CCA Medicare Advantage Plan Benefits and Services
Compare benefits to decide which is best for you
With all three plans, you have $0 medical deductibles and no referrals required for in-network providers.
Compare Plans
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Medicare Advantage PPO Plan
CCA Medicare Preferred
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Medicare Advantage PPO Plan
CCA Medicare Value
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Medicare Advantage PPO Plan
CCA Medicare Premier
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Benefits
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Monthly Plan Payment1
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| $0 | $20 | $50 | |
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Medical Deductible
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| $0 | $0 | $0 | |
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Maximum Out-of-Pocket Costs
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| $6,500 for use of in-network providers | $5,000 for use of in-network providers | $4,000 for use of in-network providers | |
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Referrals
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| None required in-network | None required in-network | None required in-network | |
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Primary Care Copay
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$0 PLUS a $25 reward after your annual wellness visit (annual exam) |
$0 PLUS a $25 reward after your annual wellness visit (annual exam) |
$0 PLUS a $25 reward after your annual wellness visit (annual exam) |
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Specialist Copay
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| $40 | $40 | $0 | |
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Lab Services Copay
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| $0 | $0 | $0 | |
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X-rays Copay
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| $0 | $15 | $15 | |
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Hospital Copay
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| $370 copay per day for days 1–5, $0 copay for days 6–90 | $275 copay per day for days 1–5, $0 copay for days 6–90 | $330 copay per day for days 1–5, $0 copay for days 6–90 | |
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Prescription Drugs2
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| $0 | $200 drug deductible, $0 Tier 1 and Tier 2 prescription drugs (up to 100 days) | $0 | |
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Dental
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| $0 copay for routine dental. Comprehensive dental care coverage up to $2,300 a year, including dentures, crowns, and two implants per arch per year | $0 copay for routine dental. Comprehensive dental care coverage up to $2,300 a year, including dentures, crowns, and two implants per arch per year | $0 copays for routine dental. Comprehensive coverage up to $1,700 a year, including dentures, crowns, and two implants per arch per year | |
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Vision
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| $0 annual exam | $0 annual exam | $0 annual exam | |
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Eyewear
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| Up to $290 per year | Up to $300 per year | $200 a year | |
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Hearing
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| $0 annual exam | $0 annual exam | $0 annual exam | |
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Hearing Aids
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| Copays starting as low as $200 | $2,000 per year | $1,000 per year | |
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Identity Theft Protection3
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| Not covered | Covered | Covered | |
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Healthy $avings (OTC) Card4
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| $660 a year, $165 a quarter for health products. | $1,140 a year, $285 a quarter for health products and approved food items3 | $520 a year, $130 a quarter for OTC health products and approved food3 | |
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Transportation
(scheduled by CCA) |
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| Not covered | 24 one-way rides per year for medical appointments | 40 one-way medical and non-medical rides per year | |
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Insulin Copay2
(for 31-day supply) |
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| $35 or less | $35 or less | $35 or less | |
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In-Home Support
(non-medical services) |
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| Not covered | Not covered | 60 hours per year through Papa’s Pals | |
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Caregiver Support
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| Not covered | Not covered | Not covered | |
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Routine Foot Care Copay
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| $40 copay. Up to 6 visits per year | $40 copay. Up to 6 visits per year | $40 copay. Up to 6 visits per year | |
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Fitness
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| Silver&Fit® membership5 that also includes home fitness kits, plus $50 yearly allowance for sneakers on your Healthy Savings Card at participating locations | Silver&Fit® membership5 that also includes home fitness kits, plus $100 yearly allowance for sneakers on your Healthy Savings Card at participating locations | $50 yearly allowance for sneakers on your Healthy Savings Card at participating locations | |
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Meals
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| 14 meals (7 days) covered after each discharge | 14 meals (7 days) covered after each discharge | 14 meals (7 days) covered after each discharge | |
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Telehealth
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| $0 copay for Telehealth available via your provider or Teladoc®5 | $0 copay for Telehealth available via your provider or Teladoc®5 | $0 copay for Telehealth available via your provider or Teladoc®5 | |
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Medical Equipment
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| 20% | 20% | $0 copay | |
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24/7 Nurse Line
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| Covered | Covered | Covered | |
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Worldwide Emergency Coverage (outside the US)
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| $90 copay, $100k limit | $0 copay, $100k limit | $0 copay, $100k limit |
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 Chapter 4 of CCA Medicare Value Evidence of Coverage or Chapter 4 of CCA Medicare Preferred Evidence of Coverage.
Do you qualify for Extra Help?
Eligible Medicare beneficiaries who have limited income may qualify for a government program called Extra Help. If you enroll in the CCA Medicare Value plan, the Extra Help program may lower your prescription drug costs and your monthly premium payment.
To check if you qualify for Extra Help, visit SSA.gov5 and search “Extra Help.” To apply over the phone or to request an application, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778).
CCA Medicare Advantage Plans Benefit Documents
CCA Medicare Advantage Plans (PPO) in MA – Summary of Benefits (2023)
CCA Medicare Preferred (MA) – Evidence of Coverage (2023)
CCA Medicare Value (MA) – Evidence of Coverage (2023)
CCA Medicare Premier (MA) – Evidence of Coverage (2023)
CCA Medicare Advantage Plans Low Income Subsidy – Premium Summary (2023)
CCA Medicare Advantage Plans (PPO) in MA – Star Ratings (2023)
1 You may need to continue to pay your Medicare Part B premium.
2 If you qualify for Extra Help, your costs may be lower.
3 Some extra benefits are special supplemental benefits, which not all members will qualify for. Contact CCA for more information.
4 Certain restrictions may apply. Only at participating locations.
5 When you click this link, you will leave the Commonwealth Care Alliance website.
The benefit information provided here is a brief summary, not a complete description of benefits. Benefits, formulary, and pharmacy and/or provider networks may change on January 1 of each year. Limitations, copayments, and restrictions may apply.
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- Schedule an in-person appointment
- Understand our plans and benefits
- Check if your doctor is in our network
- Find out your prescription costs
- Enroll in a plan
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