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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 2025, 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 out of 5 stars in 2025.
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 $130.00. 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 Contigo Plus (HMO C-SNP) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay varying copays depending on the drug tier and pharmacy. For preferred generics and standard generics, there is no copay at preferred pharmacies. Preferred brand drugs have a $5 copay at preferred pharmacies. Non-preferred drugs have 33% coinsurance, and specialty tier drugs have a $0 copay at preferred pharmacies.
Additional Benefits
The Contigo Plus (HMO C-SNP) plan offers comprehensive coverage with a focus on outpatient care, including services like primary care, vision, and dental. You'll find no copays for inpatient hospital stays, ambulance services, home health services, and many preventive services, while other services have varying copays. This plan also includes benefits for hearing aids, with up to $500 per year for prescription hearing aids, and covers a wide range of dental services, including orthodontics up to $4000 annually. You may also have access to services such as diagnostic and radiological services, medical equipment, and home infusion bundled services, with varying cost-sharing arrangements such as coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute with no copay, with prior authorization required, and additional days for Inpatient Hospital-Acute with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Inpatient Hospital Psychiatric benefits are covered, but additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services with the Contigo Plus (HMO C-SNP) plan include coverage for Outpatient Hospital Services with a copay between $25-$50, Observation Services, and Ambulatory Surgical Center (ASC) Services with a $25 copay. Outpatient Substance Abuse Services are not covered, and Outpatient Blood Services are covered with a waived three (3) pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Contigo Plus (HMO C-SNP) plan, with no copay or coinsurance for all ambulance services, although prior authorization is required. Ground ambulance services, air ambulance services, and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Contigo Plus (HMO C-SNP) plan. Emergency Services have a $50 copay, while there is no copay or coinsurance for Urgently Needed Services. Worldwide Emergency Transportation is not covered, and Worldwide Emergency Services has a maximum benefit coverage of $75.
Primary Care See details
The Contigo Plus (HMO C-SNP) plan covers primary care services, chiropractic services with a $5 copay, occupational therapy with a $5 copay, physician specialist services with a $0-$3 copay, podiatry services with up to 4 visits per year, other health care professional services with a $0-$3 copay, physical therapy and speech-language pathology services with no copay, additional telehealth benefits with a $0-$3 copay, and opioid treatment program services. Mental health and psychiatric individual and group sessions are not covered.
Preventive Services See details
The Contigo Plus (HMO C-SNP) plan covers preventive services, including Medicare-covered services with no copay, additional preventive services like Health Education, Alternative Therapies (12 visits), Nutritional/Dietary Benefit (12 visits), Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, Counseling Services, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Annual physical exams, In-Home Safety Assessment, Personal Emergency Response System, 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, Enhanced Disease Management, and Telemonitoring Services are not covered.
Hearing Services See details
The Contigo Plus (HMO C-SNP) plan covers hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, with no copay. Prescription hearing aids are covered up to a maximum of $500 per year, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Contigo Plus (HMO C-SNP) plan covers vision services, including routine eye exams, other eye exam services (eyewear eye exam), and eyewear. This plan provides one routine eye exam and one other eye exam service per year. Eyewear has a combined maximum benefit of $220.00 per year.
Dental Services See details
The Contigo Plus (HMO C-SNP) plan covers a range of dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Orthodontic services are covered up to a maximum of $4000 per year. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Contigo Plus (HMO C-SNP) plan and require prior authorization. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 10%.
Dialysis Services See details
Dialysis Services are covered by the Contigo Plus (HMO C-SNP) 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 of 0-10%, Prosthetics/Medical Supplies with a coinsurance, and Diabetic Equipment. 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 include coverage for all diagnostic services and lab services with no copay and a coinsurance of at most 15%, and diagnostic radiological services with a copay of at most $25 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 the Contigo Plus (HMO C-SNP) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the sub-services, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are covered. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare coverage and non-Medicare-covered stays are not covered. Prior authorization is required.
Other Services See details
Other Services benefits include acupuncture, covered up to 12 treatments per year. Over-the-Counter (OTC) Items, Meal Benefit, 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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