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PLATINO PLUS (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PLATINO PLUS (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 PLUS (HMO D-SNP) in 2026, please refer to our full plan details page.
PLATINO PLUS (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 PLUS (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 PLUS (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 PLUS (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 PLUS (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 $185.00. 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 $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 PLUS (HMO D-SNP) Medicare Advantage plan features an annual prescription drug deductible of $615. This is the amount you will need to pay out-of-pocket for your covered medications before the plan begins to pay its share. Specific drug coverage tier details, including exact copays and coinsurance percentages for individual medications, are currently not available for this plan. To estimate your total out-of-pocket costs, you should review the plan's formulary to see how your specific prescription drugs are classified after the deductible is met.
Additional Benefits
The PLATINO PLUS (HMO D-SNP) plan offers comprehensive coverage for core medical services with no copays and no coinsurance, ensuring affordable healthcare. This includes inpatient and outpatient hospital stays, primary care and specialist visits, emergency services, and home health care. Additionally, members benefit from dialysis, diagnostic services, and skilled nursing facility stays without any out-of-pocket costs, though some services require prior authorization. This plan also features valuable supplemental benefits with no copays or coinsurance, such as up to 30 one-way transportation trips per year to health-related locations. Members receive up to $3,000 annually for covered restorative and surgical dental services, a $500 yearly allowance for eyewear, and up to $1,000 per year for prescription hearing aids. Furthermore, the plan provides an over-the-counter allowance of $90 every three months and covers up to 12 acupuncture treatments annually.
Inpatient Hospital See details
PLATINO PLUS (HMO D-SNP) covers inpatient hospital services, including acute and psychiatric stays, with no copay and no coinsurance. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
PLATINO PLUS (HMO D-SNP) covers outpatient hospital, ambulatory surgical center, and outpatient blood services with no copay and no coinsurance. For outpatient substance abuse, some services are covered, but individual and group sessions are not covered.
Partial Hospitalization See details
PLATINO PLUS (HMO D-SNP) covers partial hospitalization services with no copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
PLATINO PLUS (HMO D-SNP) does not cover ambulance services, but provides transportation services with no copay and no coinsurance. This transportation benefit includes up to 30 one-way trips per year to any health-related location via taxi, rideshare, or medical transport.
Emergency Services See details
Emergency and urgently needed services are covered by PLATINO PLUS (HMO D-SNP) with no copays and no coinsurance. Worldwide emergency and urgent care are also covered with no copay or coinsurance up to a $75 maximum benefit, although worldwide emergency transportation is not covered.
Primary Care See details
PLATINO PLUS (HMO D-SNP) provides primary care, specialist visits, therapy, telehealth, and podiatry services with no copay and no coinsurance. Chiropractic services are partially covered, offering up to five routine visits per year while excluding other chiropractic services, whereas mental health specialty and psychiatric services are not covered.
Preventive Services See details
Preventive services are partially covered by PLATINO PLUS (HMO D-SNP) with no copay and no coinsurance for covered benefits like Medicare-covered preventive care, kidney disease education, and nutritional counseling. Some sub-services are not covered under this plan, including annual physical exams, fitness benefits, therapeutic massages, and personal emergency response systems.
Hearing Services See details
Hearing services are partially covered by PLATINO PLUS (HMO D-SNP) with no copay and no coinsurance, including one routine exam and one fitting evaluation per year. Prescription hearing aids are covered up to $1,000 annually with no copay and no coinsurance, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are covered by PLATINO PLUS (HMO D-SNP) with no copay, no coinsurance, and no deductible for annual eye exams and eyewear. Covered eyewear, including contacts, frames, lenses, and upgrades, has a combined maximum plan benefit of $500 per year with no copay or coinsurance.
Dental Services See details
Dental services are partially covered by PLATINO PLUS (HMO D-SNP) with no copay and no coinsurance for Medicare dental, restorative, endodontic, periodontic, prosthodontic, implant, and oral surgery services up to a $3,000 annual limit. Prior authorization is required for covered treatments, while preventive care (including cleanings, exams, and x-rays), orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
PLATINO PLUS (HMO D-SNP) partially covers Home Infusion bundled Services with no copay and no coinsurance, though prior authorization and step therapy are required. Under this benefit, Part D home infusion drugs and Medicare Part B insulin are covered with no copay or coinsurance, while Medicare Part B chemotherapy, radiation, and other Part B drugs are not covered.
Dialysis Services See details
Dialysis Services are covered by PLATINO PLUS (HMO D-SNP) with no copay and no coinsurance.
Medical Equipment See details
Medical equipment is partially covered by PLATINO PLUS (HMO D-SNP), featuring no copay and no coinsurance for durable medical equipment and diabetic equipment, though prior authorization is required. Prosthetic devices are covered with no copay and 0% to 5% coinsurance, while medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
PLATINO PLUS (HMO D-SNP) covers diagnostic and radiological services with no copay and no coinsurance, though prior authorization is required. While some services are covered, specific sub-services including diagnostic procedures/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 under the PLATINO PLUS (HMO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by PLATINO PLUS (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
PLATINO PLUS (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance per admission, requiring prior authorization and a 3-day inpatient hospital stay prior to admission. Additional days beyond standard Medicare-covered SNF services are not covered.
Other Services See details
Other services are partially covered by PLATINO PLUS (HMO D-SNP), offering acupuncture for up to 12 treatments per year and over-the-counter (OTC) items up to $90 every three months with no copay and no coinsurance. Meal benefits and other additional services are not covered.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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