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  • $0 monthly premium1

  • $0 drug deductible for prescriptions on the CCA formulary and prescribed over-the-counter drugs on the Medicaid formulary

  • Healthy Savings (OTC) card: $475 added every calendar quarter for covered health products and food items2

  • $0 annual eye exam and up to $350 a year for eyewear, including contacts or frames

  • $0 routine hearing exams including fittings, repairs, batteries, and replacements3

    $500 per hearing aid for a combined (ears) benefits of $1,000

  • $0 worldwide emergency services coverage outside of U.S., up to $100,000 per year

  • NEW! $0 membership to Silver&Fit® that also includes a home fitness kit, access to in‑network fitness facilities, and online workout videos4

  • $0 copays for hospital visits,3 doctor’s office visits, and telehealth

  • $25 reward added to your Healthy Savings Card after your annual wellness visit or physical exam5

  • Unlimited dental care coverage, including dentures, crowns, and four implants per year3

  • $0 unlimited rides to medical appointments and 8 one-way trips per month for non-medical services6

  • $0 routine foot care (podiatry) for conditions affecting the lower limbs3

  • The plan covers 36 visits per calendar year

  • $0 durable medical equipment and supplies3

  • 24-hour nurse and behavioral health line

The information above is based on in-network costs. For detailed information on CCA Senior Care Options benefits, see the Evidence of Coverage.

CCA Senior Care Options Benefits

CCA Senior Care Options (HMO D-SNP) (MA) – Summary of Benefits (2024)

A brief summary of the benefits and services covered by your Senior Care Options plan.

CCA Senior Care Options (HMO D-SNP) (MA) – Evidence of Coverage (2024)

A detailed document to explain how your Senior Care Options plan works and what care and services are covered.

CCA Senior Care Options (HMO D-SNP) (MA) – Annual Notice of Changes (2024)

A document that tells you about the changes to the plan’s benefits, coverage, and rules for 2024.

CCA Senior Care Options (HMO D-SNP) (MA) – Low Income Subsidy Premium Summary (2024)

As a CCA Senior Care Options member, you have no out-of-pocket expenses. This notice tells you that you do not have any costs for prescription drugs and your monthly plan premium and yearly deductible is $0.

CCA Senior Care Options (HMO D-SNP) (MA) – Star Rating (2024)

Every year, Medicare evaluates health plans based on a 5-star rating system. This document tells you our ratings from Medicare.

CCA Senior Care Options (HMO D-SNP) (MA) – Disenrollment Form

If you request disenrollment, you must continue to get all medical care from Commonwealth Care Alliance Massachusetts (CCA) Senior Care Options (HMO D-SNP) until the effective date of disenrollment. Contact us to verify your disenrollment before you seek medical services outside of our network. We will notify you of your effective date after we get this form from you.

CCA Senior Care Options (HMO Medicaid) (MA) – Disenrollment Form for MassHealth-Only Members (2024)

If you request disenrollment, you must continue to get all medical care from Commonwealth Care Alliance Massachusetts (CCA) Senior Care Options (HMO Medicaid) until the effective date of disenrollment. Contact us to verify your disenrollment before you seek medical services outside of our network. We will notify you of your effective date after we get this form from you.

1 You have to continue to pay your Medicare Part B Premium unless your Part B premium is paid for you by MassHealth.

2 The food benefit mentioned is part of a special supplemental program for the chronically ill. Not all members qualify. Certain restrictions may apply. Only at participating locations. Contact the plan for more information. Benefits are per quarter and do not roll over.

3 Prior authorization may be required. Coverage limitations may apply.

4 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 in-network locations.

5 It may take several months for your reward to be processed and added to your Healthy Savings card. Certain restrictions may apply. Only at participating locations. Contact the plan for more information.

6 Trips must be booked at least 72 hours in advance, Monday through Friday, of the expected trip date. There is a 50-mile limitation from the pick-up location. Non-medical trips not used within the month are not rolled over for future use.

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. You will be covered for all services listed above as long as they are approved and/or coordinated by your primary care provider, your care team, or Commonwealth Care Alliance (CCA). For more information, call CCA Member Services or review your CCA Senior Care Options Evidence of Coverage.

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