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ConnectiCare Choice Plan 3 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for ConnectiCare Choice Plan 3 (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on ConnectiCare Choice Plan 3 (HMO-POS) in 2025, please refer to our full plan details page.
ConnectiCare Choice Plan 3 (HMO-POS) is a HMO-POS plan offered by EmblemHealth, Inc. available for enrollment in 2025 to people living in State of Connecticut. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that ConnectiCare Choice Plan 3 (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 ConnectiCare Choice Plan 3 (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 ConnectiCare Choice Plan 3 (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. Additionally, this plan comes with a Part B Premium reduction of $2.00. 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 $6750.00 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 ConnectiCare Choice Plan 3 (HMO-POS) has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying copays depending on the drug tier and pharmacy. For example, preferred generic drugs have a $10 copay at preferred pharmacies, and $0 copay for preferred mail order. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The ConnectiCare Choice Plan 3 (HMO-POS) offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays ranging from $0 to $280. The plan covers primary care, preventive services, hearing, vision, and dental services with copays, coinsurance, and maximum benefit limits. Other covered services include ambulance, emergency, home health, and skilled nursing facility care with copays or coinsurance. The plan also offers coverage for medical equipment, home infusion, and dialysis services. However, some services like cardiac rehabilitation, additional hours of home health care, and certain dental and vision upgrades are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a $430 copay for days 1-4 and no copay for days 5-90, while Inpatient Hospital Psychiatric has a $2036 copay.
Outpatient Services See details
Outpatient Services are covered by the ConnectiCare Choice Plan 3 (HMO-POS), including outpatient hospital services and substance abuse services, with copays ranging from $0 to $280. Observation Services have a copay of $280, while Ambulatory Surgical Center (ASC) Services have no copay. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the ConnectiCare Choice Plan 3 (HMO-POS) with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the ConnectiCare Choice Plan 3 (HMO-POS). Ground Ambulance Services have a $275 copay, while Air Ambulance Services have a 20% coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered under the ConnectiCare Choice Plan 3 (HMO-POS). Emergency Services has a $110 copay and no coinsurance, while Urgently Needed Services has a $45 copay and no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $50,000.
Primary Care See details
ConnectiCare Choice Plan 3 (HMO-POS) covers Primary Care, including Primary Care Physician Services, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $35 copay, Physician Specialist Services with a $35 copay, Mental Health Specialty Services with a $40 copay, Physical Therapy and Speech-Language Pathology Services with a $40 copay, and Additional Telehealth Benefits with a $0-$40 copay. Podiatry Services are not covered.
Preventive Services See details
The ConnectiCare Choice Plan 3 (HMO-POS) covers preventive services including Medicare-covered services, annual physical exams, health education, and fitness benefits. Additional services like in-home safety assessments, personal emergency response systems, and medical nutrition therapy are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with a $45 copay, but do not include fitting/evaluation for hearing aids, or prescription or OTC hearing aids. One routine hearing exam is covered per year.
Vision Services See details
Vision services include eye exams with a $45 copay, and eyewear with a combined maximum benefit of $400 per year. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are also covered, while upgrades are not covered.
Dental Services See details
Dental services include a $45 copay for Medicare dental services. Other dental services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services. Orthodontic services have a $100 deductible with a maximum plan benefit of $2,000 per year. Other covered services include restorative services with 20% to 50% coinsurance, endodontics with 50% coinsurance, periodontics with 50% coinsurance, prosthodontics (removable) with 50% coinsurance, implant services with 50% coinsurance, prosthodontics (fixed) with 50% coinsurance, and oral and maxillofacial surgery with 50% coinsurance. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the ConnectiCare Choice Plan 3 (HMO-POS) with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered by the ConnectiCare Choice Plan 3 (HMO-POS), including Durable Medical Equipment (DME) with a 10-20% coinsurance and Prosthetics/Medical Supplies, and Diabetic Equipment with a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The ConnectiCare Choice Plan 3 (HMO-POS) covers diagnostic and radiological services, including diagnostic procedures and tests with a $30 copay, lab services with no copay, diagnostic radiological services with a copay up to $250, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with a $45 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the ConnectiCare Choice Plan 3 (HMO-POS) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
ConnectiCare Choice Plan 3 (HMO-POS) does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for these services if they were covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the ConnectiCare Choice Plan 3 (HMO-POS), with a $0 copay for days 1-20 and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with a maximum benefit of $50.00 per month, as well as other services that are not covered, including acupuncture and meal benefits. Additional services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are also not covered.
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