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Elderplan Extra Help (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Elderplan Extra Help (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Elderplan Extra Help (HMO-POS) in 2026, please refer to our full plan details page.
Elderplan Extra Help (HMO-POS) is a HMO-POS plan offered by Elderplan, Inc. available for enrollment in 2025 to people living in Brx, Ki, Na, NY, Put, Qu, Rich, Wes. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Elderplan Extra Help (HMO-POS) 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 Elderplan Extra Help (HMO-POS).
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 Elderplan Extra Help (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $58.80. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 a $375.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $7550.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $7550.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 Elderplan Extra Help (HMO-POS) Medicare prescription drug plan features an annual drug deductible of $375. For Tier 1 preferred generic drugs, members pay no copay for up to a three-month supply at standard pharmacies and standard mail order. Tier 2 generic medications cost a $10 copay for a one-month supply at standard pharmacies, with a reduced $20 copay for a three-month supply through standard mail order. For brand-name and specialty drugs, the plan utilizes a mix of copays and coinsurance. Tier 3 preferred brand drugs have a $47 copay for a one-month supply at standard pharmacies, while Tier 4 non-preferred drugs carry a $100 copay. Tier 5 specialty medications require a 28% coinsurance for both standard pharmacy and standard mail-order options.
Additional Benefits
The Elderplan Extra Help (HMO-POS) plan offers comprehensive medical coverage with no copay for primary care doctor visits and low copays ranging from no copay to $35 for specialist visits. For inpatient hospital stays, members pay a $425 copay per day for days one through five and no copay for days six through 90. Emergency room visits carry a $110 copay, which is waived if admitted, while outpatient services feature no copays but require up to a 20% coinsurance. Supplemental benefits include routine vision and hearing exams with no copay, plus allowances of up to $200 annually for eyewear and $500 every three years for hearing aids. Dental care is covered with copays ranging from no copay to $150 or a 20% coinsurance depending on the service. Members also receive up to 32 one-way transportation trips per year and a $140 quarterly over-the-counter allowance with no copay.
Inpatient Hospital See details
Elderplan Extra Help (HMO-POS) covers inpatient acute hospital stays with a $425 copay for days 1 through 5, no copay for days 6 through 90, and no coinsurance. Inpatient psychiatric stays are covered with a $400 copay for days 1 through 5, no copay for days 6 through 90, and no coinsurance. Prior authorization is required for these services, and additional hospital days or non-Medicare-covered stays are not covered.
Outpatient Services See details
Elderplan Extra Help (HMO-POS) covers outpatient services with no copays, although coinsurance applies to several services. You will pay a 20% coinsurance for outpatient hospital, observation, and outpatient substance abuse services, 0% to 20% coinsurance for ambulatory surgical center services, and no coinsurance for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization services are covered by Elderplan Extra Help (HMO-POS) with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Elderplan Extra Help (HMO-POS) covers ground and air ambulance services with a $215 copay and no coinsurance per trip, subject to prior authorization. Transportation services are partially covered, offering up to 32 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Elderplan Extra Help (HMO-POS) covers emergency services with a $110 copay and urgently needed services with a $35 copay, both featuring no coinsurance and with copays waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum benefit with no copays and no coinsurance.
Primary Care See details
Elderplan Extra Help (HMO-POS) offers primary care doctor visits with no copay and no coinsurance, and specialist visits with a copay ranging from no copay to $35 and no coinsurance. Physical, occupational, speech, and podiatry therapies require a $35 copay and no coinsurance, whereas telehealth, mental health, psychiatric, and opioid treatment services have varying copays and no coinsurance. Chiropractic services are not covered under this plan.
Preventive Services See details
Elderplan Extra Help (HMO-POS) offers partially covered preventive services with no copay and no coinsurance for annual physical exams, fitness benefits, alternative therapies, and various screenings, while kidney disease education has no copay and a 20% coinsurance. Several additional services are not covered, including health education, nutritional benefits, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
Hearing services are covered by Elderplan Extra Help (HMO-POS), which offers Medicare-covered exams for a $35 copay and no coinsurance, plus routine exams and fitting evaluations every three years with no copay. Prescription hearing aids for a single ear are partially covered up to $500 every three years with no copay or coinsurance, though inner ear, outer ear, over-the-ear, and OTC hearing aids are not covered.
Vision Services See details
Elderplan Extra Help (HMO-POS) partially covers vision services, featuring one routine eye exam per year with no copay and no coinsurance, while other covered eye exams have a $35 copay and no coinsurance, and other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $200 annual maximum for contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Elderplan Extra Help (HMO-POS) provides dental services with no copay and 20% coinsurance for Medicare-covered dental, and no coinsurance with copays ranging from $0 to $150 for preventive and comprehensive services. This benefit is partially covered, as other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Elderplan Extra Help (HMO-POS) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this plan, Medicare Part B chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under Elderplan Extra Help (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Elderplan Extra Help (HMO-POS) covers medical equipment with no copays, though coinsurance applies to several services. Durable medical equipment is covered with no copay and ranges from no coinsurance to 20% coinsurance, while prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts require a 20% coinsurance. Diabetic supplies are covered with no copay.
Diagnostic and Radiological Services See details
Elderplan Extra Help (HMO-POS) covers diagnostic and radiological services, offering diagnostic services with no coinsurance, no copay for lab services, and a copay of up to $35 for diagnostic procedures. Radiological services require prior authorization and carry a $20 copay for outpatient X-rays along with a minimum 20% coinsurance for diagnostic and therapeutic radiological services.
Home Health Services See details
Home health services are covered by Elderplan Extra Help (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Elderplan Extra Help (HMO-POS) covers some cardiac rehabilitation services with no copay and no coinsurance, though prior authorization is required. However, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Elderplan Extra Help (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and a three-day prior inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage provided for additional days.
Other Services See details
Elderplan Extra Help (HMO-POS) offers partial coverage for other services, featuring acupuncture with no copay and no coinsurance for up to 20 treatments per year. Eligible over-the-counter (OTC) items are also covered with no copay and no coinsurance up to $140 every three months via reimbursement, though meal benefits are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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