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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 2026, 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, 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 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) Medicare prescription drug plan features an annual drug deductible of $375. Tier 1 preferred generic drugs are highly accessible with no copay for one-, two-, or three-month fills at standard pharmacies and standard mail order. For Tier 2 generic medications, standard pharmacy copays are $10 for a one-month supply and $30 for a three-month supply, while a three-month mail order costs a $20 copay. Standard pharmacy copays for Tier 3 preferred brand drugs are $47 for a one-month supply, whereas Tier 4 non-preferred drugs require a $100 copay for one month. Opting for a three-month standard mail order lowers these costs to a $94 copay for Tier 3 and a $200 copay for Tier 4. Specialty drugs in Tier 5 require a 28% coinsurance for all supply durations at both standard pharmacies and mail order.
Additional Benefits
Elderplan Flex (HMO-POS) offers comprehensive medical coverage featuring no copay for primary care visits, routine eye exams, and home health services. Specialist visits, physical therapy, and urgent care require affordable copays ranging from $0 to $35, while emergency room visits carry a $115 copay. For inpatient hospital stays, members pay a daily copay of $425 for days one through five of acute stays, with no copay for days six through ninety. The plan also features robust dental, vision, and hearing benefits, including no copay or coinsurance for routine care up to generous annual limits like $2,500 for dental and $1,500 for hearing aids. Additionally, members can take advantage of up to 48 one-way transportation trips to approved locations and a $140 quarterly over-the-counter allowance with no copay. Outpatient services, dialysis, and durable medical equipment generally require no copay but are subject to a coinsurance of up to 20 percent.
Inpatient Hospital See details
Elderplan Flex (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a $425 daily copay for days 1 to 5 of acute stays and a $375 daily copay for days 1 to 5 of psychiatric stays, with no copay for days 6 to 90. Prior authorization is required, and the benefit is only partially covered as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Elderplan Flex (HMO-POS) covers outpatient services with no copays, though a 20% coinsurance applies to outpatient hospital, observation, and substance abuse services, and up to 20% for ambulatory surgical center services. Outpatient blood services are fully covered with no copay and no coinsurance.
Partial Hospitalization See details
Elderplan Flex (HMO-POS) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Elderplan Flex (HMO-POS) covers ground and air ambulance services with a $215 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 48 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Elderplan Flex (HMO-POS) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $35 copay and no coinsurance, with copays waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance, up to a maximum plan benefit limit of $50,000.
Primary Care See details
Elderplan Flex (HMO-POS) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $35 copay and no coinsurance. Physical, occupational, and speech therapies require a $35 copay and no coinsurance, while some chiropractic services are covered, though routine and other chiropractic services are not covered.
Preventive Services See details
Elderplan Flex (HMO-POS) preventive services are partially covered, offering annual physical exams, alternative therapies, and fitness benefits with no copay and no coinsurance, though kidney disease education requires a 20% coinsurance and no copay. Numerous additional services are not covered, including health education, weight management, personal emergency response systems, and in-home safety assessments.
Hearing Services See details
Elderplan Flex (HMO-POS) covers Medicare-covered hearing exams with a $35 copay and no coinsurance, while routine annual hearing exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $1,500 annual limit, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Elderplan Flex (HMO-POS) covers vision services with no coinsurance, featuring one routine eye exam per year with no copay and other covered eye exams for a $25 copay, though other eye exam services are not covered. Covered eyewear, including contacts, lenses, frames, and upgrades, has no copay and no coinsurance up to a $500 annual maximum plan benefit.
Dental Services See details
Dental services are partially covered by Elderplan Flex (HMO-POS), with Medicare-covered dental requiring no copay and a 20% coinsurance. Other preventive and comprehensive services, such as exams, cleanings, and restorative care, feature no copay and no coinsurance up to a $2,500 annual limit, though other diagnostic, other preventive, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Elderplan Flex (HMO-POS) covers home infusion bundled services with no copay, although prior authorization is required. Under this plan, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while Medicare Part B chemotherapy and other drugs carry a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Elderplan Flex (HMO-POS) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Elderplan Flex (HMO-POS) covers durable medical equipment (DME) with no copay and no coinsurance to 20% coinsurance. Prosthetics, medical supplies, and diabetic therapeutic shoes or inserts are covered with no copay and 20% coinsurance, while diabetic supplies feature no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under Elderplan Flex (HMO-POS) with no coinsurance for diagnostic services, which include lab services at no copay and diagnostic procedures with a $0 to $35 copay. Radiological services require prior authorization and feature a 20% coinsurance for therapeutic and diagnostic services, while outpatient X-rays carry a $20 copay and coinsurance.
Home Health Services See details
Elderplan Flex (HMO-POS) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under Elderplan Flex (HMO-POS), meaning that intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Elderplan Flex (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and a $196 daily copay for days 21 to 100. Prior authorization and a 3-day inpatient hospital stay are required, and days beyond the Medicare-covered limit are not covered.
Other Services See details
Elderplan Flex (HMO-POS) covers acupuncture and over-the-counter (OTC) items with no copay and no coinsurance, but does not cover meal benefits. Acupuncture is limited to 20 treatments per year, and OTC items are covered up to $140 every three months via reimbursement.
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