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PLATINO ALCANCE (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PLATINO ALCANCE (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 ALCANCE (HMO D-SNP) in 2025, please refer to our full plan details page.
PLATINO ALCANCE (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 ALCANCE (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 ALCANCE (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 ALCANCE (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 ALCANCE (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 $55.00. 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 ALCANCE (HMO D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, your costs will depend on the specific drug tier, which is not specified in this summary. Once your total drug costs reach $2,000, you enter the Catastrophic Coverage Phase, where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy (LIS), you may have reduced costs for your prescriptions.
Additional Benefits
The PLATINO ALCANCE (HMO D-SNP) plan offers comprehensive coverage, including inpatient and outpatient services, with no copay for emergency services, ambulance services, and home health services. The plan also covers vision, dental, and hearing services, with specific allowances for eyewear and hearing aids. Additionally, the plan provides coverage for primary care, preventive services, and other services such as dialysis, medical equipment, and home infusion bundled services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. Additional Days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including all outpatient hospital services, observation services, and ambulatory surgical center (ASC) services, are covered, but individual and group sessions for outpatient substance abuse are not covered. Outpatient blood services are covered with three pints deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. There is no information provided about the cost of this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by the PLATINO ALCANCE (HMO D-SNP) plan. All Ambulance Services are covered with no copay or coinsurance, while Ground and Air Ambulance Services are not covered; Transportation Services to any health-related location are covered for up to 28 one-way trips per year with no copay or coinsurance, using taxi, rideshare services, or medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage and Worldwide Urgent Coverage are covered by the PLATINO ALCANCE (HMO D-SNP) plan with no copay and no coinsurance. Worldwide Emergency Transportation is not covered by this plan.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Routine Chiropractic Care is covered for up to 5 visits per year. Individual and group sessions for Mental Health Specialty Services and Individual and group sessions for Psychiatric Services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered zero dollar preventive services, health education, alternative therapies (12 visits), nutritional/dietary benefits (12 visits), remote access technologies, counseling services, kidney disease education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, though 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, a fitness benefit, enhanced disease management, telemonitoring services, and home and bathroom safety devices and modifications are not covered.
Hearing Services See details
The PLATINO ALCANCE (HMO D-SNP) plan covers hearing exams, routine hearing exams (1 every year), and fitting/evaluation for hearing aids (1 every year). Prescription hearing aids (all types) are covered up to a maximum of $1750.00 per year, but prescription hearing aids for the inner, outer, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The PLATINO ALCANCE (HMO D-SNP) plan covers vision services including routine eye exams and other eye exam services, each limited to one visit per year with no copay or coinsurance. Eyewear is covered up to a combined maximum of $500 per year, and the plan also covers contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The PLATINO ALCANCE (HMO D-SNP) plan covers dental services, including Medicare dental, orthodontic, restorative, adjunctive general, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery. Maxillofacial prosthetics and orthodontics are not covered. The plan has a maximum benefit of $2,750 per year for orthodontic services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the PLATINO ALCANCE (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 with this plan. There is no copay or coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits are covered by the PLATINO ALCANCE (HMO D-SNP) plan, including Durable Medical Equipment (DME) and Prosthetics/Medical Supplies - Non-Medicare benefit with no copay and no coinsurance; however, Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. There are preferred vendors/manufacturers for Durable Medical Equipment (DME), and authorization is required for all covered benefits.
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 ALCANCE (HMO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered. Prior authorization is required for these services.
Other Services See details
Other Services includes acupuncture and over-the-counter (OTC) items. Acupuncture is covered for up to 12 treatments per year. OTC items are covered up to $70 every three months, including nicotine replacement therapy and naloxone.
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