CCA Medicare Excel Plan Benefits
CCA Health makes it easy to get the care you need with a wide range of benefits
Compare Plans
CCA Medicare Excel (HMO)
San Joaquin, Stanislaus, and Merced counties
Plan 001
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CCA Medicare Excel (HMO)
Santa Clara County
Plan 002
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Benefits
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Monthly Plan Payment
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$01 | $01 | |
Medical Deductible
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$0 | $0 | |
Maximum Out-of-Pocket Costs
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$1,500 | $1,500 | |
Primary Care Copay
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$0 | $0 | |
Specialist Copay
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$02 | $02 | |
Lab Services Copay
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$02 | $02 | |
Hospital Copay
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$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 |
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Prescription Drugs
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$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 |
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Vision
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$0 annual exam | $0 annual exam | |
Eyewear
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Up to $300 per year for routine eyewear | Up to $300 per year for routine eyewear | |
Hearing
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$0 annual exam | $0 annual exam | |
Hearing Aids
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$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
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Generic Viagra® (Sildenafil) coverage | Generic Viagra® (Sildenafil) coverage | |
Healthy Savings Card4
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$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 |
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Wellness Reward
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$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) |
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$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). |
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Acupuncture
(Medicare-covered) |
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$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
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$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)
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$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)
CCA Medicare Excel (HMO) Plan 001 (CA) – Evidence of Coverage (2024)
CCA Health (CA) – Medicare Star Ratings (2024)
CCA Medicare Excel Plan 002 Benefit Documents
CCA Medicare Excel (HMO) Plan 001 and Plan 002 (CA) – Summary of Benefits (2024)
CCA Medicare Excel (HMO) Plan 002 (CA) – Evidence of Coverage (2024)
CCA Health (CA) – Medicare Star Ratings (2024)
1 You have to continue to pay your Medicare Part B Premium.
2 Prior authorization is required. Referral may be required.
3 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.
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