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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 $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 $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. If you qualify for the low-income subsidy (LIS), also known as "Extra Help", you will have no copay for your Part D drugs. After 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, where you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The PLATINO PLUS (HMO D-SNP) plan offers a wide range of benefits. This plan covers inpatient and outpatient services, including emergency, primary care, preventive, hearing, vision, dental, and home health services. Many services have no copay, such as ambulance, emergency, primary care, vision, home health, and dialysis services. This plan also provides coverage for additional services, such as partial hospitalization, transportation, hearing aids, and medical equipment. There are also some limitations to the services offered. For example, some services, like outpatient substance abuse, are only partially covered, and some services require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. Additional Days for Inpatient Hospital-Acute are also covered, but Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services. Outpatient substance abuse services are partially covered, but individual and group sessions for outpatient substance abuse are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the PLATINO PLUS (HMO D-SNP) plan, but requires prior authorization. There is no information about the cost of this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered. All Ambulance Services are covered with no copay or coinsurance, however, Ground and Air Ambulance Services are not covered; Transportation Services to any health-related location are covered for 28 one-way trips per year with no copay or coinsurance.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services 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
Under the PLATINO PLUS (HMO D-SNP) plan, Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Individual and group sessions for mental health specialty services, and individual and group sessions for psychiatric services are not covered.
Preventive Services See details
Preventive Services are covered, including Health Education, Alternative Therapies (12 visits), Nutritional/Dietary Benefit (12 sessions), Remote Access Technologies, Counseling Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Annual physical exams, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, Enhanced Disease Management, Telemonitoring Services, and Home and Bathroom Safety Devices and Modifications are not covered.
Hearing Services See details
Hearing Services include coverage for routine hearing exams and fitting/evaluation for hearing aids, with one visit covered per year, and prescription hearing aids with a plan-specified amount of $1000 per year; however, hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
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, with no copay or coinsurance. This plan also covers eyewear, 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 dental services including Medicare Dental Services, Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Oral and Maxillofacial Surgery, and Implant Services, with a maximum benefit of $3,500 per year. Maxillofacial Prosthetics and Orthodontics are not covered by this plan.
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 with this plan. There is no copay or coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits are covered under the PLATINO PLUS (HMO D-SNP) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance between 0% and 5% and no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a coinsurance, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the PLATINO PLUS (HMO D-SNP) plan. However, Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered, and 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, although authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required.
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 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 also covers over-the-counter (OTC) items with a maximum benefit coverage amount of $50.00 every three months. Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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