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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. After you meet your deductible, your costs for drugs will vary depending on the tier and pharmacy you use. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy (LIS), you may have reduced premiums.
Additional Benefits
The PLATINO ALCANCE (HMO D-SNP) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with some services requiring prior authorization. This plan features no copays for ambulance and transportation services, emergency services, primary care, preventive services, hearing services, home health services, medical equipment, and diagnostic and radiological services. The plan also includes vision and dental benefits, with annual maximums for eyewear and dental services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric services, are covered. The plan covers additional days for Inpatient Hospital-Acute, but Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient blood services, with prior authorization required for outpatient hospital and observation services. Outpatient substance abuse services are partially covered; individual and group sessions are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the PLATINO ALCANCE (HMO D-SNP) plan, but requires prior authorization. There is no information 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, but Ground and Air Ambulance Services are not covered; Transportation Services to any health-related location are covered for 28 one-way trips per year with no copay or coinsurance, using taxi, rideshare, or medical transport.
Emergency Services See details
Emergency Services, including Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage, are covered by PLATINO ALCANCE (HMO D-SNP) with no copay and no coinsurance, except for Worldwide Emergency Transportation which is not covered. Worldwide Emergency Services has a maximum plan benefit coverage of $75.00.
Primary Care See details
The PLATINO ALCANCE (HMO D-SNP) plan covers primary care physician services, chiropractic services (with a doctor referral, up to 5 visits per year), occupational therapy services (with prior authorization, no copay or coinsurance), physician specialist services (with prior authorization and a doctor referral), podiatry services (with a doctor referral, up to 4 visits per year), physical therapy and speech-language pathology services (with prior authorization, no copay or coinsurance), additional telehealth benefits (with a doctor referral), and opioid treatment program services. Individual and group sessions for mental health and psychiatric services are not covered.
Preventive Services See details
Preventive Services are covered by the PLATINO ALCANCE (HMO D-SNP) plan, but 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, fitness benefit, 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 (unlimited), glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit are covered.
Hearing Services See details
Hearing services include routine hearing exams and fitting/evaluation for hearing aids, each covered once per year with no copay or coinsurance. Prescription hearing aids (all types) are covered, up to a maximum of $1750 per year, with no copay or coinsurance, 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 with 1 visit every year. The plan also covers eyewear, with a combined maximum of $500 every year, plus contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The PLATINO ALCANCE (HMO D-SNP) plan covers various 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. However, Maxillofacial Prosthetics and Orthodontics are not covered, and there is a maximum benefit of $2750 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the PLATINO ALCANCE (HMO D-SNP) plan, including Medicare Part B Insulin Drugs. However, 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 specific cost information provided for this benefit.
Medical Equipment See details
Medical equipment benefits are covered under the PLATINO ALCANCE (HMO D-SNP) plan. Durable Medical Equipment (DME) is covered with no copay and no coinsurance, but Durable Medical Equipment for use outside the home is 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 or coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the PLATINO ALCANCE (HMO D-SNP) plan. Specifically, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered. Prior authorization is required.
Other Services See details
The PLATINO ALCANCE (HMO D-SNP) plan covers acupuncture, with a limit of 12 treatments per year, and no copay or coinsurance. Over-the-counter items are covered up to $70 every three months, and the plan also covers nicotine replacement therapy and Naloxone. Other services such as meal benefits, Early and Periodic Screening, and Private Duty Nursing Services are not covered.
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