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Ahorro Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Ahorro Plus (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Ahorro Plus (HMO) in 2026, please refer to our full plan details page.
Ahorro Plus (HMO) is a HMO plan offered by Guidewell Mutual Holding Corporation available for enrollment in 2026 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 Ahorro 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 Ahorro 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 Ahorro 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 $65.00. 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 Ahorro Plus (HMO) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs, you will pay no copay for a 1-month or 3-month supply at a preferred pharmacy, or for a 3-month supply through standard mail order. Standard pharmacy copays for these tiers are also very low, starting at just $3 to $8 for a 1-month supply. Brand-name and specialty medications are also highly accessible under this plan. Tier 3 preferred brands require a low $5 copay for a 1-month supply at preferred pharmacies, while Tier 4 non-preferred brands have a $10 copay. Specialty drugs in Tier 5 carry a 33% coinsurance across all pharmacy options, ensuring predictable costs for high-tier medications.
Additional Benefits
The Ahorro Plus (HMO) plan offers robust coverage with no copays and no coinsurance for many essential services, including inpatient hospital stays, primary care visits, preventive screenings, and home health care. For outpatient medical needs, members pay low copays ranging from $25 to $50 for outpatient hospital services and a $50 copay for emergency care, which is waived upon hospital admission. Specialist visits and telehealth services are also highly affordable, requiring no copay to a maximum $5 copay. Supplemental benefits are a highlight of this plan, featuring no copays for dental care up to a $2,500 annual limit, vision care with a $350 eyewear allowance, and hearing services with a $500 hearing aid limit. Members also benefit from up to 14 free one-way transportation trips per year and a $50 quarterly over-the-counter allowance. While many services have no cost, coinsurance does apply to dialysis at 20 percent, durable medical equipment up to 10 percent, and Part B chemotherapy drugs up to 20 percent.
Inpatient Hospital See details
Ahorro Plus (HMO) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance. However, the benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, and prior authorization is required for acute stays.
Outpatient Services See details
Outpatient services are covered by Ahorro Plus (HMO), including outpatient hospital care with a $25 to $50 copay and ambulatory surgical center services for a $25 copay, both with no coinsurance. Outpatient blood services are covered with no copay, coinsurance, or deductible, while outpatient substance abuse services are not covered.
Partial Hospitalization See details
Ahorro Plus (HMO) covers partial hospitalization services with no copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered under Ahorro Plus (HMO), though ground and air ambulance services are not covered in practice. Transportation services are covered with no copay and no coinsurance, offering up to 14 one-way trips per year to any health-related location via taxi, rideshare, or medical transport.
Emergency Services See details
Emergency services under Ahorro Plus (HMO) are covered with a $50 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no copay and no coinsurance, while worldwide emergency and urgent care are covered with no copay and no coinsurance up to a $75 maximum limit, though worldwide emergency transportation is not covered.
Primary Care See details
Ahorro Plus (HMO) covers primary care, occupational therapy, physical therapy, podiatry, and opioid treatment with no copay and no coinsurance. Specialist visits, telehealth, and routine chiropractic care (up to 5 visits yearly) require a $0 to $5 copay and no coinsurance, though mental health sessions, psychiatric sessions, and non-routine chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by Ahorro Plus (HMO) with no copay and no coinsurance for covered services, which include Medicare-covered preventive screenings, kidney disease education, and nutritional counseling. While select supplemental benefits like alternative therapies and health education are included, other services such as the annual physical exam, fitness benefits, and in-home safety assessments are not covered.
Hearing Services See details
Ahorro Plus (HMO) hearing services are partially covered, providing routine exams, fitting evaluations, and prescription hearing aids with no copay and no coinsurance. While prescription hearing aids are covered up to a $500 annual maximum, 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 Ahorro Plus (HMO) with no copay, no coinsurance, and no deductible for exams and eyewear. Members receive one routine eye exam and one eyewear exam per year, as well as a $350 annual allowance for contacts, eyeglasses, and upgrades.
Dental Services See details
Dental services are partially covered by Ahorro Plus (HMO) with no copay and no coinsurance for covered preventive and comprehensive care, though some services require prior authorization. While many diagnostic, restorative, and surgical procedures are covered up to a $2,500 annual maximum, maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Ahorro Plus (HMO) with no copay, requiring prior authorization and step therapy. Medicare Part B insulin is provided with no copay and no coinsurance, while chemotherapy and other Part B drugs are subject to a 0% to 20% coinsurance.
Dialysis Services See details
Ahorro Plus (HMO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Ahorro Plus (HMO) partially covers medical equipment with no copays, featuring 0% to 10% coinsurance for durable medical equipment, prosthetics, and medical supplies, and no coinsurance for diabetic equipment. Prior authorization is required for these covered services, while diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered under the Ahorro Plus (HMO) plan, offering no copay and no coinsurance for covered diagnostic procedures, lab services, and diagnostic radiological services, though prior authorization is required. Outpatient X-ray services and therapeutic radiological services are not covered.
Home Health Services See details
Home health services are covered under the Ahorro Plus (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Ahorro Plus (HMO) plan, as none of the individual sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are covered.
Skilled Nursing Facility (SNF) See details
Ahorro Plus (HMO) covers Skilled Nursing Facility (SNF) services per admission with no copay and no coinsurance, though prior authorization and a three-day inpatient hospital stay are required before admission. Additional days beyond the standard Medicare-covered benefit are not covered by this plan.
Other Services See details
Other services are partially covered by Ahorro Plus (HMO), featuring 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 $50 every three months for select items.
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