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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) prescription drug coverage includes an annual drug deductible of $615. This means you will need to pay this amount out-of-pocket for your medications before the plan starts to cover its portion of your prescription drug costs. Specific drug coverage tier details, such as individual copays and coinsurance rates, are currently unavailable for this plan. To determine your exact costs for specific prescriptions under this deductible, you should consult the plan's comprehensive formulary.
Additional Benefits
The PLATINO PLUS (HMO D-SNP) plan offers robust healthcare coverage with no copays and no coinsurance for the vast majority of medical services. Members enjoy no-cost access to inpatient and outpatient hospital stays, emergency care, primary and specialist visits, and dialysis. Essential services like home health care and skilled nursing facility stays are also covered with no copay, though prior authorization is required for some benefits. Beyond standard medical care, the plan provides valuable routine benefits including vision and hearing services with no copays and generous annual allowances. Dental services are covered up to a $3,000 yearly limit with no copay, and members receive 30 one-way trips for health-related transportation and a $50 quarterly over-the-counter allowance. However, certain exclusions apply, such as cardiac rehabilitation and preventive dental care, which are not covered under this plan.
Inpatient Hospital See details
PLATINO PLUS (HMO D-SNP) provides inpatient hospital coverage with no copay and no coinsurance for acute and psychiatric stays, although prior authorization is required for acute care. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under PLATINO PLUS (HMO D-SNP) are covered with no copay and no coinsurance for outpatient hospital, ambulatory surgical center, and blood services, though prior authorization may be required. While outpatient substance abuse services are technically covered with no copay or coinsurance, individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization is covered by PLATINO PLUS (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by PLATINO PLUS (HMO D-SNP) with no copay and no coinsurance. Transportation is covered for up to 30 one-way trips per year to any health-related location via taxi, rideshare, or medical transport, but ground ambulance, air ambulance, and plan-approved health-related location transportation services are not covered.
Emergency Services See details
PLATINO PLUS (HMO D-SNP) covers emergency and urgently needed services with no copay and no coinsurance. Worldwide emergency and urgent care are also covered with no copay and no coinsurance up to a $75 maximum limit, though worldwide emergency transportation is not covered.
Primary Care See details
PLATINO PLUS (HMO D-SNP) covers primary care, specialist, therapy, telehealth, and podiatry services with no copay and no coinsurance. Chiropractic services are partially covered as other chiropractic services are not covered, and mental health and psychiatric benefits only cover some services as individual and group sessions 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 all covered services, including kidney disease education, counseling, and diabetes self-management. Some sub-services are not covered under this plan, including annual physical exams, fitness benefits, therapeutic massages, and in-home safety assessments.
Hearing Services See details
Hearing services are covered under PLATINO PLUS (HMO D-SNP) with no copay or coinsurance, including one routine hearing exam and one fitting evaluation annually. Prescription hearing aids are partially covered up to a $1,000 yearly limit with no copay or coinsurance, though OTC, inner-ear, outer-ear, and over-the-ear hearing aids are not covered.
Vision Services See details
PLATINO PLUS (HMO D-SNP) vision services are covered with no copays, no coinsurance, and no deductibles for eye exams and eyewear. Benefits include one routine eye exam and one eyewear exam per year, as well as a combined maximum allowance of $500 annually for contact lenses, eyeglasses, frames, and upgrades.
Dental Services See details
PLATINO PLUS (HMO D-SNP) dental services are partially covered with no copay and no coinsurance, requiring prior authorization and featuring a $3,000 annual maximum. Covered benefits include Medicare dental, restorative, endodontics, periodontics, prosthodontics, implants, and oral surgery, while preventive services (such as exams, cleanings, and x-rays), maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
PLATINO PLUS (HMO D-SNP) provides partially covered Home Infusion bundled Services with no copay and no coinsurance, though prior authorization and step therapy are required. Under this benefit, insulin and Part D home infusion drugs are covered, but Medicare Part B chemotherapy, radiation, and other Part B drugs are not covered.
Dialysis Services See details
Dialysis Services are fully covered under the PLATINO PLUS (HMO D-SNP) plan with no copay and no coinsurance required for members.
Medical Equipment See details
PLATINO PLUS (HMO D-SNP) partially covers medical equipment, offering durable medical equipment and diabetic equipment with no copay and no coinsurance, subject to prior authorization. Prosthetic devices are covered with no copay and a 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, 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 by PLATINO PLUS (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the PLATINO PLUS (HMO D-SNP) plan, which excludes coverage for cardiac, intensive cardiac, pulmonary, and SET for PAD services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by PLATINO PLUS (HMO D-SNP) with no copay and no coinsurance, though prior authorization and a three-day prior inpatient hospital stay are required. Additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services under the PLATINO PLUS (HMO D-SNP) are partially covered, featuring no copay and no coinsurance for up to 12 acupuncture treatments per year and a $50 quarterly over-the-counter item allowance. 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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