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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 $90.00. 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 deductible is the amount you must pay out-of-pocket for covered medications before the plan begins to pay its share. Knowing this upfront cost helps you budget for your annual prescription expenses. Specific drug tier details, copayments, and coinsurance amounts are currently unavailable for this plan. To find out how your specific medications are covered and what your final costs will be, you should review the plan's formulary directly.
Additional Benefits
The PLATINO PLUS (HMO D-SNP) plan offers comprehensive coverage with no copays, no deductibles, and no coinsurance for the vast majority of its covered services. This includes major medical needs such as inpatient and outpatient hospital stays, primary and specialist doctor visits, emergency care, and dialysis. Prosthetic devices are one of the few covered items that may require a small coinsurance of up to five percent. Members also enjoy valuable supplemental benefits with no copay or coinsurance, including comprehensive dental care up to a three thousand dollar annual limit and vision services with a five hundred dollar eyewear allowance. The plan also covers prescription hearing aids up to one thousand dollars annually, up to thirty one-way health-related transportation trips, and a fifty dollar quarterly over-the-counter allowance.
Inpatient Hospital See details
PLATINO PLUS (HMO D-SNP) covers inpatient hospital services with no copay and no coinsurance for both acute and psychiatric stays, with prior authorization required for acute care. The benefit is partially covered because upgrades, non-Medicare-covered stays, and additional days for psychiatric stays are not covered.
Outpatient Services See details
Outpatient services are covered by PLATINO PLUS (HMO D-SNP) with no copay and no coinsurance for outpatient hospital, ambulatory surgical center, and blood services. Some outpatient substance abuse services are covered, but individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization is covered by the PLATINO PLUS (HMO D-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered under PLATINO PLUS (HMO D-SNP), offering transportation to any health-related location for up to 30 one-way trips per year with no copay and no coinsurance. However, ground ambulance, air ambulance, and plan-approved location transportation services are not covered.
Emergency Services See details
PLATINO PLUS (HMO D-SNP) emergency and urgently needed services are covered 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 benefit limit, though worldwide emergency transportation is not covered.
Primary Care See details
PLATINO PLUS (HMO D-SNP) offers primary care, specialist, therapy, telehealth, and opioid treatment services with no copay and no coinsurance, though prior authorization is required for select services. Chiropractic care is partially covered with no copay or coinsurance for up to 5 routine visits per year (other chiropractic services are not covered), while mental health specialty and psychiatric services are not covered because individual and group sessions are excluded.
Preventive Services See details
Preventive Services are partially covered by PLATINO PLUS (HMO D-SNP) with no copay and no coinsurance for eligible services like health education, alternative therapies, counseling, and nutritional benefits. However, the plan does not cover the annual physical exam, fitness benefit, personal emergency response system, in-home safety assessments, therapeutic massage, and medical nutrition therapy. Additional excluded services include post-discharge medication reconciliation, readmission prevention, wigs, weight management, adult day health, palliative care, in-home support, caregiver support, extra smoking cessation, enhanced disease management, telemonitoring, and home safety modifications.
Hearing Services See details
Hearing Services under PLATINO PLUS (HMO D-SNP) are partially covered, featuring no copay and no coinsurance for annual routine hearing exams and fitting evaluations. Prescription hearing aids are covered with no copay or coinsurance up to a $1,000 yearly limit, 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. This benefit includes one routine eye exam and one eyewear exam per year, along with a $500 annual maximum allowance for eyewear such as contacts, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by PLATINO PLUS (HMO D-SNP) with no copay and no coinsurance, up to a $3,000 annual maximum with prior authorization required. Covered benefits include Medicare dental and comprehensive services like implants, endodontics, and oral surgery, while preventive services (such as exams, cleanings, 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, although prior authorization and step therapy apply. While insulin is covered under this benefit, Medicare Part B chemotherapy/radiation drugs and other Medicare Part B drugs are not covered.
Dialysis Services See details
PLATINO PLUS (HMO D-SNP) covers Dialysis Services in full, offering these essential treatments with no copay and no coinsurance for plan 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, and prosthetic devices with no copay and 0% to 5% coinsurance. This benefit is partially covered because medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the PLATINO PLUS (HMO D-SNP) plan with no copay and no coinsurance, although prior authorization is required. While some services are covered, diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays 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, subject to prior authorization. However, only some services are covered, as 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, requiring prior authorization and a three-day prior inpatient hospital stay. However, additional days beyond the standard Medicare-covered days are not covered.
Other Services See details
PLATINO PLUS (HMO D-SNP) partially covers other services, offering acupuncture and over-the-counter (OTC) items with no copay and no coinsurance, while meal benefits are not covered. Covered services include up to 12 acupuncture treatments per year and a $50 OTC allowance every three months.
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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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