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Enlace Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Enlace Plus (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Enlace Plus (HMO) in 2026, please refer to our full plan details page.
Enlace Plus (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 4.5 out of 5 stars in 2026.
It's important to know that Enlace Plus (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 Enlace Plus (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 Enlace Plus (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 $75.00. 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 Enlace Plus (HMO) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately with no deductible to meet. You will pay no copay for Tier 1 generic, Tier 2 generic, Tier 3 preferred brand, and Tier 6 select care drugs when utilizing preferred pharmacies or standard mail-order services. Standard pharmacy copays for these tiers are highly affordable, ranging from $3 to $30 for a 1-month supply. For Tier 4 non-preferred brand drugs, the plan features a $5 copay at preferred pharmacies and a $55 copay at standard pharmacies for a 1-month supply. Tier 5 specialty drugs require a 33% coinsurance across all pharmacy and mail-order options. Utilizing preferred pharmacies and standard mail order is the most cost-effective way to secure your medications under this plan.
Additional Benefits
The Enlace Plus (HMO) Medicare plan offers comprehensive coverage with significant cost savings, featuring no copays or coinsurance for inpatient hospital stays, skilled nursing care, and primary care doctor visits. Specialist consultations are highly affordable with copays of only $0 to $5 and no coinsurance, while outpatient hospital services require a $25 to $50 copay. Emergency room visits carry a $75 copay that is waived if admitted, and urgently needed services require no copay or coinsurance. The plan also provides exceptional dental, vision, and hearing benefits with no copays or coinsurance, including up to $3,000 annually for dental care and a $400 yearly limit for eyewear. Members also benefit from up to $1,500 per year for prescription hearing aids and an over-the-counter allowance of up to $200 monthly for health items. To ensure easy access to care, the plan covers up to 18 free one-way trips annually to health-related destinations.
Inpatient Hospital See details
Enlace Plus (HMO) covers inpatient hospital services with no copay and no coinsurance for both acute and psychiatric stays, though prior authorization is required for acute care. While acute stays include unlimited additional covered days, this benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Enlace Plus (HMO) outpatient services are covered with no coinsurance, featuring a $25.00 to $50.00 copay for outpatient hospital services and a $25.00 copay for ambulatory surgical center services. Outpatient blood services have no copay and no coinsurance, while outpatient substance abuse individual and group sessions are not covered.
Partial Hospitalization See details
Enlace Plus (HMO) covers partial hospitalization services with no copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Enlace Plus (HMO) does not cover ground or air ambulance services, but transportation services are covered with no copay and no coinsurance. Eligible members receive up to 18 one-way trips per year to any health-related location via taxi, rideshare, or medical transport.
Emergency Services See details
Emergency services are partially covered by Enlace Plus (HMO) with a $75 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, while urgently needed services have no copay or coinsurance. Worldwide emergency and urgent services are covered with no copay or coinsurance up to a $75 maximum plan benefit, but worldwide emergency transportation is not covered.
Primary Care See details
Enlace Plus (HMO) offers primary care, physical therapy, speech therapy, and opioid treatment with no copay and no coinsurance, while specialist, telehealth, and podiatry services have copays ranging from $0 to $5 and no coinsurance. Chiropractic services are partially covered with a $0 to $5 copay and no coinsurance (excluding other chiropractic services), occupational therapy requires a $10 copay and no coinsurance, and mental health and psychiatric services are not covered.
Preventive Services See details
Enlace Plus (HMO) offers partially covered preventive services with no copay and no coinsurance, which includes Medicare-covered zero-dollar services, kidney disease education, and select counseling or nutritional benefits. However, some services are not covered under this plan, including annual physical exams, fitness benefits, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
Enlace Plus (HMO) covers hearing services with no copay and no coinsurance, including one routine hearing exam and one fitting evaluation every year. Prescription hearing aids are covered with no copay or coinsurance up to a $1,500 annual maximum, though OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Enlace Plus (HMO) with no copay, no coinsurance, and no deductible, including one routine eye exam and one eyewear exam every year. Covered eyewear, including contact lenses, eyeglasses, and upgrades, also features no copay or coinsurance up to a combined maximum benefit of $400 annually.
Dental Services See details
Dental services are partially covered by Enlace Plus (HMO) with no copay and no coinsurance for all covered preventive and comprehensive services, up to a $3,000 annual maximum. While most diagnostic, preventive, and restorative treatments are covered, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Enlace Plus (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, insulin is covered with no copay and no coinsurance, while Medicare Part B chemotherapy, radiation, and other Part B drugs feature no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Enlace Plus (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Enlace Plus (HMO) partially covers medical equipment with no copay for covered items, though prior authorization is required. Covered durable medical equipment and prosthetics carry a 0% to 10% coinsurance, while diabetic equipment has no coinsurance, but medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Enlace Plus (HMO) partially covers diagnostic and radiological services with prior authorization required, offering no copay and no coinsurance for covered diagnostic procedures, lab services, and diagnostic radiological services. However, therapeutic radiological services and outpatient X-ray services are not covered under this plan.
Home Health Services See details
Enlace Plus (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Enlace Plus (HMO) offers Cardiac Rehabilitation Services with no copay and no coinsurance, though prior authorization is required. While some services are covered, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Enlace Plus (HMO) with no copay and no coinsurance per admission, requiring prior authorization and a prior three-day inpatient hospital stay. Additional days beyond standard Medicare-covered days are not covered.
Other Services See details
Other services are partially covered by Enlace Plus (HMO), which offers acupuncture and over-the-counter (OTC) items with no copay and no coinsurance, while meal benefits are not covered. Acupuncture is limited to 12 treatments per year, and the OTC benefit provides up to $200 per month for select health items.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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.
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