2023 CCA Medicare Advantage plans benefits
You now have MORE benefits—starting at $0
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 Premium1
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| $0 | $20 | $50 | |
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Annual 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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Primary Care Provider
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$0 copay PLUS a $25 reward after your annual wellness visit (annual exam) |
$0 copay PLUS a $25 reward after your annual wellness visit (annual exam) |
$0 copay PLUS a $25 reward after your annual wellness visit (annual exam) |
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Specialist
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| $40 copay | $40 copay | $0 copay | |
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Lab Services2
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| $0 copay | $0 copay | $0 copay | |
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Outpatient X-rays2
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| $0 copay | $15 copay | $0 copay | |
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Inpatient Hospital2
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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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Annual Prescription (Part D) Deductible
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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 and preventive dental services. Comprehensive dental care coverage2 up to $2,300 a year, including dentures, crowns, and two implants per arch per year | $0 copay for routine and preventive dental services. Comprehensive dental care coverage2 up to $2,300 a year, including dentures, crowns, and two implants per arch per year | $0 copay for routine and preventive dental services. Comprehensive dental care coverage2 up to $1,700 a year, including dentures, crowns, and two implants per arch per year | |
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Vision Services
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| $0 routine exam | $0 routine exam | $0 routine exam | |
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Eyewear
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| $290 allowance for for frames or contact lenses | $300 allowance for for frames or contact lenses | $200 allowance for for frames or contact lenses | |
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Hearing Services
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| $0 routine exam | $0 routine exam | $0 routine exam | |
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Hearing Aids
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| Copays starting as low as $200 2 aids (1 per ear ) | $2,000 per year for 2 aids (1 per ear) | $1,000 per year for 2 aids (1 per ear) | |
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Healthy Savings card (OTC)4
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| $165 added every three months for approved health products |
$285 added every three months for approved health products Can also cover Healthy Foods for specific qualifying members3 |
$130 added every three months for approved health products Can also cover Healthy Foods for specific qualifying members3 |
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Transportation
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| Not covered | Up to 24 one-way medical-only trips per year to plan-approved | Up to 40 one-way medical and non-medical trips to plan-approved locations | |
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In-Home Support
(non-medical services)2 |
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| Not covered | Not covered | 60 hours per year through Papa Health | |
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Caregiver Support
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| Not covered | Not covered | Not covered | |
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Routine Foot Care Copay2
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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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Meals2
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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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Medical Equipment2
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| 20% | 20% | $0 copay | |
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Annual Wellness Visit Reward
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| $25 reward for an annual wellness visit or physical exam6 | $25 reward for an annual wellness visit or physical exam6 | $25 reward for an annual wellness visit or physical exam6 | |
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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 detailed information on CCA Medicare Preferred, CCA Medicare Value, and CCA Medicare Premier benefits, see the Evidence of Coverage document below.
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 Preferred (MA) – Annual Notice of Changes (2023)
CCA MA Medicare Preferred (PPO) Disenrollment Form
CCA Medicare Value (MA) – Evidence of Coverage (2023)
CCA Medicare Value (MA) – Annual Notice of Changes (2023)
CCA MA Medicare Value (PPO) Disenrollment Form
CCA Medicare Premier (MA) – Evidence of Coverage (2023)
CCA MA Medicare Premier (PPO) Disenrollment Form
CCA Medicare Advantage Plans Low Income Subsidy – Premium Summary (2023)
CCA Medicare Advantage Plans (PPO) in MA – Star Ratings (2023)
1 You must continue to pay your Medicare Part B premium.
2 Prior authorization may be required.
3 The benefits mentioned are 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.
4 Certain restrictions may apply. Only at participating locations.
5 When you click this link, you will leave the Commonwealth Care Alliance website.
6 It may take several months for your wellness visit to be processed and for your benefit to be allocated to your Healthy Savings card.
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 can get this document for free in other formats, such as large print, braille, or audio. Call 866-610-2273 (TTY 711), 8 am to 8 pm, 7 days a week, from October 1 to March 31. (April 1 to September 30: 8 am to 8 pm, Monday to Friday, and 8 am to 6 pm, Saturday and Sunday.) The call is free.
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