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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 2025, 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 out of 5 stars in 2025.
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 $174.70. 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 PLUS (HMO D-SNP) plan has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy, you will pay $0 for Part D drugs. After the deductible, you'll pay the costs for drugs in each tier until your total drug costs reach $2000. Once you reach $2000 in out-of-pocket drug costs, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The PLATINO PLUS (HMO D-SNP) plan offers a variety of benefits beyond standard Medicare coverage. This includes no copay for ambulance services, emergency services, and home health services. The plan also covers hearing exams, vision exams, and dental services, with specific limits and prior authorization requirements for certain services. This plan provides coverage for several outpatient services, including services for substance abuse, and covers other services such as acupuncture, and over-the-counter items. While the plan has some limitations, it offers a broad range of services with varying cost-sharing structures, including no copays for many services and a maximum benefit for hearing aids and eyewear.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered; however, Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. Additional Days for Inpatient Hospital-Acute are 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. 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 PLUS (HMO D-SNP) plan, but requires prior authorization. There is no information about the cost of this benefit in the provided snippet.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered, with no copay or coinsurance for all ambulance services. Ground and Air Ambulance Services are not covered, while Transportation Services to any health-related location are covered for up to 28 one-way trips per year, using taxi, rideshare, 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 PLUS (HMO D-SNP) plan with no copay and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The PLATINO PLUS (HMO D-SNP) plan covers primary care physician services, chiropractic services (5 visits per year), occupational therapy services (with prior authorization, no copay or coinsurance), physician specialist services (with prior authorization), podiatry services (4 visits per year), other health care professional services (with prior authorization), physical therapy and speech-language pathology services (with prior authorization, no copay or coinsurance), additional telehealth benefits, and opioid treatment program services. Mental health and psychiatric services are partially covered, but individual and group sessions are not covered.
Preventive Services See details
The PLATINO PLUS (HMO D-SNP) plan covers preventive services, but does not cover 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 benefits, enhanced disease management, telemonitoring services, and home and bathroom safety devices and modifications. Health education, alternative therapies (up to 12 visits), nutritional/dietary benefits (up to 12 individual sessions), counseling services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), 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 hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids, with no copay. Prescription hearing aids are covered up to a maximum of $1000 per year, and other hearing services are limited to one visit per year. OTC hearing aids and prescription hearing aids for the inner, outer, and over the ear are not covered.
Vision Services See details
The PLATINO PLUS (HMO D-SNP) plan covers vision services, including routine eye exams and other eye exam services, each limited to one visit per year. Eyewear is also covered, with a combined maximum benefit of $500 per year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The PLATINO PLUS (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. This plan has a maximum benefit of $3,500 per year for orthodontic services and covers other dental services with prior authorization. Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the PLATINO PLUS (HMO D-SNP) plan, including Medicare Part B Insulin Drugs, but Medicare Part B Chemotherapy/Radiation Drugs are not covered. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the PLATINO PLUS (HMO D-SNP) plan. There is no copay or coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered by the PLATINO PLUS (HMO D-SNP) plan, including Durable Medical Equipment (DME) with a coinsurance between 0% and 5%, and Prosthetics/Medical Supplies with a coinsurance between 0% and 5%; however, Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. There is no copay for these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the PLATINO PLUS (HMO D-SNP) plan, 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 PLUS (HMO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit does require authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but not in practice. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required for this benefit.
Other Services See details
The PLATINO PLUS (HMO D-SNP) plan covers acupuncture, with a limit of 12 treatments per year. This plan also covers over-the-counter (OTC) items, with a maximum benefit coverage amount of $90 every three months, and includes nicotine replacement therapy and Naloxone. However, the plan does not cover meal benefits, and other services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, Private Duty Nursing Services, and others are not covered.
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