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CCA Health makes it easy to get the care you need with a wide range of benefits

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CCA Medicare Excel (HMO)
San Joaquin, Stanislaus, and Merced counties
Plan 001
CCA Medicare Excel (HMO)
Santa Clara County

Plan 002
Benefits
Monthly Plan Payment
$01 $01
Medical Deductible
$0 $0
Maximum Out-of-Pocket Costs
$1,500 $1,500
Primary Care Copay
$0 $0
Specialist Copay
$02 $02
Lab Services Copay
$02 $02
Hospital Copay
$0 per day for days 1-3
$100 for day 4-73
$0 per day 8 days and beyond
$0 per day for days 1-3
$100 for day 4-73
$0 per day 8 days and beyond
Prescription Drugs
$0 for Tier 1 and 2 prescription drugs
$30 Tier 3 prescription drugs
$0 for Tier 1 and 2 prescription drugs
$30 Tier 3 prescription drugs
Vision
$0 annual exam $0 annual exam
Eyewear
Up to $300 per year for routine eyewear Up to $300 per year for routine eyewear
Hearing
$0 annual exam $0 annual exam
Hearing Aids
$1,000 per year for two hearing aids (1 per ear)3 $1,000 per year for two hearing aids (1 per ear)3
Viagra
Generic Viagra® (Sildenafil) coverage Generic Viagra® (Sildenafil) coverage
Healthy Savings Card4
$120 every calendar quarter to purchase CCA-Health approved over-the-counter products.
Plus, an additional $100 per year to pay for vision services or medical transportation
$120 every calendar quarter to purchase CCA-Health approved over-the-counter products.
Plus, an additional $100 per year to pay for vision services or medical transportation
Wellness Reward
$25 reward added to your Healthy Savings card after your annual wellness visit or physical exam5 $25 reward added to your Healthy Savings card after your annual wellness visit or physical exam5
Acupuncture & Chiropractic Services
(Non-Medicare covered)
$0 copay for up to 25 non-Medicare covered visits per year
(combined visit limit for acupuncture and chiropractic).
$0 copay for up to 25 non-Medicare covered visits per year
(combined visit limit for acupuncture and chiropractic).
Acupuncture
(Medicare-covered)
$0 copay for up to 20 visits per year for chronic lower back pain $0 copay for up to 20 visits per year for chronic lower back pain
Fitness Benefit
$0 Silver&Fit® membership that also includes a home fitness kit, access to a in-network fitness facility and online workout videos6 $0 Silver&Fit® membership that also includes a home fitness kit, access to a in-network fitness facility and online workout videos6
Worldwide Emergency Coverage (outside the US)
$0 copay for emergency and urgent care services; $100,000 limit for coverage $0 copay for emergency and urgent care services; $100,000 limit for coverage

The above chart reflects in-network costs. Costs may vary depending on plan type, product, or service. For details on out-of-network costs, see the Evidence of Coverage document for your plan.

CCA Medicare Excel Plan 001 Benefit Documents

CCA Medicare Excel (HMO) Plan 001 and Plan 002 (CA) – Summary of Benefits (2024)

A brief summary of the benefits and services covered by your CCA Medicare Excel 001 plans.

CCA Medicare Excel (HMO) Plan 001 (CA) – Evidence of Coverage (2024)

A detailed document to explain how your CCA Medicare Excel works and what care and services are covered.

CCA Health (CA) – Medicare Star Ratings (2024)

Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next. This document tells you our ratings from Medicare.

CCA Medicare Excel Plan 002 Benefit Documents

CCA Medicare Excel (HMO) Plan 001 and Plan 002 (CA) – Summary of Benefits (2024)

A brief summary of the benefits and services covered by your CCA Medicare Excel 001 plans.

CCA Medicare Excel (HMO) Plan 002 (CA) – Evidence of Coverage (2024)

A detailed document to explain how your CCA Medicare Excel works and what care and services are covered.

CCA Health (CA) – Medicare Star Ratings (2024)

Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next. This document tells you our ratings from Medicare.

1 You have to continue to pay your Medicare Part B Premium.

2 Prior authorization is required. Referral may be required.

Prior authorization is required.

4 Certain restrictions apply. Participating locations only. Contact the plan for more information.

5 It may take several months for your reward to be processed and added to your Healthy Savings card. Certain restrictions apply. Participating locations only. Contact the plan for more information.

6 The Silver&Fit® program is provided by American Specialty Health Fitness, Inc. (ASH Fitness), a subsidiary of American Specialty Health Incorporated (ASH). Silver&Fit are trademarks of ASH and used with permission herein. Restrictions may apply. Only at participating locations.

Every year, Medicare evaluates plans based on a 5-star rating system. 

Viagra is a registered trademark of Pfizer, Inc.

The benefit information provided here is a brief summary, not a complete description of benefits. Benefits, formulary, and pharmacy and provider networks may change on January 1 of each year. Limitations, copayments, and restrictions may apply.

CCA Medicare Excel (HMO) is a health plan with a Medicare contract. Enrollment depends on contract renewal.

To learn more or become a member

833-382-2862 (TTY 711)
October to March, 8 am – 8 pm (PT), 7 days a week