2023 CCA Medicare Excel Benefits
As a CCA Medicare Excel (HMO) member, you now get MORE benefits—including $0 primary care and specialist copays, $0 labs, and prescription drugs starting at $0. You also get $220 per year to cover over-the-counter health products and more.
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 referral may be required2 | $0 referral may be required2 | |
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Lab Services Copay
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| $02 | $02 | |
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Hospital Copay
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$0 days 1–3 $100/day, days 4-72 |
$0 days 1–3 $100/day, days 4-72 |
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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 exam2 | $0 annual exam2 | |
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Eyewear
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| $300 per year2 | $300 per year2 | |
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Hearing
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| $0 annual exam | $0 annual exam | |
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Hearing Aids
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| $1,000 per year or 2 aids (1 per ear)2 | $1,000 per year or 2 aids (1 per ear)2 | |
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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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Healthy Savings Card
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| $100 per year on your Healthy Savings card to be used at vision provider offices toward eyewear including frame and lens enhancements | $100 per year on your Healthy Savings card to be used at vision provider offices toward eyewear including frame and lens enhancements | |
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Transportation
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| $0 copay for up to 48 one-way medical trips to plan-approved locations each year2 | $0 copay for up to 48 one-way medical trips to plan-approved locations each year2 | |
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Acupuncturist
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| $0 copay for up to 15 combined acupuncture and chiropractic visits per year2 | $0 copay for up to 15 combined acupuncture and chiropractic visits per year2 | |
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Chiropractor Office Visit
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| $0 copay for up to 15 combined acupuncture and chiropractic visits per year2 | $0 copay for up to 15 combined acupuncture and chiropractic visits per year2 | |
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Fitness Benefit
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| Silver&Fit® membership that includes a home fitness kit3 | Silver&Fit® membership that includes a home fitness kit3 | |
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Worldwide Emergency Coverage (outside the US)
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| $100,000 limit for coverage | $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 PLAN 001 – Benefit Highlights (2023)
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CCA Medicare Excel PLAN 001 – Summary of Benefits (2023)
A brief summary of the benefits and services covered by your CCA Medicare Excel 002 plans.
view:
CCA Medicare Excel PLAN 001 – Evidence of Coverage (2023)
A detailed document to explain how your CCA Medicare Excel works and what care and services are covered.
view:
CCA Medicare Excel PLAN 001 – Annual Notice of Changes for 2023
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CCA Medicare Excel Low Income Subsidy CA – Premium Summary (2023)
A notice for members who qualify for extra help paying for their prescription drug coverage.
view:
CCA Health CA – Medicare Star Ratings (2023)
Medicare rates health plans on their services every year. This document tells you our ratings from Medicare.
view:
CCA Medicare Excel Plan 002 Benefit Documents
CCA Medicare Excel PLAN 002 – Benefit Highlights (2023)
view:
CCA Medicare Excel PLAN 002 – Summary of Benefits (2023)
A brief summary of the benefits and services covered by your CCA Medicare Excel 002 plans.
view:
CCA Medicare Excel PLAN 002 – Evidence of Coverage (2023)
A detailed document to explain how your CCA Medicare Excel works and what care and services are covered.
view:
CCA Medicare Excel PLAN 002 – Annual Notice of Changes for 2023
view:
CCA Medicare Excel Low Income Subsidy CA – Premium Summary (2023)
A notice for members who qualify for extra help paying for their prescription drug coverage.
view:
CCA Health CA – Medicare Star Ratings (2023)
Medicare rates health plans on their services every year. This document tells you our ratings from Medicare.
view:
1 You have to continue to pay your Medicare Part B Premium unless your Part B premium is paid for you by Medicaid. Viagra is a registered trademark of Pfizer Inc.
2 Prior authorization may be required.
3 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.
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