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ConnectiCare Flex Plan 2 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for ConnectiCare Flex Plan 2 (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on ConnectiCare Flex Plan 2 (HMO-POS) in 2025, please refer to our full plan details page.
ConnectiCare Flex Plan 2 (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 Flex Plan 2 (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 Flex Plan 2 (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 Flex Plan 2 (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $93.00. 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 $300.00 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 Maximum Out-Of-Pocket cost of $10000.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10000.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $6350.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10000.00 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 Flex Plan 2 (HMO-POS) has a $300 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, preferred generic drugs have a $10 copay at preferred pharmacies and no copay through preferred mail order. Non-preferred drugs have a 27% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The ConnectiCare Flex Plan 2 (HMO-POS) offers a range of benefits, including inpatient hospital stays with a copay, outpatient services, and coverage for emergency services. This plan provides coverage for primary care with a $15 copay, preventive services at no copay, and partial coverage for hearing, vision, and dental services. The plan also includes coverage for home health services with no copay and skilled nursing facility services.
Inpatient Hospital See details
The ConnectiCare Flex Plan 2 (HMO-POS) covers inpatient hospital stays, including services not usually covered by Medicare, with a copay of $375 for days 1-4 and no copay for days 5-90. Inpatient Hospital Psychiatric benefits are also covered, with a copay of $2290.
Outpatient Services See details
Outpatient Services includes coverage for Outpatient Hospital Services with a copay between $0 and $250, Observation Services with a $250 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $35 copay for individual and group sessions, and Outpatient Blood Services with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered under the ConnectiCare Flex Plan 2 (HMO-POS) with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
The ConnectiCare Flex Plan 2 (HMO-POS) covers ambulance services, with a $300 copay for ground ambulance services and 20% coinsurance for air ambulance services. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the ConnectiCare Flex Plan 2 (HMO-POS). Emergency Services have a $125 copay, and Urgently Needed Services have a $35 copay, but there is no coinsurance for either. Worldwide Emergency Services has a maximum plan benefit coverage of $50,000.
Primary Care See details
The ConnectiCare Flex Plan 2 (HMO-POS) covers primary care physician services with a $15 copay, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, physician specialist services with a $35 copay, mental health specialty services with a $35 copay for individual and group sessions, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with a $15-$35 copay, and opioid treatment program services with a $35 copay. This plan does not cover podiatry services and routine chiropractic care.
Preventive Services See details
Preventive services include Medicare-covered services with no copay, annual physical exams, health education, kidney disease education services, and other services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs with no copay. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing services with the ConnectiCare Flex Plan 2 (HMO-POS) include routine hearing exams with a $35 copay for one exam per year, but fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with a $35 copay, including routine eye exams once per year. Eyewear is partially covered, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are partially covered under the ConnectiCare Flex Plan 2 (HMO-POS), with a $35 copay for Medicare Dental Services, while Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay. 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 by the ConnectiCare Flex Plan 2 (HMO-POS) with a coinsurance of 20%.
Medical Equipment See details
Medical equipment is covered by the ConnectiCare Flex Plan 2 (HMO-POS), including durable medical equipment with 10% to 20% coinsurance and prosthetics/medical supplies with a 20% coinsurance; however, durable medical equipment for use outside the home is not covered. Diabetic equipment is covered with coinsurance, including diabetic supplies and therapeutic shoes/inserts, each with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by ConnectiCare Flex Plan 2 (HMO-POS). Diagnostic Procedures/Tests have a $25 copay, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $250, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $40 copay.
Home Health Services See details
Home Health Services are covered by the ConnectiCare Flex Plan 2 (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
Cardiac Rehabilitation Services are generally covered, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. There is a copay for covered services; however, more details about the copay are not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the ConnectiCare Flex Plan 2 (HMO-POS), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The ConnectiCare Flex Plan 2 (HMO-POS) plan does not cover acupuncture, over-the-counter items, meal benefits, 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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