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Elderplan Flex (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Elderplan Flex (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Elderplan Flex (HMO-POS) in 2025, please refer to our full plan details page.
Elderplan Flex (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 Flex (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 Flex (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 Flex (HMO-POS), 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.
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 Flex (HMO-POS) plan has a $375.00 deductible for prescription drugs. After the deductible, you will pay a copay for your prescriptions depending on the drug tier and the pharmacy you use. For example, if you use a standard pharmacy, you will pay a $10 copay for preferred generic drugs, $47 for standard generic drugs, and $100 for preferred brand drugs. Non-preferred drugs have a 28% coinsurance. Once your total drug costs reach $2000.00, you enter the next coverage phase, where you may pay nothing for your drugs.
Additional Benefits
The Elderplan Flex (HMO-POS) plan offers comprehensive coverage, including inpatient hospital stays with a copay, outpatient services with coinsurance, and emergency services with copays. Primary care, preventive, vision, and dental services are covered, with varying copays or no copays. Hearing services are also covered, as well as home health services and skilled nursing facility stays, with prior authorization required. This plan provides additional benefits like ambulance and transportation services, and covers medical equipment and diagnostic services with coinsurance or copays. The plan also offers benefits for home infusion services, dialysis, and other services such as acupuncture and over-the-counter items. However, some services such as cardiac rehabilitation, additional hours of care, and certain other specialized services are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a copay of $390 for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you will pay a copay of $350 for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services and Observation Services have a 20% coinsurance. Ambulatory Surgical Center (ASC) Services have a coinsurance between 0% and 20%, and Outpatient Substance Abuse Services have a 20% coinsurance. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Elderplan Flex (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 by the Elderplan Flex (HMO-POS) plan, including both ground and air ambulance services with a $215 copay, and transportation services to a plan-approved health-related location with no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered with a $90 copay, and Urgently Needed Services are covered with a $35 copay, but both have no coinsurance. Worldwide Emergency Services are covered, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, all with no copay and no coinsurance.
Primary Care See details
The Elderplan Flex (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a copay between $0 and $35, and mental health specialty services with a copay between $5 and $20 depending on the service. This plan also covers podiatry services with a $35 copay, other health care professional services with a copay between $0 and $35, psychiatric services with a copay between $5 and $25, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with a copay between $0 and $10, and opioid treatment program services with a $20 copay. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, and additional preventive services, which may include copays depending on the service. Kidney Disease Education Services has a 20% coinsurance. Other preventive services, such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visits have no copay.
Hearing Services See details
Hearing Services include hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with a maximum benefit of $1500 per year; however, inner ear, outer ear, and over-the-ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $25 copay, and routine eye exams with no copay. Eyewear benefits, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, are covered with no copay, and a combined maximum plan benefit of $500 per year.
Dental Services See details
Dental services are covered, including Medicare Dental Services with a 20% coinsurance. Other dental services have no copay. Orthodontic services are covered up to a maximum of $2500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Elderplan Flex (HMO-POS) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
The Elderplan Flex (HMO-POS) plan covers medical equipment, including Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetic Devices and Medical Supplies with a 20% coinsurance. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Elderplan Flex (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $35, while Lab Services have no copay. Diagnostic Radiological Services and Therapeutic Radiological Services have a coinsurance of at most 20%, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Elderplan Flex (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 not covered by the Elderplan Flex (HMO-POS) plan. This includes 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Elderplan Flex (HMO-POS) plan, but prior authorization is required. For days 1-20, there is no copay, and for days 21-100, the copay is $196. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under the Elderplan Flex (HMO-POS) plan, acupuncture has no copay, and over-the-counter (OTC) items also have no copay. The plan offers up to $140 for OTC items every three months, and covers nicotine replacement therapy and naloxone. Meal Benefit, 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 are not covered.
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