, no deductibles, and no coinsurance on primary care visits, specialist consultations, hospital stays, and home health services. While most durable medical equipment is also covered with no copay, prosthetic devices are a minor exception and may carry a coinsurance of up to five percent. In addition to standard medical care, this plan features several valuable supplemental benefits to help manage your health and wellness. Members receive routine vision care with no copay and up to a three hundred dollar annual allowance for eyewear, as well as up to twelve hundred dollars yearly for select dental services. The plan also includes no-copay hearing services with a three hundred twenty-five dollar annual hearing aid allowance, alongside twelve one-way transportation trips per year to health-related destinations.
Inpatient Hospital See details
PLATINO ADVANCE (HMO D-SNP) covers inpatient acute and psychiatric hospital services with no copay and no coinsurance, though prior authorization is required for acute care. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional days for psychiatric stays are not covered.
Outpatient Services See details
PLATINO ADVANCE (HMO D-SNP) offers outpatient hospital, ambulatory surgical center, and outpatient blood services with no copay and no coinsurance. While some outpatient substance abuse services are covered with no copay and no 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, though prior authorization is required for some services.
Ambulance and Transportation Services See details
PLATINO ADVANCE (HMO D-SNP) covers ambulance and transportation services with no copay and no coinsurance. While some ambulance services are covered, ground and air ambulance services are not covered under this plan, but members do receive up to 12 one-way transportation trips per year to any health-related location via taxi, rideshare, or medical transport.
Emergency Services See details
Emergency services and urgently needed services are covered by PLATINO ADVANCE (HMO D-SNP) with no copay and no coinsurance. Worldwide emergency and urgent services are partially covered with no copay or coinsurance up to a maximum benefit of $75, though worldwide emergency transportation is not covered.
Primary Care See details
Primary care benefits for PLATINO ADVANCE (HMO D-SNP) are covered with no copay and no coinsurance, including specialist, therapy, and telehealth services. Chiropractic and podiatry benefits are partially covered with no copay and no coinsurance, excluding other chiropractic services, while some mental health and psychiatric services are covered but individual and group sessions are not.
Preventive Services See details
PLATINO ADVANCE (HMO D-SNP) offers partially covered preventive services with no copay and no coinsurance for covered benefits like 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
Hearing services are partially covered by PLATINO ADVANCE (HMO D-SNP), offering no copay and no coinsurance for one routine hearing exam and one fitting evaluation per year. Prescription hearing aids are covered up to a $325 annual limit with no copay or coinsurance, though OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are covered by PLATINO ADVANCE (HMO D-SNP) with no copay, no coinsurance, and no deductible, which includes one routine eye exam and one eyewear exam every year. Eyewear, including contact lenses, eyeglasses, and upgrades, is also covered with no copay or coinsurance up to a combined maximum plan benefit of $300 per year.
Dental Services See details
PLATINO ADVANCE (HMO D-SNP) dental services are partially covered, featuring no copay and no coinsurance for Medicare dental, restorative, endodontics, periodontics, prosthodontics, and oral surgery up to a $1,200 annual maximum. Preventive and diagnostic services (including exams, cleanings, and x-rays), implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
PLATINO ADVANCE (HMO D-SNP) offers partially covered home infusion bundled services with no copay and no coinsurance, though prior authorization and step therapy are required. Covered benefits include Part D home infusion drugs and Medicare Part B insulin, while Medicare Part B chemotherapy, radiation, and other Part B drugs are not covered.
Dialysis Services See details
Dialysis Services are covered under the PLATINO ADVANCE (HMO D-SNP) plan with no copay and no coinsurance.
Medical Equipment See details
Medical Equipment is partially covered by PLATINO ADVANCE (HMO D-SNP), offering durable medical equipment and diabetic equipment with no copay and no coinsurance, while prosthetic devices have no copay and a 0% to 5% coinsurance. However, medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by PLATINO ADVANCE (HMO D-SNP) with no copay, no coinsurance, and required prior authorization. However, only some services are covered in practice, as diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays 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; however, only some services are covered, and cardiac, intensive cardiac, pulmonary, 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, as additional days beyond Medicare-covered services are not covered. Prior authorization and a three-day inpatient hospital stay are required prior to admission.
Other Services See details
Other services are partially covered by PLATINO ADVANCE (HMO D-SNP), which offers 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.
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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.
* 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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