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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 $85.00. 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 PLUS (HMO D-SNP) plan has a deductible of $590.00. If you qualify for the low-income subsidy (LIS), you may have your premium reduced. During the initial coverage phase, after you pay the deductible, you will pay the costs for your drugs in each tier until your total drug costs reach $2000. Once you reach that amount, you will enter the next coverage phase. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Part D covered drugs.
Additional Benefits
The PLATINO PLUS (HMO D-SNP) plan provides comprehensive coverage, including inpatient and outpatient services, emergency care, and primary care. The plan also includes coverage for hearing, vision, and dental services, with specific allowances for hearing aids, eyewear, and a wide range of dental procedures. This plan offers additional benefits like ambulance and transportation services, with no copay for ambulance services and up to 28 one-way trips for transportation to health-related locations. It also covers home health services, dialysis services, and medical equipment with varying coinsurance, and includes additional services such as acupuncture and OTC items, each with specific limitations.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered. However, Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay 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. Outpatient substance abuse services are partially covered, and 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.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by the PLATINO PLUS (HMO D-SNP) plan. All Ambulance Services are covered with no copay or coinsurance, but Ground Ambulance and Air Ambulance Services are not covered. Transportation Services to any health-related location are covered for up to 28 one-way trips per year via taxi, rideshare services, or medical transport, with no copay or coinsurance.
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 (up to 5 visits per year), occupational therapy services (with authorization), physician specialist services (with prior authorization), podiatry services (up to 4 visits per year), other healthcare professional services (with prior authorization), physical therapy and speech-language pathology services (with authorization), additional telehealth benefits, and opioid treatment program services. However, individual and group sessions for mental health and psychiatric services 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, home and bathroom safety devices, and modifications. The plan also covers health education, alternative therapies (12 visits), nutritional/dietary benefits (12 individual sessions), counseling services, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following welcome visits.
Hearing Services See details
The PLATINO PLUS (HMO D-SNP) plan covers hearing exams, routine hearing exams (1 per year), and fitting/evaluation for hearing aids (1 per year). Prescription hearing aids (all types) are covered up to $1000 per year, but prescription hearing aids for the inner, outer, or over-the-ear are not covered, nor are OTC hearing aids.
Vision Services See details
The PLATINO PLUS (HMO D-SNP) plan covers vision services, including routine eye exams once per year, and other eye exam services once per year. Eyewear is covered with a combined maximum benefit of $500 per year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The PLATINO PLUS (HMO D-SNP) plan covers 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. Maxillofacial Prosthetics and Orthodontics are not covered. The plan has a maximum benefit of $3,500 per year for Orthodontic Services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the PLATINO PLUS (HMO D-SNP) plan, and prior authorization is required. Medicare Part B Insulin Drugs are covered, but Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered by the PLATINO PLUS (HMO D-SNP) plan. There is no copay or coinsurance for this benefit.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment, prosthetic devices, and medical supplies with a coinsurance between 0% and 5%. Durable medical equipment for use outside the home, and diabetic supplies and therapeutic shoes/inserts are 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 PLUS (HMO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered under the PLATINO PLUS (HMO D-SNP) plan. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare coverage and non-Medicare-covered stays are not covered. Prior authorization is required for SNF services.
Other Services See details
The PLATINO PLUS (HMO D-SNP) plan covers acupuncture with a limit of 12 treatments per year, and it does not require a copay or coinsurance. The plan also covers Over-the-Counter (OTC) items, including nicotine replacement therapy and naloxone, up to a maximum of $50 every three months. Other services such as meal benefits, EPSDT, and case management are not covered.
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