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ConnectiCare Choice Plan 1 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for ConnectiCare Choice Plan 1 (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 1 (HMO-POS) in 2025, please refer to our full plan details page.
ConnectiCare Choice Plan 1 (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 1 (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 1 (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 1 (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $152.00. 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 $4150.00 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 1 (HMO-POS) has a $300 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $10 copay at preferred pharmacies, while standard generic drugs have a $42 copay. Specialty tier drugs have no copay.
Additional Benefits
The ConnectiCare Choice Plan 1 (HMO-POS) offers a variety of healthcare benefits. This plan includes coverage for inpatient hospital stays, with a copay of $345 per day for days 1-5, and no copay for days 6-90. Outpatient services have a range of copays, while emergency services have a $140 copay. This plan covers primary care services with a $10 copay, and also offers preventive services with no copay. The plan has coverage for hearing and vision services, and also includes dental services with a $30 copay for Medicare dental services. Additionally, the plan covers ambulance services with a copay, and offers home health services with no copay.
Inpatient Hospital See details
Inpatient Hospital coverage for the ConnectiCare Choice Plan 1 (HMO-POS) includes a copay of $345 per day for days 1-5, and no copay for days 6-90 for Inpatient Hospital-Acute; Inpatient Hospital Psychiatric has a copay of $2545 per admission or stay, and additional days and upgrades are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services with a copay between $0 and $200, observation services with a $200 copay, ambulatory surgical center services with no copay, and outpatient substance abuse services with a $30 copay for both individual and group sessions. Outpatient blood services are also covered, with a waived three-pint deductible.
Partial Hospitalization See details
ConnectiCare Choice Plan 1 (HMO-POS) covers partial hospitalization with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the ConnectiCare Choice Plan 1 (HMO-POS). Ground ambulance services have a $200 copay, while air ambulance services have a 20% coinsurance; however, transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered. Emergency Services have a $140 copay, and Urgently Needed Services have a $30 copay; both have no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage amount of $50,000.
Primary Care See details
ConnectiCare Choice Plan 1 (HMO-POS) covers primary care physician services with a $10 copay, chiropractic services with a $20 copay, occupational therapy services with a $30 copay, physician specialist services with a $30 copay, and physical therapy/speech-language pathology services with a $30 copay. The plan also covers mental health specialty services, psychiatric services, and opioid treatment program services, each with a copay of $30 for individual and group sessions, and covers additional telehealth benefits with a copay ranging from $10 to $30. Routine chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered preventive services, annual physical exams, health education, kidney disease education services, and other preventive services with no copay. However, in-home safety assessment, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing services include routine hearing exams with a $30 copay per visit, and one routine hearing exam is covered every year. Fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams with a $30 copay. Eyewear is partially covered, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, with a $30 copay for Medicare dental services. Other services such as restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are covered as optional supplemental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization, with a $35 copay for Medicare Part B Insulin Drugs and a coinsurance of 0-20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered by the ConnectiCare Choice Plan 1 (HMO-POS) with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered by the ConnectiCare Choice Plan 1 (HMO-POS), including Durable Medical Equipment (DME) with 10-20% coinsurance and Prosthetics/Medical Supplies, which has a coinsurance for Medicare-covered devices and supplies. Diabetic Equipment is also covered, with 20% coinsurance for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services and lab services, and also for all radiological services, with prior authorization required. Diagnostic Procedures/Tests have a $25 copay, lab services have no copay, diagnostic radiological services have a copay up to $200, therapeutic radiological services have a coinsurance of 20% or more, and outpatient X-Ray services have a $35 copay.
Home Health Services See details
Home Health Services are covered by the ConnectiCare Choice Plan 1 (HMO-POS) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the ConnectiCare Choice Plan 1 (HMO-POS). Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the ConnectiCare Choice Plan 1 (HMO-POS), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered, and non-Medicare-covered stays are not covered.
Other Services See details
Other Services are not covered for the ConnectiCare Choice Plan 1 (HMO-POS), including acupuncture, over-the-counter items, meal benefits, and more. This plan does not require authorization or a referral for these services.
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