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Contigo Plus (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Contigo Plus (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Contigo Plus (HMO C-SNP) in 2026, please refer to our full plan details page.
Contigo Plus (HMO C-SNP) is a HMO C-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 Contigo Plus (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Contigo Plus (HMO C-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 Contigo Plus (HMO C-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 Contigo Plus (HMO C-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 $70.00. 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 $4200.00 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 Contigo Plus (HMO C-SNP) Medicare plan features a $0 drug deductible, meaning your prescription coverage begins immediately. Beneficiaries enjoy no copay for Tier 1 preferred generics, Tier 2 generics, Tier 3 preferred brands, and Tier 6 select care drugs when using a preferred pharmacy or standard mail order. If you choose a standard pharmacy, copays for these same tiers range from $3 to $20 for a one-month supply. For Tier 4 non-preferred brands, the plan requires a $10 copay at preferred pharmacies and a $55 copay at standard pharmacies for a one-month supply. Tier 5 specialty drugs incur a 33% coinsurance across both preferred and standard pharmacies, as well as standard mail order. This structured coverage helps manage prescription drug costs effectively depending on your choice of pharmacy and medication tier.
Additional Benefits
The Contigo Plus (HMO C-SNP) plan offers highly affordable healthcare coverage with no copays and no coinsurance for many essential services, including inpatient hospital stays, primary care visits, and preventive care. For outpatient hospital services and emergency care, members can expect low copayments ranging from $25 to $50 with no coinsurance. Specialist visits also feature low copays of up to $5 with no coinsurance, making routine medical management exceptionally cost-effective. This plan provides robust coverage for dental, vision, and hearing services with no copays or coinsurance, featuring annual allowances of up to $2,500 for dental treatments and $220 for eyewear. Additionally, diagnostic tests, home health, and skilled nursing facility care are covered with no copays or coinsurance. While most services require no out-of-pocket costs, select treatments like dialysis and Part B drugs carry a coinsurance of up to 20 percent.
Inpatient Hospital See details
Contigo Plus (HMO C-SNP) covers inpatient acute and psychiatric hospital services with no copay and no coinsurance. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Contigo Plus (HMO C-SNP) covers outpatient hospital services with a $25 to $50 copay and ambulatory surgical center services with a $25 copay, both requiring prior authorization and carrying no coinsurance. Outpatient blood services have no copay, coinsurance, or deductible, but outpatient substance abuse services are not covered in practice because individual and group sessions are excluded.
Partial Hospitalization See details
Contigo Plus (HMO C-SNP) covers partial hospitalization services with no copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Contigo Plus (HMO C-SNP) covers some ambulance and transportation services with no copay and no coinsurance, though prior authorization is required. While some services are covered, ground ambulance, air ambulance, and transportation to plan-approved or health-related locations are not covered.
Emergency Services See details
Contigo Plus (HMO C-SNP) covers emergency services with a $50 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with no copay or coinsurance. Worldwide emergency services are partially covered up to a $75 maximum with no copay or coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Contigo Plus (HMO C-SNP) primary care benefits feature no copays and no coinsurance for primary care visits, physical and speech therapy, routine podiatry (up to 4 visits per year), and opioid treatment. Specialists, occupational therapy, and telehealth services require low copays ranging from $0 to $5 with no coinsurance, though some services like individual and group sessions for mental health and psychiatric services, and non-routine chiropractic care, are not covered.
Preventive Services See details
Preventive services are partially covered by Contigo Plus (HMO C-SNP) with no copay and no coinsurance for covered options like counseling, fitness benefits, and health education. However, several services are not covered under this plan, including annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and therapeutic massage.
Hearing Services See details
Contigo Plus (HMO C-SNP) offers partially covered hearing services with no copay and no coinsurance, including one routine hearing exam and one fitting evaluation annually. Prescription hearing aids are covered up to a $500 maximum per year for both ears combined, though OTC hearing aids as well as inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision services are covered by Contigo Plus (HMO C-SNP) with no copay, no coinsurance, and no deductible, which includes one routine eye exam and one eyewear exam per year. Covered eyewear, including contact lenses and eyeglasses, also features no copay or coinsurance up to a combined maximum benefit of $220 annually.
Dental Services See details
Contigo Plus (HMO C-SNP) provides partially covered dental services with no copay and no coinsurance for covered diagnostic, preventive, and comprehensive treatments, up to a $2,500 annual limit. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Contigo Plus (HMO C-SNP) with no copay, although prior authorization and step therapy are required. Under this benefit, Part B insulin has no copay and no coinsurance, while chemotherapy and other Part B drugs have a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Contigo Plus (HMO C-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Contigo Plus (HMO C-SNP) with no copay and coinsurance ranging from no coinsurance to 10% for durable medical equipment, prosthetics, and medical supplies. This benefit is partially covered, as diabetic supplies and diabetic therapeutic shoes or inserts are not covered, though other diabetic equipment features no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Contigo Plus (HMO C-SNP) with prior authorization, offering diagnostic tests, lab services, and diagnostic radiological services with no copay and no coinsurance. Therapeutic radiological services and outpatient x-ray services are not covered.
Home Health Services See details
Home Health Services are covered by Contigo Plus (HMO C-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Contigo Plus (HMO C-SNP) with no copay and no coinsurance, subject to prior authorization. Although some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Contigo Plus (HMO C-SNP) partially covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. Admission requires a prior inpatient hospital stay of at least 3 days, and additional days beyond Medicare-covered stays are not covered.
Other Services See details
Contigo Plus (HMO C-SNP) partially covers other services, offering acupuncture with no copay and no coinsurance for up to 12 treatments per year. Over-the-counter (OTC) items and meal benefits are not covered under this plan.
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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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