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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 2025, 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, Qu, Wes. This plan received an overall rating of 3.5 out of 5 stars in 2025.
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 $41.00. 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 $590.00 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) plan has an enhanced alternative drug benefit. This plan has a deductible of $590. Once you meet your deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. In the initial coverage phase, you will pay a copay of $10 for preferred generic drugs, $47 for standard generic drugs, and $100 for preferred brand drugs at standard pharmacies. Non-preferred drugs have a 25% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs.
Additional Benefits
The Elderplan Extra Help (HMO-POS) plan offers a range of benefits, including inpatient hospital stays with copays, and outpatient services with coinsurance. It also covers ambulance services with a copay, and transportation services with no copay. The plan also covers many services like primary care, hearing, vision, and dental services, each with varying copays or coinsurance. This plan provides additional benefits such as preventive services with no or low copays, home health services with no cost, and coverage for home infusion and dialysis. Other covered services include medical equipment, diagnostic and radiological services, and skilled nursing facility stays with specific copays. The plan also provides coverage for acupuncture and over-the-counter items with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For acute care, you'll pay a $390 copay for days 1-5, and no copay for days 6-90; for psychiatric care, you'll pay a $350 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services and observation services with a 20% coinsurance, and outpatient blood services with no copay. Ambulatory surgical center services and outpatient substance abuse services are also covered, with a coinsurance between 0% and 20% depending on the specific service.
Partial Hospitalization See details
Partial Hospitalization is covered by the Elderplan Extra Help (HMO-POS) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $215 copay for both ground and air ambulance services and no coinsurance. Transportation Services to a plan-approved health-related location has no copay, no coinsurance, and covers up to 32 one-way trips per year via rideshare, bus/subway, van, or medical transport; transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Elderplan Extra Help (HMO-POS) plan. Emergency Services have a $90 copay, and Urgently Needed Services have a $35 copay, but both have no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay and no coinsurance.
Primary Care See details
The Elderplan Extra Help (HMO-POS) plan covers Primary Care, including Primary Care Physician Services with no copay, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $25 copay, Physician Specialist Services with a $0-$25 copay, and Mental Health Specialty Services with a $20 copay for individual sessions and a $5 copay for group sessions. The plan also covers Podiatry Services with a $25 copay, Other Health Care Professional services with a $0-$25 copay, Psychiatric Services with a $25 copay for individual sessions and a $5 copay for group sessions, Physical Therapy and Speech-Language Pathology Services with a $25 copay, Additional Telehealth Benefits with a $0-$10 copay, and Opioid Treatment Program Services with a $20 copay. However, Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services with a copay for certain services. Kidney disease education services have a 20% coinsurance. Other preventive services, such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, have no copay. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. Alternative Therapies and Fitness Benefit are covered with no copay.
Hearing Services See details
Hearing Services include hearing exams and prescription hearing aids. Hearing exams have a $35 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay; prescription hearing aids have a $500 plan maximum benefit.
Vision Services See details
Vision services include eye exams with a $25 copay, and eyewear with no copay. Routine eye exams are covered with no copay, and eyeglasses, eyeglass lenses, eyeglass frames, and upgrades are covered with no copay, and contact lenses are covered with no copay.
Dental Services See details
The Elderplan Extra Help (HMO-POS) plan covers dental services with a 20% coinsurance for Medicare Dental Services. Other dental services include oral exams, dental x-rays, cleaning, and fluoride treatments with no copay, as well as restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, prosthodontics, fixed, and oral and maxillofacial surgery with varying copays. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the Elderplan Extra Help (HMO-POS) plan with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment under the Elderplan Extra Help (HMO-POS) plan includes Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with no copay and coinsurance for Medicare-covered devices and supplies. Diabetic Equipment is covered with coinsurance for Medicare-covered supplies and no copay for Diabetic Supplies.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Elderplan Extra Help (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $35, and Lab Services have no copay, while Diagnostic Radiological Services and Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Elderplan Extra Help (HMO-POS) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the sub-services of Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Elderplan Extra Help (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $196. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Elderplan Extra Help (HMO-POS) plan covers acupuncture with no copay, and covers over-the-counter (OTC) items with no copay up to $140 every three months. The plan does not cover meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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