A non-government entity
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 $20.00. 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:
Sign up for PLATINO PLUS (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The PLATINO PLUS (HMO D-SNP) Medicare plan features an annual prescription drug deductible of $615. This deductible represents the amount you must pay out-of-pocket for your covered medications before the plan begins to pay its share. Specific drug tier details, including individual copayments and coinsurance rates, are currently unavailable for this plan. To verify how your specific prescriptions are covered and to estimate your total out-of-pocket costs, it is recommended to consult the plan's formulary.
Additional Benefits
The PLATINO PLUS (HMO D-SNP) plan offers comprehensive coverage with no copays and no coinsurance for most essential medical services. This includes inpatient and outpatient hospital stays, primary care and specialist visits, emergency care, and dialysis services. Beneficiaries can also access home health, skilled nursing facility care, and diagnostic services without worrying about out-of-pocket costs. Additional benefits like dental, vision, and hearing services are also covered with no copays, coinsurance, or deductibles, featuring a $3,000 annual dental limit, a $500 vision allowance, and a $1,000 hearing aid limit. The plan also includes up to 30 one-way transportation trips per year to health-related locations and a $30 quarterly allowance for over-the-counter items. These robust benefits ensure that members receive vital healthcare services with minimal financial burden.
Inpatient Hospital See details
Inpatient hospital services are partially covered by PLATINO PLUS (HMO D-SNP) with no copay and no coinsurance for both acute and psychiatric stays. Prior authorization is required for acute care, and while unlimited additional acute days are covered, upgrades, non-Medicare-covered stays, and additional psychiatric days 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. While some outpatient substance abuse services are covered, individual and group sessions are not covered under this plan.
Partial Hospitalization See details
PLATINO PLUS (HMO D-SNP) covers partial hospitalization services with no copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
PLATINO PLUS (HMO D-SNP) covers transportation services with no copay and no coinsurance for up to 30 one-way trips per year to any health-related location via taxi, rideshare, or medical transport, though transportation to plan-approved locations is not covered. Ambulance services are not covered by the plan, as both ground and air ambulance services are excluded.
Emergency Services See details
Emergency services, urgently needed care, and worldwide emergency services are covered by PLATINO PLUS (HMO D-SNP) with no copay and no coinsurance. Worldwide benefits are partially covered up to a $75 maximum limit, and worldwide emergency transportation is not covered.
Primary Care See details
PLATINO PLUS (HMO D-SNP) provides primary care, specialist, and therapy services with no copay and no coinsurance. Chiropractic care is partially covered as other chiropractic services are not covered, and for mental health and psychiatric benefits, some services are covered but individual and group sessions are not.
Preventive Services See details
Preventive services are partially covered by PLATINO PLUS (HMO D-SNP) with no copay and no coinsurance for covered options like kidney education, counseling, and limited alternative therapies. However, several services are not covered, including annual physical exams, fitness benefits, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, tobacco cessation, disease management, telemonitoring, and home safety modifications.
Hearing Services See details
Hearing services are covered under PLATINO PLUS (HMO D-SNP) with no copay, no coinsurance, and no deductible, which includes one routine exam and one fitting evaluation annually. Prescription hearing aids are partially covered with a $1,000 annual maximum for both ears combined, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
PLATINO PLUS (HMO D-SNP) covers vision services with no copay, no coinsurance, and no deductible. This benefit includes one routine eye exam and one eyewear exam per year, as well as a $500 annual allowance for contact lenses, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by PLATINO PLUS (HMO D-SNP) with no copay and no coinsurance for covered services, up to a $3,000 annual maximum. While Medicare dental, restorative, endodontics, periodontics, prosthodontics, implants, and oral surgery are covered, oral exams, dental x-rays, diagnostic services, cleanings, fluoride, preventive services, maxillofacial prosthetics, and orthodontics 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, subject to prior authorization and step therapy. While Part D home infusion drugs and Medicare Part B insulin are covered, Medicare Part B chemotherapy or radiation drugs and other Part B drugs are not covered.
Dialysis Services See details
Dialysis Services are covered under the PLATINO PLUS (HMO D-SNP) plan with no copay and no coinsurance.
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. Prosthetic devices are covered with no copay and 0% to 5% coinsurance, but 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 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 offered by PLATINO PLUS (HMO D-SNP) with no copay and no coinsurance. However, some services are covered but 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, though prior authorization and a three-day inpatient hospital stay are required. Additional days beyond Medicare-covered SNF care are not covered under this plan.
Other Services See details
PLATINO PLUS (HMO D-SNP) covers acupuncture and over-the-counter (OTC) items with no copay and no coinsurance, though meal benefits are not covered. Acupuncture is limited to 12 treatments per year, and OTC items have a maximum benefit of $30 every three months.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved