AHM_Platino Plus (HMO SNP) 2012

The AHM_Platino Plus (HMO SNP) is a plan designed for Medicare beneficiaries subscribed to Part A and Part B and who, at the same time, are eligible for the Medicaid coverage.

$25 reduction to the Medicare Part B Premium, up to $300 annually
$0 monthly premium
$0 deductible
$0/$0.50 copayment on prescription drugs: brand or generic **
$0/$1 copayment on PCP and Specialist visits **
$0 copayment on ambulance services (only when medically necessary)
$0/$1 copayment on laboratories and X-rays **
Oral Nutritional Supplements (3 units per day for 4 weeks every year) *
Adult diapers (3 diapers per day) *
One shower chair (every 5 years) *
One Blood Pressure Monitor (every 5 years) *
$25 monthly for health programs such as gym memberships

* Certain restrictions apply.

** Coverage Code 010 / Coverage Code 011

Plan is available to beneficiaries residing in one of the 78 municipalities of Puerto Rico.

To enroll, you must have Medicare Parts A and B and Medicaid.

Please refer to the Evidence of Coverage and/or the Summary of Benefits for information on copayments/coinsurance.

Premiums, copayments, coinsurance and deductibles may vary based on the level of help received.

Annual Notice of Change AHM_Platino Plus (HMO SNP) H5774_1054_12_01_E File & Use 08312011

Evidence of Coverage AHM_Platino Plus (HMO SNP) CMS Approved 11222012

Summary of Benefits AHM_Platino Plus (HMO SNP) H5774_1001_12_01_E CMS Approved 09082011

Last Updated 04/18/2012