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 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)
CCA Medicare Excel PLAN 001 – Summary of Benefits (2023)
CCA Medicare Excel PLAN 001 – Evidence of Coverage (2023)
CCA Medicare Excel PLAN 001 – Annual Notice of Changes for 2023
CCA Medicare Excel Low Income Subsidy CA – 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 PLAN 002 – Annual Notice of Changes for 2023
CCA Medicare Excel Low Income Subsidy CA – Premium Summary (2023)
CCA Health CA – Medicare Star Ratings (2023)
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.
Access a wide range of benefits—for $0 a month1
Compare Plans
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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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|---|
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Benefits
|
||
|
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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| $1,500 | $1,500 | |
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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 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 | |
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Eyewear
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| $300 per year for routine eyewear | $300 per year for routine eyewear | |
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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 for two hearing aids (1 per ear)2 | $1,000 per year for two hearing 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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Healthy Savings Card3
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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 exam4 | $25 reward added to your Healthy Savings card after your annual wellness visit or physical exam4 | |
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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 | |
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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 videos5 | $0 Silver&Fit® membership that also includes a home fitness kit, access to a in-network fitness facility and online workout videos5 | |
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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 PLAN 001 – Benefit Highlights (2024)
CCA Medicare Excel PLAN 001 and PLAN 002 (CA) – Summary of Benefits (2024)
CCA Medicare Excel PLAN 001 – Evidence of Coverage (2024)
CCA Medicare Excel Low Income Subsidy CA – Premium Summary (2024)
CCA Medicare Excel PLAN 001 – Annual Notice of Changes for 2024
CCA Health CA – Medicare Star Ratings (2024)
CCA Medicare Excel Plan 002 Benefit Documents
CCA Medicare Excel PLAN 002 – Benefit Highlights (2024)
CCA Medicare Excel PLAN 001 and PLAN 002 (CA) – Summary of Benefits (2024)
CCA Medicare Excel PLAN 002 – Evidence of Coverage (2024)
CCA Medicare Excel Low Income Subsidy CA – Premium Summary (2024)
CCA Medicare Excel PLAN 002 – Annual Notice of Changes for 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.
3 Certain restrictions apply. Participating locations only. Contact the plan for more information.
4 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.
5 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.
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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