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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 $40.00. 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. You will pay no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs when using a preferred pharmacy or a 3-month standard mail-order service. Standard retail pharmacies are also highly affordable, with 1-month copays ranging from only $3 to $8 for these generic drug tiers. For Tier 3 preferred brands and Tier 4 non-preferred brands, preferred pharmacies offer low 1-month copays of $5 and $10 respectively, while standard pharmacies charge copays of $30 and $55. If you require Tier 5 specialty drugs, you will pay a 33% coinsurance across preferred, standard, and mail-order options. Utilizing preferred pharmacies or standard mail order for 3-month supplies provides the most significant cost savings under this HMO plan.
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 preventive care. Members also benefit from no copays on routine vision and dental services, which include a $350 annual eyewear allowance and up to $2,500 in yearly dental coverage. Additionally, home health services, diagnostic lab tests, and skilled nursing facility stays are covered at no cost to you. For other medical needs, the plan features low copays, such as $0 to $5 for specialist visits and $25 to $50 for outpatient hospital services. Emergency care has a $50 copay, which is waived upon hospital admission, while dialysis requires 20% coinsurance and durable medical equipment ranges from 0% to 10% coinsurance. Furthermore, the plan includes valuable extras like 14 free one-way transportation trips annually and a $50 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Ahorro Plus (HMO) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance. This benefit is partially covered, as room upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Ahorro Plus (HMO) covers outpatient hospital services with a $25 to $50 copay and no coinsurance, and ambulatory surgical center services with a $25 copay and no coinsurance. Outpatient blood services are covered with no copay, no coinsurance, and no deductible, while some outpatient substance abuse services are covered with no copay or coinsurance, but individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization is covered by Ahorro Plus (HMO) with no copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are provided by Ahorro Plus (HMO), though ground and air ambulance services are not covered. 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
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, and urgently needed services with no copay or coinsurance. Worldwide emergency and urgent services are also covered with no copay or coinsurance up to a $75 maximum plan benefit, although worldwide emergency transportation is not covered.
Primary Care See details
Ahorro Plus (HMO) covers primary care, therapy, podiatry, and opioid treatment services with no copay and no coinsurance. Specialist visits, telehealth, and partially covered routine chiropractic care require a $0 to $5 copay and no coinsurance, while other chiropractic services are not covered. Some mental health and psychiatric services are covered with no copay and no coinsurance, though individual and group sessions for both are not covered.
Preventive Services See details
Preventive services are partially covered under the Ahorro Plus (HMO) plan with no copay and no coinsurance for covered care, including Medicare-covered preventive services, kidney disease education, alternative therapies, and nutritional sessions. However, several services are not covered, such as annual physical exams, fitness benefits, weight management programs, and in-home safety assessments.
Hearing Services See details
Ahorro Plus (HMO) provides partial coverage for hearing services with no copays or coinsurance for annual routine exams, fitting evaluations, and prescription hearing aids up to a $500 yearly limit. 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
Ahorro Plus (HMO) covers vision services with no copay, no coinsurance, and no deductible. This benefit includes one routine eye exam and one eyewear exam annually, as well as a $350 yearly allowance for contacts, eyeglasses, and frames.
Dental Services See details
Ahorro Plus (HMO) dental services are partially covered with no copay and no coinsurance for preventive and comprehensive care, though prior authorization is required for certain services. While most comprehensive dental treatments are covered up to a $2,500 annual maximum, orthodontics and maxillofacial prosthetics are not covered.
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, insulin is provided with no copay and no coinsurance, while Medicare Part B chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Ahorro Plus (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is partially covered by Ahorro Plus (HMO), featuring no copays and 0% to 10% coinsurance for durable medical equipment and prosthetics. While diabetic equipment is covered with no copay and no coinsurance, 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 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 offered by Ahorro Plus (HMO) with no copay and no coinsurance, though prior authorization is required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Ahorro Plus (HMO) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance per stay, though prior authorization and a three-day inpatient hospital stay are required. This benefit is partially covered, as the plan does not cover additional days beyond the standard Medicare-covered limit.
Other Services See details
Ahorro Plus (HMO) covers 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 a $50 allowance every three months for select items, including nicotine replacement therapy and naloxone.
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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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