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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 the deductible is met, the plan covers the cost of your prescriptions. If you qualify for the low-income subsidy (LIS) or "Extra Help", your Part D costs will be $0.00. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The PLATINO ADVANCE (HMO D-SNP) plan offers a range of benefits with varying cost structures. Emergency services, including worldwide coverage, have no copay or coinsurance. Primary care, hearing, and vision services are included, with specific limits on hearing aid coverage and eyewear. The plan also covers dental services up to $1,750 per year, home health services, and medical equipment, often with no copay. The plan provides coverage for inpatient and outpatient services, home infusion, dialysis, and diagnostic services, often with no copay. Transportation to health-related locations is covered up to 12 one-way trips per year. However, some services like outpatient substance abuse, certain home health services, and some dental and vision procedures are either not covered or have limitations.
Inpatient Hospital See details
Inpatient Hospital benefits for PLATINO ADVANCE (HMO D-SNP) cover Inpatient Hospital-Acute services, including additional days, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Inpatient Hospital Psychiatric benefits are covered, but Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services. Outpatient substance abuse services are partially covered, with individual and group sessions for outpatient substance abuse not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the PLATINO ADVANCE (HMO D-SNP) plan, but prior authorization is required. There is no information about the cost of this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, but ground and air ambulance services, as well as transportation services to plan-approved health-related locations, are not covered. Transportation services to any health-related location are covered for up to 12 one-way trips per year via taxi, rideshare services, or medical transport, with no copay or coinsurance.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage are covered 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 physician services, chiropractic services (with a limit of 5 visits per year), occupational therapy services, physician specialist services, podiatry services (with a limit of 4 visits per year), and physical therapy and speech-language pathology services. The plan does not cover individual or group sessions for Mental Health or Psychiatric Specialty services.
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, readmission 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. Health Education, Alternative Therapies (12 visits), Nutritional/Dietary Benefits (12 visits), Remote Access Technologies, Counseling Services (individual sessions, 20 minutes each), Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered.
Hearing Services See details
The PLATINO ADVANCE (HMO D-SNP) plan covers hearing exams, including routine hearing exams once per year, and fitting/evaluation for hearing aids, and prescription hearing aids up to $300 per year. Prescription hearing aids for the inner ear, outer ear, and over the ear, as well as 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 exam covered every year. Eyewear benefits are covered, with a combined maximum benefit of $300 per year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The PLATINO ADVANCE (HMO D-SNP) plan covers dental services including Medicare dental services, orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Maxillofacial prosthetics, implant services, and orthodontics are not covered. This plan has a maximum benefit of $1,750 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the PLATINO ADVANCE (HMO D-SNP) plan, including Insulin and Medicare Part B Insulin Drugs. Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered by the PLATINO ADVANCE (HMO D-SNP) plan. There is no copay or coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered by the PLATINO ADVANCE (HMO D-SNP) plan, with no copay. Durable Medical Equipment has a coinsurance between 0% and 5%, while Durable Medical Equipment for use outside the home is not covered. Prosthetics and Medical Supplies have a coinsurance, with no copay. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered. 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. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered by the PLATINO ADVANCE (HMO D-SNP) plan, but none of the sub-services are covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered. Prior authorization is required for SNF services.
Other Services See details
Other Services includes coverage for acupuncture, with a limit of 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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