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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 $35.00. 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 Generic), Tier 2 (Generic), and Tier 6 (Select Care Drugs), there is 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 lower-tier drugs range from just $3 to $8 for a 1-month supply. Brand-name medications are also highly affordable, with Tier 3 (Preferred Brand) copays starting at $5 and Tier 4 (Non-Preferred Brand) starting at $10 for a 1-month supply at preferred pharmacies. Standard mail order offers excellent savings with a $10 copay for Tier 3 and a $20 copay for Tier 4 3-month supplies. Specialty medications in Tier 5 require a 33% coinsurance across all pharmacy types for both 1-month and 3-month supplies.
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 care, and home health services. Specialist visits and telehealth services are highly affordable, requiring a copay of up to $5 and no coinsurance. Outpatient hospital and ambulatory surgical services feature low copays ranging from $25 to $50, while emergency care carries a $50 copay that is waived if you are admitted. This plan also provides valuable supplemental benefits with no copayments or coinsurance, including comprehensive dental care up to a $2,500 annual limit, routine vision care with a $350 eyewear allowance, and hearing services up to $500 yearly. Additionally, members receive up to 14 free one-way transportation trips per year to health-related locations and a $50 quarterly allowance for over-the-counter items. While some services like dialysis and certain Part B drugs require a 20% coinsurance, the plan overall focuses on keeping out-of-pocket costs minimal.
Inpatient Hospital See details
Ahorro Plus (HMO) covers inpatient hospital services with no copay and no coinsurance for Medicare-covered acute and psychiatric stays, though prior authorization is required for acute care. While unlimited additional days for acute stays are covered, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Ahorro Plus (HMO) covers outpatient services with no coinsurance, featuring a $25 to $50 copay for outpatient hospital services and a $25 copay for ambulatory surgical center services, both of which require prior authorization. Outpatient blood services have no copay or coinsurance, and while some outpatient substance abuse services are covered with no copay or coinsurance, individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization is covered under the Ahorro Plus (HMO) plan with no copay and no coinsurance, although prior authorization is required for these services.
Ambulance and Transportation Services See details
Ahorro Plus (HMO) offers transportation services with no copay and no coinsurance for up to 14 one-way trips per year to any health-related location, but ground and air ambulance services are not covered. Eligible transportation modes under this plan include taxi, rideshare services, and medical transport.
Emergency Services See details
Ahorro Plus (HMO) 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 and urgent care are partially covered with no copay or coinsurance up to a $75 maximum limit, though worldwide emergency transportation is not covered.
Primary Care See details
Ahorro Plus (HMO) covers primary care, therapy, podiatry, and opioid treatment with no copay and no coinsurance, while specialist and telehealth services require a $0 to $5 copay and no coinsurance. Chiropractic, mental health, and psychiatric benefits are partially covered with no coinsurance, but exclude other chiropractic services as well as individual and group sessions.
Preventive Services See details
Preventive services are covered by Ahorro Plus (HMO) with no copay and no coinsurance for Medicare-covered preventive care, kidney disease education, and select additional services like counseling and nutritional benefits. This benefit is partially covered, as an annual physical exam, fitness benefits, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered under the Ahorro Plus (HMO) plan, offering no copay and no coinsurance for annual routine hearing exams, fittings, and prescription hearing aids up to a $500 yearly limit. However, over-the-counter 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, which includes one routine eye exam and one eyewear exam every year. Eyewear, including contact lenses, frames, and lenses, is also covered with no copay or coinsurance up to a combined maximum benefit of $350 per year.
Dental Services See details
Ahorro Plus (HMO) dental services are partially covered with no copay and no coinsurance for preventive care and most comprehensive procedures, up to a $2,500 annual maximum. While many diagnostic, restorative, and surgical services are included, maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the Ahorro Plus (HMO) plan with no copay, though prior authorization is required. Covered Part B insulin drugs carry no copay and no coinsurance, while Medicare Part B chemotherapy, radiation, and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Ahorro Plus (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Ahorro Plus (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and coinsurance ranging from no coinsurance to 10%, subject to prior authorization. Diabetic equipment is partially covered with no copay and no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by Ahorro Plus (HMO) and require prior authorization. Covered diagnostic procedures, lab services, and diagnostic radiological services feature no copay and no coinsurance, while therapeutic radiological services and outpatient X-ray 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, although 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 specific sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are covered in practice.
Skilled Nursing Facility (SNF) See details
Ahorro Plus (HMO) covers Skilled Nursing Facility (SNF) services per stay with no copay and no coinsurance, though prior authorization and a prior three-day inpatient hospital stay are required. Additional days beyond the standard Medicare-covered limit are not covered under this plan.
Other Services See details
Ahorro Plus (HMO) offers partial coverage for Other Services, providing acupuncture limited to 12 treatments per year and over-the-counter (OTC) items up to $50 every three months with no copay and no coinsurance. Meal benefits and other additional services under this category are not covered.
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