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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 $20.00. 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) Medicare 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 fills at preferred pharmacies, or for 3-month fills through standard mail order. Standard retail pharmacy copays for these lower-tier drugs range from $3 to $8 for a 1-month supply. Tier 3 preferred brands require a $5 copay at preferred pharmacies and $30 at standard pharmacies for a 1-month supply. Tier 4 non-preferred brand drugs cost a $10 copay at preferred pharmacies and $55 at standard pharmacies. Specialty medications in Tier 5 carry a 33% coinsurance across all pharmacy options, including preferred, standard, and mail order.
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, and home health care. Specialist visits feature a low copay of up to five dollars, while outpatient hospital services require a copay ranging from twenty-five to fifty dollars. Additionally, emergency care is available with a fifty-dollar copay that is waived upon admission, and urgent care services require no copay. This plan also includes valuable supplemental benefits such as routine dental, vision, and hearing care with no copays, alongside a three hundred fifty dollar eyewear allowance and a five hundred dollar hearing aid limit. Members can also benefit from up to fourteen free one-way transportation trips per year to health-related destinations, a fifty-dollar quarterly over-the-counter allowance, and covered acupuncture treatments. Part B drugs, including chemotherapy, and medical equipment may require coinsurance up to twenty percent and ten percent, respectively, but feature no copays.
Inpatient Hospital See details
Ahorro Plus (HMO) offers inpatient hospital benefits with no copay and no coinsurance for both acute and psychiatric stays, though prior authorization is required for acute stays. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Ahorro Plus (HMO) outpatient services include outpatient hospital care with a $25 to $50 copay and no coinsurance, and ambulatory surgical center services for a $25 copay and no coinsurance. Outpatient blood services feature no copay, no coinsurance, and no deductible, while outpatient substance abuse services are not covered.
Partial Hospitalization See details
Partial hospitalization is covered by Ahorro Plus (HMO) with no copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Ahorro Plus (HMO) with no copay and no coinsurance. While ground ambulance, air ambulance, and transportation to plan-approved locations are not covered, the plan covers up to 14 one-way trips per year to any health-related location via taxi, rideshare, or medical transport.
Emergency Services See details
Ahorro Plus (HMO) covers emergency services with a $50 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no copay or coinsurance, and worldwide emergency and urgent services are partially covered up to a $75 maximum with no copay or coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Ahorro Plus (HMO) features primary care, occupational therapy, physical therapy, and podiatry services with no copay and no coinsurance. Specialist visits, telehealth, and routine chiropractic care require a copay of $0 to $5 and no coinsurance, though chiropractic is only partially covered because other chiropractic services are excluded. For mental health and psychiatric benefits, some services are covered, but individual and group sessions are not covered.
Preventive Services See details
Preventive services are partially covered by Ahorro Plus (HMO) with no copay and no coinsurance for covered benefits, such as counseling and alternative therapies. However, the plan does not cover annual physical exams, fitness benefits, weight management, therapeutic massage, telemonitoring, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation, and home safety modifications.
Hearing Services See details
Ahorro Plus (HMO) partially covers hearing services, offering one routine hearing exam and one fitting evaluation per year with no copay and no coinsurance. Prescription hearing aids are covered up to a $500 annual limit with no copay and no coinsurance, though inner ear, outer ear, over the ear, and over-the-counter hearing aids are not covered.
Vision Services See details
Ahorro Plus (HMO) covers vision services with no copay, no coinsurance, and no deductible. This includes one routine eye exam and one eyewear exam annually, alongside a $350 yearly allowance for eyewear such as contact lenses, eyeglasses, and frames.
Dental Services See details
Dental services are partially covered by Ahorro Plus (HMO) with no copay and no coinsurance for preventive and most comprehensive treatments, though maxillofacial prosthetics and orthodontics are not covered. Covered orthodontic services are subject to an annual maximum benefit of $2,500, and several comprehensive dental procedures require prior authorization.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Ahorro Plus (HMO) with no copay, though prior authorization is required. Covered insulin has no copay and no coinsurance, while chemotherapy, radiation, and other Medicare Part B drugs have no copay and 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 medical equipment with no copay and coinsurance ranging from 0% to 10%, though prior authorization is required. While durable medical equipment, prosthetics, and medical supplies are covered, diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by Ahorro Plus (HMO), offering diagnostic procedures, lab services, and diagnostic radiological services with no copay and no coinsurance, subject to prior authorization. Outpatient x-ray services and therapeutic radiological services are not covered under this benefit.
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 covered under the Ahorro Plus (HMO) plan with no copay and no coinsurance, although only some services are covered in practice as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Ahorro Plus (HMO) with no copay and no coinsurance per stay, requiring prior authorization and a three-day prior inpatient hospital stay. 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 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 OTC allowance every three months.
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