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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 $115.00. 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 features an annual drug deductible of $615. This deductible is the amount you must pay out-of-pocket for your medications before the plan begins to cover its portion of the costs. Specific details regarding drug tiers, copays, and coinsurance are currently not available for this plan. When evaluating this plan, factoring in the $615 deductible is essential for estimating your overall annual healthcare expenses. To get a complete picture of your potential medication costs, you may want to verify how your specific prescriptions are covered under this plan. Knowing these initial costs helps you determine if this plan fits your budget and medical needs.
Additional Benefits
The PLATINO PLUS (HMO D-SNP) plan offers comprehensive medical coverage with no copays and no coinsurance for the vast majority of its covered services. Members can access essential care, including inpatient and outpatient hospital stays, primary and specialist doctor visits, emergency services, and home health care, entirely free of cost-sharing. While key services like dialysis and skilled nursing facility stays are fully covered with no copay, some services require prior authorization. In addition to core medical care, this plan provides valuable supplemental benefits with no copay, including a $500 annual eyewear allowance, a $1,000 annual hearing aid benefit, and up to $3,000 in dental coverage for select services. Members also benefit from 30 free one-way transportation trips per year to health-related destinations and a $50 quarterly over-the-counter allowance. However, it is important to note that ground and air ambulance services, as well as cardiac rehabilitation, are not covered under this plan.
Inpatient Hospital See details
PLATINO PLUS (HMO D-SNP) covers inpatient hospital acute and psychiatric stays with no copay and no coinsurance, although prior authorization is required for acute care. Unlimited additional days are covered for acute stays, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
PLATINO PLUS (HMO D-SNP) covers outpatient hospital, ambulatory surgical center, and blood services with no copay and no coinsurance. Some outpatient substance abuse services are covered with no copay and no coinsurance, but individual and group sessions are not covered.
Partial Hospitalization See details
PLATINO PLUS (HMO D-SNP) covers partial hospitalization services with no copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
PLATINO PLUS (HMO D-SNP) provides transportation services with no copay and no coinsurance for up to 30 one-way trips per year to any health-related location. While some ambulance services are covered with no copay and no coinsurance, ground and air ambulance services are not covered.
Emergency Services See details
PLATINO PLUS (HMO D-SNP) covers emergency and urgently needed services with no copays and no coinsurance. Worldwide emergency and urgent care are also covered with no copay or coinsurance up to a $75 maximum benefit, though worldwide emergency transportation is not covered.
Primary Care See details
PLATINO PLUS (HMO D-SNP) primary care benefits feature no copay and no coinsurance for covered services, including primary care visits, specialist care, physical therapy, and telehealth. Chiropractic, mental health, and psychiatric services are partially covered with no copay or coinsurance, though other chiropractic services and individual or group sessions for mental health and psychiatry are not covered.
Preventive Services See details
PLATINO PLUS (HMO D-SNP) offers partially covered preventive services with no copay and no coinsurance for covered benefits like Medicare-covered preventive care, glaucoma screenings, and kidney disease education. However, several services are not covered under this benefit, including the annual physical exam, fitness benefits, and in-home safety assessments.
Hearing Services See details
Hearing services are partially covered by PLATINO PLUS (HMO D-SNP), featuring one routine hearing exam and one fitting evaluation per year with no copay and no coinsurance. Prescription hearing aids are covered with no copay and no coinsurance up to a $1,000 annual maximum, though inner ear, outer ear, over the ear, and over-the-counter (OTC) 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, as well as a $500 annual allowance for eyewear, including contact lenses, eyeglass 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 for covered Medicare dental, restorative, endodontic, periodontic, prosthodontic, implant, and oral surgery services, up to a $3,000 annual maximum. However, oral exams, cleanings, dental x-rays, fluoride, other preventive services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are partially covered by PLATINO PLUS (HMO D-SNP) with no copay and no coinsurance, although prior authorization and step therapy are required. This benefit covers insulin and Part D home infusion drugs, but Medicare Part B chemotherapy, radiation, and other Part B drugs are not covered.
Dialysis Services See details
Dialysis Services are covered by the PLATINO PLUS (HMO D-SNP) plan with no copay and no coinsurance.
Medical Equipment See details
Medical equipment is partially covered by PLATINO PLUS (HMO D-SNP), featuring no copay and no coinsurance for durable medical equipment and diabetic equipment. Prosthetic devices are covered with no copay and a 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 some diagnostic and radiological services with no copay and no coinsurance, though prior authorization is required. However, diagnostic procedures and 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
PLATINO PLUS (HMO D-SNP) does not cover Cardiac Rehabilitation Services, as none of the individual sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are covered under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by PLATINO PLUS (HMO D-SNP) with no copay and no coinsurance, although prior authorization and a prior three-day inpatient hospital stay are required. Additional days beyond Medicare-covered SNF services are not covered.
Other Services See details
PLATINO PLUS (HMO D-SNP) provides partial coverage for other services, featuring acupuncture limited to 12 treatments per year and a $50 quarterly over-the-counter (OTC) allowance with no copay and no coinsurance. Meal benefits, dual-eligible highly integrated services, and other miscellaneous 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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