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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 $50.00. 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 coverage begins immediately. For Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs, you will pay no copay for 1-month or 3-month supplies at preferred pharmacies, as well as for 3-month supplies through standard mail order. Standard pharmacy copays for these lower-tier drugs range from $3 to $8 for a 1-month supply. Tier 3 preferred brand drugs and Tier 4 non-preferred brands are highly affordable, with 1-month copays starting at $5 and $10 respectively at preferred pharmacies. Standard mail order is also a cost-effective option for these brands, offering a 3-month supply for a $10 copay on Tier 3 and a $20 copay on Tier 4. Specialty tier medications (Tier 5) require a 33% coinsurance across all pharmacy and mail order options.
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 require no copay to a $5 copay, while outpatient hospital services feature a $25 to $50 copay. For emergency care, members pay a $50 copay, which is waived upon hospital admission, and dialysis services require a 20% coinsurance. This plan also includes valuable supplemental benefits with no copay, such as a $2,500 annual dental allowance, a $350 annual vision allowance, and up to 14 one-way transportation trips per year. Additionally, members receive a $50 quarterly over-the-counter allowance and up to $500 annually for prescription hearing aids. However, it is important to note that ambulance services, cardiac rehabilitation, and routine mental health sessions are not covered under this plan.
Inpatient Hospital See details
Ahorro Plus (HMO) inpatient hospital benefits are partially covered, offering Medicare-covered acute and psychiatric stays with no copay and no coinsurance. While unlimited additional days are covered for acute stays, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Ahorro Plus (HMO) 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
Ahorro Plus (HMO) covers partial hospitalization services with no copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Ahorro Plus (HMO) does not cover ambulance services, but does provide transportation services with no copay and no coinsurance. Eligible members receive up to 14 one-way trips per year to any health-related location using taxi, rideshare, or medical transport.
Emergency Services See details
Ahorro Plus (HMO) covers emergency services with a $50 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services and worldwide emergency and urgent care are 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) offers primary care, occupational therapy, podiatry, physical therapy, and opioid treatment with no copay and no coinsurance, while specialist visits and telehealth require a $0 to $5 copay and no coinsurance. Chiropractic services are partially covered with a $0 to $5 copay and no coinsurance for routine care, but other chiropractic services are not covered. Mental health and psychiatric services are not covered in practice as both individual and group sessions are excluded.
Preventive Services See details
Ahorro Plus (HMO) provides partially covered preventive services with no copay and no coinsurance for covered care, including Medicare-covered preventive services, kidney disease education, and diabetes self-management training. While select benefits like health education, counseling, and limited nutritional and alternative therapy sessions are included, several services—such as annual physical exams, fitness benefits, and in-home safety assessments—are not covered.
Hearing Services See details
Hearing services are partially covered by Ahorro Plus (HMO) with no copay and no coinsurance, which includes one routine hearing exam and one fitting evaluation per year. Prescription hearing aids are covered up to a $500 annual limit with no copay or coinsurance, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are covered by Ahorro Plus (HMO) with no copays, coinsurance, or deductibles, including one routine eye exam and one eyewear exam each year. Additionally, the plan provides a $350 annual allowance for eyewear, including contacts and eyeglasses, with no copay or coinsurance.
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, up to a $2,500 annual limit. While most services are covered at no cost, maxillofacial prosthetics and orthodontics are not covered, and certain treatments require prior authorization.
Home Infusion bundled Services See details
Ahorro Plus (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs have no copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature a 0% to 20% coinsurance with no copay.
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 0% to 10% coinsurance, subject to prior authorization. Diabetic equipment is partially covered under the plan with no copay and no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Ahorro Plus (HMO) partially covers Diagnostic and Radiological Services with no copays 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 under this plan.
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 sub-services, including intensive cardiac, pulmonary, and SET for PAD services, are covered in practice.
Skilled Nursing Facility (SNF) See details
Ahorro Plus (HMO) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization and a three-day inpatient hospital stay are required prior to admission. Additional days beyond the standard Medicare-covered limit are not covered.
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. Covered benefits include up to 12 acupuncture treatments per year and a $50 quarterly allowance for OTC items.
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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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