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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 2025, 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 out of 5 stars in 2025.
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 $60.00. 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 Enlace Plus (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay different copays depending on the drug tier and pharmacy, ranging from no copay for preferred generic and specialty drugs at preferred pharmacies to 33% coinsurance for non-preferred drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D-covered drugs. If you qualify for the low-income subsidy, your costs may be reduced.
Additional Benefits
The Enlace Plus (HMO) plan offers comprehensive coverage with a variety of benefits. This plan covers inpatient hospital stays with no copay, outpatient services with copays ranging from $10 to $50, and emergency services with a $75 copay. Additional benefits include coverage for primary care, preventive services with no copay, hearing and vision services, and dental services. The plan also covers home infusion services, dialysis, medical equipment, and diagnostic services with varying coinsurance amounts.
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, and additional days are covered. Non-Medicare-covered stays and upgrades are not covered. Inpatient Hospital Psychiatric has no copay on the day of discharge, and additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $25-$50 copay, Observation Services, Ambulatory Surgical Center (ASC) Services with a $25 copay, Outpatient Substance Abuse Services with a $10 copay for both individual and group sessions, and Outpatient Blood Services with a waived three-pint deductible. Prior authorization is required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered and requires prior authorization. There is no information about the cost of this service, such as the copay or coinsurance.
Ambulance and Transportation Services See details
The Enlace Plus (HMO) plan covers ambulance and transportation services, but ground and air ambulance services are not covered. Transportation services to any health-related location are covered for up to 14 one-way trips per year, with no copay and no coinsurance.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, and Worldwide Urgent Coverage are covered by the Enlace Plus (HMO) plan. Emergency Services have a $75 copay, while Urgently Needed Services have no copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Enlace Plus (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-$5 copay, and Mental Health Specialty Services with a $10 copay for individual and group sessions. Also covered are Podiatry Services with a $0-$2 copay, Other Health Care Professional with a $0-$5 copay, Psychiatric Services with a $10 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with no copay, Additional Telehealth Benefits with a $0-$10 copay, and Opioid Treatment Program Services.
Preventive Services See details
The Enlace Plus (HMO) plan covers preventive services, including Medicare-covered services with no copay. Additional preventive services include health education, alternative therapies (12 visits), nutritional/dietary benefits (12 sessions), counseling services, enhanced disease management, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. However, annual physical exams, in-home safety assessments, personal emergency response systems, 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, fitness benefit, telemonitoring services, and home and bathroom safety devices and modifications are not covered.
Hearing Services See details
The Enlace Plus (HMO) plan covers hearing exams, routine hearing exams (1 per year), and fitting/evaluation for hearing aids (1 per year). This plan also covers prescription hearing aids (all types) up to $1500 per year, but does not cover prescription hearing aids for the inner, outer, or over the ear, or OTC hearing aids.
Vision Services See details
The Enlace Plus (HMO) plan covers vision services, including eye exams with one routine eye exam and one other eye exam service per year, as well as eyewear. Eyewear coverage includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum benefit of $400 per year.
Dental Services See details
The Enlace Plus (HMO) plan covers various 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 have a maximum plan benefit of $3000 per year. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B insulin drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. A coinsurance applies to these services, with the maximum coinsurance for Medicare Part B Chemotherapy/Radiation Drugs at 10% and the maximum coinsurance for Other Medicare Part B Drugs at 20%.
Dialysis Services See details
Dialysis Services are covered by the Enlace Plus (HMO) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment is covered under the Enlace Plus (HMO) plan, including Durable Medical Equipment (DME) with a coinsurance between 0% and 10%, but Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a coinsurance between 0% and 10%, and Medical Supplies have a coinsurance between 0% and 10%, while Diabetic Equipment is also covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Enlace Plus (HMO) plan. Diagnostic Procedures/Tests and Lab Services have no copay and a coinsurance of at most 20%, and Diagnostic Radiological Services have no copay and a coinsurance of at most 10%. However, Therapeutic Radiological Services and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Enlace Plus (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but services for Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered. Prior authorization is required.
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 for this benefit.
Other Services See details
Other Services includes acupuncture and over-the-counter (OTC) items. Acupuncture is covered for up to 12 treatments per year, and OTC items are covered up to $100.00 per month.
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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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