2023 CCA Medicare Excel Benefits
You now have MORE benefits—starting at $0
Compare Plans
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CCA Medicare Excel (HMO) San Joaquin County
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 | |
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Medical Deductible
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| $0 | $0 | |
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Maximum Out-of-Pocket Costs
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| $2,500 | $2,500 | |
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Primary Care Copay
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| $0 | $0 | |
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Specialist Copay
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| $0 | $0 | |
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Lab Services Copay
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| $0 | $0 | |
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Hospital Copay
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$0 days 1–3 $100/day, days 4-7 |
$0 days 1–3 $100/day, days 4-7 |
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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 $35 Tier 3 prescription drugs |
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Vision
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| $0 annual exam | $0 annual exam | |
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Eyewear
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| $300 per year | $300 per year | |
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Hearing
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| $0 annual | $0 annual exam | |
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Hearing Aids
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| $1,000 per year | $1,000 per year | |
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Viagra
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| Generic Viagra® (Sildenafil) coverage | Generic Viagra® (Sildenafil) coverage | |
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Wellness
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| $25 gift card after your annual wellness visit | $25 gift card after your annual wellness visit | |
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OTC Card
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| Up to $220 per year for over-the-counter health products | Up to $220 per year for over-the-counter health products | |
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Flex Card
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| Up to $100 per year for vision upgrades | Up to $100 per year for vision upgrades | |
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Transportation
(scheduled by CCA Health) |
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| 48 one-way transportation trips to network providers | 48 one-way transportation trips to network providers | |
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Insulin Copay
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$30 for 30-day; $60 for 90-day |
$35 for 30-day; $70 for 90-day |
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Acupuncturist or Chiropractor
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| 15 visits per year | 15 visits per year | |
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Fitness
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| Silver&Fit® membership that includes a home fitness kit | Silver&Fit® membership that includes a home fitness kit | |
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Telehealth
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| $0 | $0 | |
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Worldwide Emergency Coverage (outside the US)
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| $100,000 limit for coverage | $100,000 limit for coverage | |
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Referrals
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| Required for some services | Required for some services |
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 PLAN 001 – Benefit Highlights (2023)
CCA Medicare Excel PLAN 001 – Summary of Benefits (2023)
CCA Medicare Excel PLAN 001 – Evidence of Coverage (2023)
CCA Medicare Excel Low Income Subsidy – Premium Summary (2023)
CCA Health CA – Medicare Star Ratings (2023)
CCA Medicare Excel Plan 002 Benefit Documents
CCA Medicare Excel PLAN 002 – Benefit Highlights (2023)
CCA Medicare Excel PLAN 002 – Summary of Benefits (2023)
CCA Medicare Excel PLAN 002 – Evidence of Coverage (2023)
CCA Medicare Excel Low Income Subsidy – Premium Summary (2023)
CCA Health CA – Medicare Star Ratings (2023)
1 You may need to continue to pay your Medicare Part B premium.
Viagra is a registered trademark of Pfizer Inc.
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.
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.