ConnectiCare Choice Plan 2 (HMO-POS)
Medicare Advantage Plan H3528-003 • 2026 • Litchfield County, CT
ConnectiCare Choice Plan 2 (HMO-POS) Medicare Advantage Plan H3528-003 • 2026 • Litchfield County, CT
CMS Plan ID H3528-003 identifies the Medicare Advantage plan ConnectiCare Choice Plan 2, a HMO-POS Part C plan offered by ConnectiCare for the 2026 plan year. This plan uses a Health Maintenance Organization with a Point of Service (HMO-POS) provider network and comes without Part D prescription drug coverage.
ConnectiCare Choice Plan 2 Overview
Plan Overview for H3528-003-0 |
|
|---|---|
| CMS Plan ID: | H3528-003-0 |
| Plan Type: | HMO-POS |
| Plan Year: | 2026 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Medical Deductible: | $0.00 |
| Maximum Out-of-Pocket: | $6000.00 (In-Network) |
| Part B Give Back: | Not offered |
| Prescription Drug Coverage: | Not Included |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | Litchfield County, CT |
| Enrollment (Nationwide) | 948 beneficiaries |
| Enrollment (CMS – Local) | 64 beneficiaries in Litchfield County |
| Provided By: | ConnectiCare |
Coverage Overview for ConnectiCare Choice Plan 2
ConnectiCare Choice Plan 2 is a Medicare Advantage HMO-POS plan that includes Medicare Part A and Part B coverage, with limited access to out-of-network providers in certain situations. The monthly premium is $0.00, and costs are generally lower when services are received from in-network providers.
Primary care visits have a $0 copay, specialist visits come with a $10 copay, urgent care services carry a $10 copay, and ambulance transportation is $50 copay. These costs apply toward the annual maximum out-of-pocket (MOOP) limit of $6000.00. After this limit is reached, in-network services are fully covered.
This plan is listed by CMS under Plan ID {title_plan_id}. A summary of cost sharing is provided below.
Cost-Sharing Overview
Cost-sharing for ConnectiCare Choice Plan 2 includes out-of-pocket expenses for covered healthcare services. The table below provides a summary of typical in-network out-of-pocket costs for plan H3528-003.
This section outlines in-network costs for primary care and specialist office visits, along with related preventive services.
| Covered Service | In-Network Cost |
|---|---|
| Primary: | In-network: $0 copay |
| Specialist: | In-network: $10 copay |
This section outlines in-network costs for preventive and wellness services included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0-$15 copay |
| Routine chiropractic: | Not covered |
| Fitness benefits: | In-network: $0 copay |
| Health education: | In-network: $0 copay |
| Counseling services: | Not covered |
| Over-the-counter drug benefits: | In-network: $0 copay |
| Health transportation (non-emergency): | Not covered |
This section outlines in-network costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Covered Service | In-Network Cost |
|---|---|
| Diagnostic radiology services: | In-network: $0-$175 copay |
| Lab services: | In-network: $0-$10 copay |
| Outpatient x-rays: | In-network: $15 copay |
| Diagnostic tests and procedures: | In-network: $25 copay |
This section outlines in-network costs for emergency services, urgent care, ambulance transportation, inpatient hospital stays, and skilled nursing facility care.
| Covered Service | In-Network Cost |
|---|---|
| Emergency room care: | $100 copay |
| Worldwide emergency care: | $100 copay |
| Urgent care: | $10 copay |
| Inpatient hospital care: | In-network: | Tier 1 | $295 per day for days 1-6 | $0 per day for days 7-90 | $0 per stay |
| Skilled Nursing Facility: | In-network: | Tier 1 | $0 per day for days 1-20 | $214 per day for days 21-100 |
| Ground ambulance: | In-network: $50 copay |
This section outlines in-network costs for mental health services, including outpatient therapy and inpatient psychiatric care.
| Covered Service | In-Network Cost |
|---|---|
| Outpatient individual therapy: | In-network: $10 copay |
| Outpatient group therapy: | In-network: $10 copay |
| Inpatient psychiatric hospital care: | In-network: | Tier 1 | $295 per day for days 1-6 | $0 per day for days 7-90 | $0 per stay |
This section outlines in-network costs for rehabilitation services, including physical therapy, speech and language therapy, and occupational therapy.
| Covered Service | In-Network Cost |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $10 copay |
| Occupational therapy: | In-network: $10 copay |
This section outlines in-network costs for medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Covered Service | In-Network Cost |
|---|---|
| Diabetes supplies: | In-network: $0 copay |
| Durable medical equipment: | In-network: 0%-20% coinsurance |
| Prosthetics: | In-network: $0 copay |
This section outlines in-network cost sharing for chemotherapy and other Medicare Part B-covered drugs.
| Covered Service | In-Network Cost |
|---|---|
| Chemotherapy: | In-network: 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: 0%-20% coinsurance |
This section outlines in-network cost sharing for dental services, including preventive care, exams, x-rays, cleanings, and comprehensive dental procedures.
| Covered Service | In-Network Cost |
|---|---|
| Oral exam: | In-network: $0 copay | Out-of-network: 0%-50% coinsurance |
| Dental x-rays: | In-network: $0 copay | Out-of-network: 0%-50% coinsurance |
| Cleaning: | In-network: $0 copay | Out-of-network: 0%-50% coinsurance |
| Periodontics: | In-network: 50% coinsurance | Out-of-network: 0%-50% coinsurance |
| Endodontics: | In-network: 50% coinsurance | Out-of-network: 0%-50% coinsurance |
| Restorative services: | In-network: 20%-50% coinsurance | Out-of-network: 0%-50% coinsurance |
| Implant services: | Not covered |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | In-network: 50% coinsurance | Out-of-network: 0%-50% coinsurance |
This section outlines in-network cost sharing for vision services, including eye exams, eyeglasses, and contact lenses.
| Covered Service | In-Network Cost |
|---|---|
| Routine eye exam: | In-network: $0 copay |
| Contact lenses: | In-network: $0 copay |
| Eyeglass frames only: | In-network: $0 copay |
| Eyeglass lenses only: | In-network: $0 copay |
| Eyeglasses (frames & lenses): | In-network: $0 copay |
| Upgrades: | Not covered |
This section outlines in-network cost sharing for hearing-related services, including exams, fittings, and hearing aids.
| Covered Service | In-Network Cost |
|---|---|
| Hearing exam: | In-network: $0 copay |
| Fitting/evaluation: | In-network: $0 copay |
| Prescription hearing aids: | In-network: $0 copay |
| OTC hearing aids: | In-network: $0 copay |
This section outlines in-network cost sharing for additional and special needs services that may be included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Adult day health services: | Not covered |
| Home-based palliative care: | Not covered |
| Personal emergency response system: | Not covered |
| Weight management programs: | Not covered |
| Wigs for chemotherapy-related hair loss: | Not covered |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | Not covered |
Certain preventive services are covered 100% by ConnectiCare Choice Plan 2 as a Part B benefit.
Prescription Drug Coverage
This plan does not include a Medicare Part D plan for prescriptions.
CMS 5-Star Ratings
Medicare Advantage (Part C) and Part D plans are rated each year by CMS on a 5-star scale. Ratings summarize plan performance across clinical care and member experience measures.
| CMS Measure | Star Rating |
|---|---|
| 2026 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 |
What is the monthly premium for ConnectiCare Choice Plan 2 (HMO-POS)?
The 2026 monthly premium is $0.00. The Medicare Part B premium is paid separately.
What is the MOOP for ConnectiCare Choice Plan 2 in 2026?
The 2026 in-network MOOP is $6000.00. Once this limit is reached, covered in-network costs are fully covered.
How many beneficiaries are enrolled in this plan?
The plan has 948 enrolled beneficiaries according to CMS.
Is there a Part D deductible for this plan?
The plan’s Part D deductible is $0.00, applied to covered prescription drug costs.
Contact Information for ConnectiCare
| Contact Type | Details |
|---|---|
| Website: | ConnectiCare Plan Page |
| New Members: | 1-866-384-3002 |
| Existing Members: | 1-800-224-2273 |
| Plan Address: | 175 Scott Swamp Road | Build 2 | Farmington, CT 06032 |
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed May 2, 2026
- CMS.gov, Medicare Part C & D Performance — Last accessed May 2, 2026
- CMS.gov, Plan Benefits Package — Last accessed May 2, 2026
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed May 2, 2026
Data sources and methodology documentation..
- ConnectiCare (official source), http://www.connecticare.com/medicare — Last accessed October 13, 2025
- Medicare.gov, "Compare types of Medicare Advantage Plans" — Last accessed 25 May, 2025
- AARP.org, "The Big Choice: Original Medicare vs. Medicare Advantage" — Last accessed 25 May, 2025
- Medicare.gov, "Your coverage options" — Last accessed 25 May, 2025
MedicarePlans.com is an independent informational resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program.
Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.