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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 prescription drug deductible of $590. If you qualify for the low-income subsidy, you will pay $0 for your drugs. After your deductible is met, you will pay the costs for your drugs based on the drug tier until your total drug costs reach $2000. Once you reach $2000 in total drug costs, you will enter the catastrophic coverage phase, where you will pay nothing for your Medicare Part D covered drugs.
Additional Benefits
The PLATINO PLUS (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Many services, such as emergency services, ambulance services, and home health services, have no copay. The plan also covers hearing aids up to $1,000 per year, eyewear up to $500 per year, and a wide range of dental services. This plan provides coverage for inpatient and outpatient services, including some mental health services, as well as coverage for dialysis and medical equipment with a coinsurance between 0% and 5%. Additionally, the plan includes coverage for acupuncture (12 treatments per year) and over-the-counter items up to $50 every three months.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, though Non-Medicare-covered stays, upgrades, and additional days for psychiatric services are not covered. Prior authorization is required for Inpatient Hospital-Acute.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient blood services. Outpatient substance abuse services are partially covered, as individual and group sessions are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. There is no information about cost sharing in the provided text.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by the PLATINO PLUS (HMO D-SNP) plan. While all ambulance services are covered with no copay or coinsurance, ground and air ambulance services are not covered; however, transportation services to any health-related location are covered for up to 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, though Worldwide Emergency Services has a maximum benefit coverage amount of $75. Worldwide Emergency Transportation is not covered.
Primary Care See details
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. Occupational Therapy and Physical Therapy services have no copay and no coinsurance, but require authorization. Mental Health and Psychiatric Services do not cover individual or group sessions.
Preventive Services See details
Preventive Services are covered, but 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 benefit, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications are not covered. Health Education, Alternative Therapies (up to 12 visits), Nutritional/Dietary Benefit (up to 12 visits), Remote Access Technologies, Counseling Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered.
Hearing Services See details
Hearing Services includes coverage for routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams and fitting/evaluation for hearing aids are each covered for one visit per year. Prescription hearing aids are covered up to a maximum of $1,000 per year.
Vision Services See details
The PLATINO PLUS (HMO D-SNP) plan covers vision services, including routine eye exams, other eye exam services, and eyewear. The plan covers one routine eye exam and one other eye exam service per year. Eyewear is covered up to a combined maximum of $500 every year, and includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The PLATINO PLUS (HMO D-SNP) plan covers a range of 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 under this plan. There is a $3,500 maximum plan benefit 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. Medicare Part B Insulin Drugs are covered, while Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered under the plan. There is no copay or coinsurance for this benefit.
Medical Equipment See details
Medical equipment benefits are covered by the PLATINO PLUS (HMO D-SNP) plan. Durable Medical Equipment (DME) has a coinsurance between 0% and 5% with no copay, but durable medical equipment for use outside the home is not covered. Prosthetic devices have a coinsurance between 0% and 5% with no copay. Medical supplies have a coinsurance between 0% and 5% with no copay. Diabetic supplies and diabetic therapeutic shoes/inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the PLATINO PLUS (HMO D-SNP) plan, 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 or coinsurance, though additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for the covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the PLATINO PLUS (HMO D-SNP) plan, but additional days beyond Medicare coverage and non-Medicare-covered stays are not covered. Prior authorization is required.
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, including nicotine replacement therapy and naloxone. This plan does not cover meal benefits, and several other services are not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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