PMC Premier Platino (HMO D-SNP) Costs & Coverage — Santa Isabel Municipio, Puerto Rico
CMS Plan-ID H4004-048-0 identifies PMC Premier Platino (HMO D-SNP), a Dual-Eligible Medicare Special Needs Plan offered by Medicare y Mucho Mas (MMM) for the 2026 plan year.
The most recent CMS enrollment data shows an estimated 5,872 beneficiaries enrolled in this plan, with 30 in Santa Isabel Municipio.
PMC Premier Platino Overview
Plan Overview for
H4004-048-0
|
|
|---|---|
| CMS Plan ID: |
H4004-048-0
|
| Plan Type: | HMO D-SNP |
| Plan Year: | 2026 |
| Monthly Premium: |
$0.00
Plus your Medicare Part B premium. |
| Medical Deductible: | $0.00 |
| Maximum Out-of-Pocket: | $3250.00 (In-Network) |
| Part B Give Back: | −$35.00 reduction |
| Prescription Drug Coverage: | Basic, $615.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | Santa Isabel Municipio, PR |
| Enrollment (Nationwide): | 5,872 beneficiaries |
| Provided By: | Medicare y Mucho Mas (MMM) |
To learn more about your plan options, costs, and enrollment periods without agent assistance, try our helpful Medicare Resources below (click to open).
Medicare Plan Decision Resources
Eligibility and Plan Network
Eligibility Requirements
[dsnp]PMC Premier Platino is a Medicare D-SNP plan for dual-eligible beneficiaries (Medicare and Medicaid).
| Special Needs Plan Type: | Dual-Eligible Special Needs Plan (D-SNP) |
|---|---|
| Medicare Requirement: | Medicare Part A and Part B |
| Special Needs Requirement: | Must qualify for Medicaid |
| Service Area Requirement: | Must live in the plan's service area |
| Prescription Drug Coverage: | Prescription drug coverage (Part D) is included. |
- PMC Premier Platino is a Medicare C-SNP plan for individuals with specific chronic or disabling conditions.
| Type of Special Needs Plan: | Chronic Condition (C-SNP) |
|---|---|
| Eligibility Requirement: | Must have Medicare Part A and Part B |
| Special Needs Requirement: | |
| Service Area Requirement: | Must live in the plan's designated service area |
| Prescription Drug Coverage: | Prescription drug coverage is included. |
- PMC Premier Platino is an Institutional Special Needs Plan (I-SNP) for individuals living in an institution or requiring nursing-level care at home.
| Special Needs Plan Type: | Institutional Special Needs Plan (I-SNP) |
|---|---|
| Medicare Requirement: | Must have both Medicare Part A and Part B |
| Special Needs Requirement: | |
| Service Area Requirement: | Must live in the plan's designated service area |
| Prescription Drug Coverage: | Prescription drug coverage is included. |
Plan Network
PMC Premier Platino operates on a Health Maintenance Organization (HMO) network. Members usually access care through in-network providers, and referrals are often needed for specialty services. The plan covers emergency services and out-of-area dialysis regardless of network status.
Plan Network
This plan uses a Preferred Provider Organization (PPO) network, allowing you to see providers both inside and outside the network. Costs are typically lower when using in-network providers, and referrals are not usually needed for specialist care. Emergency care and out-of-area dialysis are covered.
Plan Network
PMC Premier Platino uses a Health Maintenance Organization Point-of-Service (HMO-POS) network for delivery of care. As an HMO-POS member, you typically receive services through the plan’s network of providers, with referrals generally required for specialists. Some out-of-network services may be covered at a higher cost. Emergency care and out-of-area dialysis are covered.
5-Star Rating Marks
The Centers for Medicare & Medicaid Services (CMS) annually rates Medicare Advantage HMO D-SNPs in nine key categories using a 5-star system. These ratings help you gauge the quality of care and service you might receive with this Medicare y Mucho Mas (MMM) plan.
| CMS Measure | Star Rating |
|---|---|
| 2026 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Covered Services & Costs
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | In-network: $0 copay |
| Specialist: | In-network: $0 copay |
Medicare Advantage plans often include preventive and wellness benefits designed to help members stay healthy, identify risks early, and maintain an active lifestyle.
| Service | Enrollee Cost (in-network) |
|---|---|
| Annual wellness exam: | Not covered |
| Telehealth benefit: | In-network: $0 copay |
| Routine chiropractic: | In-network: $0 copay |
| Fitness benefits: | In-network: $0 copay |
| Health education: | In-network: $0 copay |
| Counseling services: | Not covered |
| Over the counter drug benefits: | In-network: $0 copay |
| Health transportation (non-emergency): | In-network: $0 copay |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $0 copay |
| Wordwide emergency care: | $75 copay |
| Urgent care: | $0 copay |
| Inpatient hospital care: | Tier 1 | $0 per stay |
| Skilled Nursing Facility: | Tier 1 | Tier 2 | $0 copay |
| Ground ambulance: | In-network: $0 copay |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | In-network: $0 copay |
| Outpatient group therapy: | In-network: $0 copay |
| Inpatient psychiatric hospital care: | Tier 1 | $0 per stay |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $0 copay |
| Occupational therapy: | In-network: $0 copay |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | In-network: $0 copay |
| Durable medical equipment: | In-network: $0 copay |
| Prosthetics: | In-network: $0 copay |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | In-network: $0 copay |
| Lab services: | In-network: $0 copay |
| Outpatient x-rays: | In-network: $0 copay |
| Diagnostic tests and procedures: | In-network: $0 copay |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | In-network: $0 copay |
| Other Part B drugs (Medicare-covered): | In-network: $0 copay |
This section details the dental services covered under your plan including Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| Oral exam: | Not covered |
| Dental x-rays: | Not covered |
| Cleaning: | Not covered |
| Periodontics: | Not covered |
| Endodontics: | Not covered |
| Restorative services: | In-network: $0 copay |
| Implant services: | In-network: $0 copay |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | Not covered |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Hearing exam: | Not covered |
| Fitting/evaluation: | In-network: $0 copay |
| Prescription hearing aids: | In-network: $0 copay |
| OTC hearing aids: | Not covered |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Routine eye exam: | Not covered |
| Contact lenses: | In-network: $0 copay |
| Eyeglass frames only: | Not covered |
| Eyeglass lenses only: | Not covered |
| Eyeglasses (frames & lenses): | In-network: $0 copay |
| Upgrades: | Not covered |
Medicare Advantage plans may include extra benefits and special needs services designed to support members with chronic conditions, mobility limitations, or other complex health needs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Adult day health services: | Not covered |
| Home based palliative care: | Not covered |
| Personal emergency response system: | Not covered |
| Weight management programs: | Not covered |
| 'Wigs for chemotherapy hair loss: | Not covered |
| Alternative therapies: | In-network: $0 copay |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | In-network: $0 copay |
PMC Premier Platino covers 100% of certain preventive services as a required Part B benefit.
Prescription Drug Coverage
Plan Premium
The following table outlines the prescription drug plan premium details of this plan.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $0.00 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $0.00 |
| Low Income Premium Subsidy: | $Not Applicable |
| Low Income Premium Subsidy CMS Pays: | $0.00 |
| Low Income Subsidy Premium: | $0.00 |
For more information about the Low Income Subsidy, refer to the Social Security Extra Help page.
Plan Deductible
The Medicare Part D annual deductible with this plan is $615.00. This is the amount you must pay at the pharmacy before Medicare y Mucho Mas (MMM) begins paying its share.
Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, PMC Premier Platino has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Brand-name drugs | 25% coinsurance | Coming soon |
| Generic drugs | 25% coinsurance | Coming soon |
| *Deductible does not apply. | ||
Contact Medicare y Mucho Mas (MMM)
Call 833-748-3201 (TTY 711) to speak with a licensed HealthCompare insurance agent (M-F 8AM-10PM, Sat 9AM-8PM EST) and learn more about this plan and other plans on this site. You may also Enroll Online .
| Contact Type | Details |
|---|---|
| Website: | Medicare y Mucho Mas (MMM) Plan Page |
| New Members: | 1-833-668-2402 |
| Existing Members: | 1-866-333-5471 |
| Plan Address: | 350 Chardon Avenue | Suite 500 Torre Chardon | San Juan, PR 00918 |
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | CMS Version |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | {cms_landscape_data_version} |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | {cms_performance_data_version} |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | {cms_pbp_data_version} |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | {cms_enrollment_data_version} |
| Publisher | Reference | Last Accessed |
|---|---|---|
| Medicare y Mucho Mas (MMM) (official source) | http://www.mmmpr.com | October 13, 2025 |
| CMS.gov | Dual Eligible Special Needs Plans (D-SNPs) | September 20, 2025 |
| Medicare.gov | Compare types of Medicare Advantage Plans | 25 May, 2025 |
| Medicare.gov | Joining a plan | 5 May, 2025 |
Medicare.org independently compiles and interprets Medicare plan information using data published by the Centers for Medicare & Medicaid Services (CMS), official plan information, and other authoritative Medicare sources. The sources used for this plan are documented below.
Medicare.org is an independent Medicare information and enrollment resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program. Enrollment assistance is provided through HealthCompare, an Allstate company.
Medicare plan data and editorial content curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for Medicare plan interpretation and publication.