ConnectiCare Flex Plan 3 (HMO-POS) A 2022 New Haven County, Connecticut Medicare Advantage Plan
ConnectiCare Flex Plan 3, by ConnectiCare, is a 2022 Medicare Advantage HMO-POS plan for Medicare beneficiaries living in New Haven County, Connecticut. Delivery of healthcare services and costs are different than in Original MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage., but the plan may offer additional benefits.
Key Takeaways
- It is a HMO-POS Medicare Advantage plan offered by ConnectiCare.
- It provides all the same hospital and medical coverage as Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Part B (Original Medicare).
- It features extra benefits that Original Medicare does not cover.
- ConnectiCare Flex Plan 3 allows its members use healthcare providers outside of the plan's network for certain situations or types of treatment.
- If you use out-of-network services, you'll pay an additional point-of-service (POS) charge.
- The premium is $70.00 per month, and you must continue paying your Medicare Part B premiumThe Medicare Part B premium is the monthly charge paid by beneficiaries for their outpatient medical care, services, and supplies. A beneficiary's premium may be uplifted by an IRMAA surcharge if their income is above....
- This plan does not offer a Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. premium reduction (no giveback benefit).
- The health plan does not have an annual deductible.
- Out-of-pocket expenses with this plan are capped at $5,500 per year (in-networkDoctors, hospitals, pharmacies, and other healthcare providers that agree to health plan members' services and supplies at a set price are in-network providers. With some health plans, your care is only covered if you get...).
- The out-of-pocket limit does not include premiumsA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. or the cost of prescriptions.
- The plan includes a prescription drug plan (Medicare Part DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each...). The annual Part D deductible is $300.00.
- It offers the following supplemental benefits: Dental, Vision, Hearing (limitations apply, see below).
| Plan Basics | |
|---|---|
| Plan ID: | H3528-011-2 |
| Plan Type: | Local HMO |
| Plan Year: | 2022 |
| Premium: | $70.00/mo Plus your Part B premium. |
| Health Plan Deductible: | $0.00 |
| Out-of-Pocket Maximum: | $5,500/yr |
| Part B Reduction: | $0.00/mo |
| Drug Plan Benefit: | Enhanced, $300.00 deductible |
| Rx Gap Coverage: | No |
| Supplemental Benefits: | Dental, Vision, Hearing |
| Availability: | New Haven County, Connecticut |
| Insured By: | ConnectiCare |
WARNING: Before enrolling in this or any other Medicare Advantage plan, it is very important to understand what your costs will be for both inpatient and outpatient careOutpatient Care is medical care that does not require an overnight stay at the hospital. Medicare Part B provides coverage for Outpatient Care.. Feel free to download our Summary of Benefits document to help you compare this plan.
Health Plan Costs & Benefits
Premiums, deductiblesA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share., and copays vary widely from plan to plan. It is very important to compare costs and apply them to your personal financial and healthcare needs.
Monthly Premium
ConnectiCare Flex Plan 3's total monthly premium in New Haven County is $70.00. This includes your prescription coverage, as well. Plus, you must continue to pay your monthly Medicare Part B premium.
Some Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). include a monthly Part B premium reduction, also known as the Medicare give back. This plan's Part B premium reduction is $0.00. The monthly premium does not include the plan's supplemental premium for add-on benefits (if available).
Annual Deductible
ConnectiCare Flex Plan 3's annual health plan deductible is $0.00. This does not include the deductible for the prescription drug plan (if any), which is detailed below.
Maximum Out-of-Pocket Limit
The Maximum Out-of-Pocket (MOOP) with this ConnectiCare plan is $5,500. Unlike Original Medicare, Medicare Advantage plans must set an annual Maximum Out-of-Pocket (MOOP) limit on inpatient and outpatient healthcare services. Once you reach this amount of spending on your copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service., all of your Medicare Part A and Part B services will be covered at no additional charge for the remainder of the year. MOOP does not include monthly premiums, prescriptions, or other extra benefits.
Health Plan Out-of-Pocket Costs
The following table is a summary of the most common out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. you will incur if you join this ConnectiCare plan:
| Healthcare Service | Member Cost |
|---|---|
| Health plan deductible | $0 |
| Maximum out-of-pocket enrollee responsibility (does not include prescription drugs) | $5,500 In-network $10,000 Out-of-network |
| Doctor Visits | |
| Primary (In-Network) | $5 copay per visit |
| Primary (Out-of-Net) | 50% coinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service. per visit |
| Specialist (In-Network) | $50 copay per visit |
| Wellness programs (e.g., fitness, nursing hotline) | Covered |
| Preventive care | $0 copay |
| Mental Health Services | |
| Inpatient hospital - psychiatric (In-Network) | $1,871 per stay (authorization required) |
| Outpatient individual therapy visit (In-Network) | $40 copay (authorization required) |
| Outpatient individual therapy visit with a psychiatrist (In-Network) | $40 copay (authorization required) |
| Outpatient group therapy visit (Out-of-Net) | 50% coinsurance (authorization required) |
| Outpatient individual therapy visit (Out-of-Net) | 50% coinsurance (authorization required) |
| Outpatient group therapy visit (In-Network) | $40 copay (authorization required) |
| Inpatient hospital - psychiatric (Out-of-Net) | 50% per stay (authorization required) |
| Outpatient group therapy visit with a psychiatrist (In-Network) | $40 copay (authorization required) |
| Outpatient individual therapy visit with a psychiatrist (Out-of-Net) | 50% coinsurance (authorization required) |
| Rehabilitation Services | |
| Occupational therapy visit (In-Network) | $40 copay |
| Physical therapy and speech and language therapy visit (Out-of-Net) | 50% coinsurance |
| Physical therapy and speech and language therapy visit (In-Network) | $40 copay |
| Medical Equipment / Supplies | |
| Durable medical equipmentDurable medical equipment (DME) is equipment that is designed to last and can be used repeatedly. It is suitable for home use and includes wheelchairs, oxygen equipment, and hospital beds. (e.g., wheelchairs, oxygen) (In-Network) | 10-20% coinsurance per item (authorization required) |
| Diabetes supplies (In-Network) | 20% coinsurance per item |
| Durable medical equipment (e.g., wheelchairs, oxygen) (Out-of-Net) | 50% coinsurance per item (authorization required) |
| Prosthetics (e.g., braces, artificial limbs) (In-Network) | 20% coinsurance per item (authorization required) |
| Diabetes supplies (Out-of-Net) | 50% coinsurance per item |
| Diagnostic Procedures / Lab Services / Imaging | |
| Diagnostic radiology services (e.g., MRI) (Out-of-Net) | 50% coinsurance (authorization required) |
| Outpatient x-rays (Out-of-Net) | 50% coinsurance (authorization required) |
| Diagnostic tests and procedures (In-Network) | $25 copay (authorization required) |
| Diagnostic tests and procedures (Out-of-Net) | 50% coinsurance (authorization required) |
| Lab services (Out-of-Net) | 50% coinsurance (authorization required) |
| Outpatient x-rays (In-Network) | $45 copay (authorization required) |
| Lab services (In-Network) | $20 copay (authorization required) |
| Medicare Part B Drugs | |
| Chemotherapy (In-Network) | 10-20% coinsurance (authorization required) |
| Other Part B drugs (In-Network) | 10-20% coinsurance (authorization required) |
| Other Part B drugs (Out-of-Net) | 50% coinsurance (authorization required) |
| Foot Care (podiatry Services) | |
| Foot exams and treatment (Out-of-Net) | 50% coinsurance |
| Routine foot care | Not covered |
| Hearing | |
| Hearing aids - over the ear | Not covered |
| Hearing aids - outer ear | Not covered |
| Hearing aids - inner ear | Not covered |
| Hearing exam (Out-of-Net) | 50% coinsurance |
| Fitting/evaluation | Not covered |
| Preventive Dental | |
| Oral exam (In-Network) | $0 copay (limits may apply) |
| Fluoride treatment (In-Network) | $0 copay (limits may apply) |
| Cleaning (In-Network) | $0 copay (limits may apply) |
| Comprehensive Dental | |
| Non-routine services | Not covered |
| Periodontics | Not covered |
| Diagnostic services | Not covered |
| Prosthodontics, other oral/maxillofacial surgery, other services | Not covered |
| Extractions | Not covered |
| Restorative services | Not covered |
| Vision | |
| Upgrades | Not covered |
| Eyeglass lenses (In-Network) | $0 copay (limits may apply) |
| Eyeglasses (frames and lenses) (In-Network) | $0 copay (limits may apply) |
| Routine eye exam (In-Network) | $50 copay (limits may apply) |
| Other | Not covered |
| Eyeglass frames (In-Network) | $0 copay (limits may apply) |
| Emergency Care / Urgent Care | |
| Urgent care | $50 copay per visit (always covered) |
| Ground ambulance | $325 copay |
| Inpatient hospital coverage | 50% per stay |
| Outpatient hospital coverage | 50% coinsurance per visit |
| Skilled Nursing Facility | 50% per day for days 1 through 100 |
| Optional supplemental benefits | Yes |
Feel free to download our ConnectiCare Flex Plan 3 Summary of Benefits information.
Prescription Drug Plan Costs & Benefits
ConnectiCare Flex Plan 3 includes an enhanced benefit Medicare Part D plan (PDP). Enhanced plans have a higher actuarial value than basic plans. Actuarial value simply refers to the percentage of cost that's covered by the plan.
Enhanced plans generally have higher monthly premiums than basic benefit plans but offer more benefits. For example, many enhanced PDPs do not have an annual deductible, may offer additional coverage during the coverage gap (aka, "donut hole"), and may have a broader list of supported drugs, known as a formularyA formulary is a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Medications not on a plan's formulary are generally not covered.. Some enhanced PDPs even cover excluded drugs. It's important to remember that benefits vary from plan to plan.
Prescription Drug Plan Premium
Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidySocial Security's Low-Income Subsidy (LIS) program helps Medicare beneficiaries pay for their Medicare Part D prescription drugs by paying some of the costs. Also known as "Extra Help", beneficiaries who qualify for LIS receive premium... (LIS) assistance. The following table outlines the prescription drug plan premium details of this plan.
| Basic Part D Premium: | $54.10 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $54.10 |
| Part D Premium with Full LIS Assistance: | $17.80 |
| Part D Premium with 75% LIS Assistance: | $26.90 |
| Part D Premium with 50% LIS Assistance: | $36.00 |
| Part D Premium with 25% LIS Assistance: | $45.00 |
For more information about the Low-Income Subsidy (aka, "Extra Help") program, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $300.00. This is the amount you must pay at the pharmacy before ConnectiCare begins paying its share.
NOTE: The deductible does not apply to one or more drug tiers in this plan (see "Prescription Drug Plan Out-of-Pocket Costs" below).
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, ConnectiCare Flex Plan 3 has copayments (a fixed dollar amount) and/or coinsurances (a percentage amount) that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Tier | Preferred | Standard |
|---|---|---|
| 1 (Preferred Generic) | $2.00 copay (deductible does not apply) | $9.00 copay (deductible does not apply) |
| 2 (Generic) | $10.00 copay | $20.00 copay |
| 3 (Preferred Brand) | $42.00 copay | $47.00 copay |
| 4 (Non-Preferred Drug) | $95.00 copay | $100.00 copay |
| 5 (Specialty Tier) | 27% | 27% |
CMS Rating Marks and Our Review
It's not a 5-star HMO-POS plan, but its quality of care exceeds most New Haven County Medicare Advantage HMO-POS plans in Connecticut. ConnectiCare Flex Plan 3 does an excellent job keeping its members healthy through its preventive care program with proactive screenings, tests, and vaccines. When it comes to helping members manage their chronic health conditions, this plan does an average job. New Haven County Medicare beneficiaries enrolled in this ConnectiCare plan enjoy a good member experience. Complaints and changes in plan performance are one way we can measure quality, and this plan scores good at both. If you're concerned about how this health plan will treat you when you call for assistance, don't be. Members say it's good.
If you're looking for more value, this plan offers dental, vision, and hearing benefits (limitations may apply) that are not included with Original Medicare. This plan has an additional premium of $70.00 dollars per month. The additional cost may be worth it if you fully use the plan's benefits. We suggest carefully weighing this plan's maximum out-of-pocket limit, which is $5,500 per year. With a limit that high, Original Medicare alone would cost less for a 5-day hospital stay. With no annual deductible, members of this health plan have first dollar coverage, which is comforting on a fixed budget.
Each year Medicare rates health plans (Part C) and drug plans (Part D) in several major categories. These ratings are designed to help you understand the quality of care and service you can expect if you join this plan:
| CMS Measure | Star Rating |
|---|---|
| 2022 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Contact ConnectiCare
| Plan Website: | http://www.connecticare.com/medicare |
|---|---|
| Formulay Information: | http://www.connecticare.com/medicare |
| Pharmacy Information: | ConnectiCare Pharmacy Page |
| Prospective Members: | (877)224-8220 |
| TTY Users: | (711)- |
If you qualify for Medicare but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Additional HMO-POS Medicare Advantage Plan Options
Here are some additional Medicare Advantage plans in New Haven County (HMO-POSs) that might be worth reviewing:
Citations & References
- ConnectiCare, http://www.connecticare.com/medicare, Last Accessed October 15, 2021
- Medicare.gov, "How Do Medicare Advantage Plans Work", Last Accessed June 28, 2021
- Medicare.gov, "Compare Original Medicare & Medicare Advantage", Last Accessed May 9, 2022
- Medicare.gov, "Medicare & You in Different Formats", Last Accessed November 1, 2021
- Medicare.gov, "Is Your Test, Item, or Service Covered?", Last Accessed July 3, 2021
- CMS.gov, Landscape Source Files, Last Accessed October 26, 2021
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 6, 2021
- CMS.gov, Plan Benefits Package, Last Accessed October 4, 2021
This Medicare Advantage plan information page was last updated on .