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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 Advantage plan features an annual prescription drug deductible of $615. This deductible is the amount you must pay out-of-pocket for your covered medications before the plan begins to pay its share. Understanding these upfront costs is essential when evaluating if this plan fits your monthly healthcare budget. Specific drug coverage tier details, including copayments and coinsurance rates for individual medication tiers, are not currently available for this plan. To determine how your specific prescriptions are covered and to estimate your ongoing costs, it is recommended to review the plan's comprehensive formulary. This ensures you have the most accurate pricing for your exact medication needs under the PLATINO ADVANCE (HMO D-SNP) plan.
Additional Benefits
The PLATINO ADVANCE (HMO D-SNP) plan offers comprehensive medical coverage with no copays and no coinsurance for most major services, including inpatient and outpatient hospital stays, primary and specialist care, and emergency services. Beneficiaries also pay nothing for home health care, dialysis, and skilled nursing facility services, though some of these require prior authorization. While durable medical equipment is covered with no copay, prosthetic devices may require a 0% to 5% coinsurance. For extra benefits, the plan provides routine vision care with no deductible and a $300 annual eyewear allowance, dental coverage up to $1,200 per year, and hearing aid coverage up to $325. Additionally, members can access up to 12 free one-way transportation trips and 12 acupuncture treatments per year with no copay. However, it is important to note that ambulance services, cardiac rehabilitation, and preventive dental care are not covered under this plan.
Inpatient Hospital See details
Inpatient hospital services are partially covered by PLATINO ADVANCE (HMO D-SNP) with no copay and no coinsurance for both acute and psychiatric stays. While unlimited additional days are covered for acute care, prior authorization is required, and room upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under the PLATINO ADVANCE (HMO D-SNP) plan are covered with no copay and no coinsurance, including outpatient hospital, ambulatory surgical center, and blood services. Outpatient substance abuse services are not covered since both individual and group sessions are excluded.
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) provides transportation services with no copay and no coinsurance, covering up to 12 one-way trips per year to any health-related location via taxi, rideshare, or medical transport. Ambulance services are not covered under this plan because both ground and air ambulance services are excluded.
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 care are partially covered with no copay or coinsurance up to a $75 maximum benefit limit, though worldwide emergency transportation is not covered.
Primary Care See details
Primary care and specialist services are covered by PLATINO ADVANCE (HMO D-SNP) with no copay and no coinsurance. Chiropractic care is partially covered with no copay and no coinsurance for up to 5 routine visits per year, though other chiropractic services are not covered. For mental health and psychiatric care, some services are covered with no copay and no coinsurance, but 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 care, kidney disease education, and select counseling. However, the plan does not cover annual physical exams, fitness benefits, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, and home safety modifications.
Hearing Services See details
PLATINO ADVANCE (HMO D-SNP) hearing services are covered with no copay and no coinsurance for one routine hearing exam and one fitting evaluation per year. Prescription hearing aids are partially covered with no copay or coinsurance up to a $325 annual maximum, but 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 eye exams and eyewear. Beneficiaries receive one routine eye exam and one eyewear exam annually, as well as a $300 yearly maximum allowance for contact lenses, eyeglasses, frames, and upgrades.
Dental Services See details
PLATINO ADVANCE (HMO D-SNP) covers Medicare dental, restorative, endodontics, periodontics, prosthodontics, oral surgery, and adjunctive services with no copay and no coinsurance up to a $1,200 annual limit. Preventive services—including oral exams, cleanings, and x-rays—as well as implants, orthodontics, and maxillofacial prosthetics are not covered.
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, although prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin is covered with no copay or coinsurance, while Medicare Part B chemotherapy or radiation drugs and other Part B drugs are not covered.
Dialysis Services See details
Dialysis Services are covered by PLATINO ADVANCE (HMO D-SNP) 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, and prosthetic devices with no copay and 0% to 5% coinsurance. However, general medical supplies, diabetic supplies, and diabetic 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. Although some services are covered, diagnostic procedures and 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 PLATINO ADVANCE (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the PLATINO ADVANCE (HMO D-SNP) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by PLATINO ADVANCE (HMO D-SNP) with no copay and no coinsurance, though prior authorization and a three-day inpatient hospital stay are required. Additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
PLATINO ADVANCE (HMO D-SNP) provides partial coverage for other services, offering acupuncture with no copay and no coinsurance for up to 12 treatments per year. Over-the-counter items, meal benefits, and highly integrated dual-eligible services are not covered.
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