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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 $35.00. 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. If you qualify for the low-income subsidy (LIS), you will have no copay for Part D drugs. In the initial coverage phase, you will pay the costs for drugs in each tier until your total drug costs reach $2,000. After your yearly out-of-pocket drug costs reach $2,000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The PLATINO ALCANCE (HMO D-SNP) plan offers a wide variety of benefits with no copay for many services. This plan includes coverage for inpatient and outpatient services, emergency services, primary care, preventive services, hearing, vision, dental, dialysis, medical equipment, home health, and skilled nursing facility services. Other services like acupuncture, and over-the-counter items are also covered. This plan provides coverage for ambulance and transportation services, with transportation to health-related locations covered for up to 28 one-way trips per year with no copay. Hearing aids are covered up to $1750 per year, and eyewear is covered up to $500 per year. Dental services have a maximum plan benefit of $2,750 per year.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with Prior Authorization required for Inpatient Hospital-Acute, and additional days and non-Medicare covered stays are not covered. Additional days for Inpatient Hospital-Acute are unlimited.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services. Individual and group sessions for outpatient substance abuse are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the PLATINO ALCANCE (HMO D-SNP) plan, but requires prior authorization. The plan does not specify any cost information for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by the PLATINO ALCANCE (HMO D-SNP) plan, 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 28 one-way trips per year, using taxis, rideshares, 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, while Worldwide Emergency Transportation is not covered.
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. Chiropractic Services include Routine Chiropractic Care for 5 visits per year. Mental Health Specialty Services and Psychiatric Services do not cover individual or group sessions.
Preventive Services See details
Preventive Services for the PLATINO ALCANCE (HMO D-SNP) plan cover Medicare-covered preventive services with no copay, but do not cover annual physical exams. Additional preventive services include health education, alternative therapies (12 visits), nutritional/dietary benefits (12 visits), remote access technologies, counseling services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, with some services not covered.
Hearing Services See details
The PLATINO ALCANCE (HMO D-SNP) plan covers hearing exams and routine hearing exams, with one routine hearing exam covered per year. The plan also covers fitting/evaluation for hearing aids, with one visit covered per year. Prescription hearing aids are covered up to $1750 every year, and all types of prescription hearing aids are covered. 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 once per year, as well as eyewear with a combined maximum benefit of $500 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The PLATINO ALCANCE (HMO D-SNP) plan covers a range of dental services, including Medicare Dental Services, Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Implant Services, and Oral and Maxillofacial Surgery. Maxillofacial Prosthetics and Orthodontics are not covered. There is a maximum plan benefit of $2,750 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the PLATINO ALCANCE (HMO D-SNP) plan, including 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 ALCANCE (HMO D-SNP) plan. There is no copay or coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with no copay or coinsurance, though services outside of the home are not covered. Prosthetics/Medical Supplies and Diabetic Equipment 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 ALCANCE (HMO D-SNP) plan with no copay and no coinsurance, but require authorization. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally 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 and non-Medicare-covered stays for SNF are not covered. Prior authorization is required for this benefit.
Other Services See details
Other Services include acupuncture, which is covered with a limit of 12 treatments per year, and over-the-counter (OTC) items, which are covered up to $70 every three months; however, 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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