A non-government entity
Real (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Real (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Real (HMO) in 2025, please refer to our full plan details page.
Real (HMO) is a HMO 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 Real (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Real (HMO).
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 Real (HMO), 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 $80.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
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 Real (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying copays based on the drug tier and pharmacy. For example, Preferred Generic drugs have no copay at a preferred pharmacy, while Standard Generic drugs have no copay at a preferred pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS).
Additional Benefits
The Real (HMO) plan offers a range of benefits, including coverage for inpatient hospital stays with no copay, outpatient services with copays between $25 and $50, and ambulance and transportation services with no copay. The plan also covers primary care physician services, some preventive services, hearing and vision services, dental services, and dialysis services. Additional benefits include home infusion services, medical equipment, diagnostic and radiological services, home health services, and skilled nursing facility services. The plan also covers acupuncture treatments, and offers an allowance for over-the-counter items. However, some services like mental health and psychiatric services, and additional hours of home health care are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Inpatient Hospital-Acute has no copay for a Medicare-covered stay, with additional days covered, while Non-Medicare-covered stays and upgrades are not covered. Inpatient Hospital Psychiatric has no additional benefits covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, and ambulatory surgical center services, each with a copay between $25 and $50. Outpatient substance abuse services are not covered, but outpatient blood services are covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Real (HMO) plan, but requires prior authorization. The plan does not specify any cost-sharing for this benefit.
Ambulance and Transportation Services See details
The Real (HMO) plan covers ambulance and transportation services. Ambulance services are covered with no copay and no coinsurance, but ground and air ambulance services are not covered; transportation services to any health-related location are covered for 18 one-way trips per year with no copay and no coinsurance, using taxis, rideshares, or medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage are covered by the Real (HMO) plan. Emergency Services has a $50 copay, and Worldwide Emergency Services has a maximum benefit coverage amount of $75. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Real (HMO) plan covers primary care physician services, chiropractic services with a $5 copay, occupational therapy services with a $10 copay, physician specialist services with a $0-$15 copay, podiatry services with a $0-$2 copay, other health care professional services with a $0-$15 copay, physical therapy and speech-language pathology services with no copay, additional telehealth benefits with a $0-$15 copay, and opioid treatment program services. Mental health and psychiatric services are not covered.
Preventive Services See details
Preventive Services are covered, but Annual Physical Exams, In-Home Safety Assessments, Personal Emergency Response Systems (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, Telemonitoring Services, and Home and Bathroom Safety Devices and Modifications are not covered. Health Education, Alternative Therapies (12 visits), Nutritional/Dietary Benefit (12 visits), Counseling Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, EKG following Welcome Visit, Enhanced Disease Management, and Remote Access Technologies are covered.
Hearing Services See details
Hearing Services include routine hearing exams and fitting/evaluation for hearing aids, with each covered once per year; Prescription Hearing Aids are covered up to $500 every year, while inner ear, outer ear, and over the ear hearing aids are not covered; OTC hearing aids are not covered.
Vision Services See details
The Real (HMO) plan covers vision services, including routine eye exams, other eye exam services, and eyewear. Eye exams are covered once per year, and eyewear has a combined maximum benefit of $300 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Real (HMO) plan covers several dental services, including oral exams, dental x-rays, other diagnostic dental services, cleanings, fluoride treatments, other preventive dental services, and orthodontic services. Maxillofacial Prosthetics and Orthodontics are not covered, and Orthodontic Services have a maximum benefit of $4250 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with prior authorization. For Medicare Part B Chemotherapy/Radiation Drugs, you may pay between 0% and 10% coinsurance, and for Other Medicare Part B Drugs, you may pay between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Real (HMO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 10%, and Prosthetics/Medical Supplies with a coinsurance. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Real (HMO) plan, with prior authorization required. Diagnostic Procedures/Tests and Lab Services have no copay and a coinsurance of at most 20%, while Diagnostic Radiological Services have a copay of up to $75 and Therapeutic Radiological Services and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Real (HMO) plan with no copay and no coinsurance, but 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 some services are not covered, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered. Prior authorization is required.
Other Services See details
The Real (HMO) 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 $25.00 every three months. However, meal benefits, 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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