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See our 2022 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

of 3
Medicare Advantage PPO Plan
CCA Medicare Preferred
Medicare Advantage PPO Plan
CCA Medicare Value
Medicare Advantage PPO Plan
CCA Medicare Premier
Benefits
Monthly Plan Payment1
$0 $20 $50
Medical Deductible
$0 $0 $0
Maximum Out-of-Pocket Costs
$6,500 for use of in-network providers $5,000 for use of in-network providers $4,000 for use of in-network providers
Referrals
None required in-network None required in-network None required in-network
Primary Care Copay
$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)
Specialist Copay
$40 $40 $0
Lab Services
$0 $0 $0
X-rays Copay
$0 $15 $15
Hospital Copay
$370 copay a day for days 1–5, $0 copay for days 6–90 $275 copay a day for days 1–5, $0 copay for days 6–90 $330 copay a day for days 1–5, $0 copay for days 6–90
Prescription Drugs2
$200 drug deductible, $0 Tier 1 and Tier 2 prescription drugs (up to 100 days) $200 drug deductible, $0 Tier 1 and Tier 2 prescription drugs (up to 100 days) $200 drug deductible, $0 for Tier 1 and Tier 2 prescriptions
Dental
$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
Vision
$0 annual exam $0 annual exam $0 annual exam
Eyewear
Up to $290 per year Up to $300 per year $200 a year
Hearing
$0 annual exam $0 annual exam $0 annual exam
Hearing Aids
Copays starting as low as $200 $2,000 per year $1,000 per year
Identity Theft Protection3
Not covered Covered Covered
Healthy $avings (OTC) Card3,4
$660 a year ($165 a quarter) for health products $1,140 a year ($285 a quarter) for health products and approved food items $520 a year ($130 a quarter) for OTC health products and approved food items
Transportation
(scheduled by CCA)
Not covered 24 one-way rides per year for medical appointments 40 one-way medical and non-medical rides per year
Insulin Copay2
(for 31-day supply)
$35 or less $35 or less $35 or less
In-home Support
(non-medical services)
Not covered Not covered 60 hours per year through Papa’s Pals
Caregiver Support
Not covered Not covered Not covered
Routine Foot Care Copay
$40 copay. Up to 6 visits per year $40 copay. Up to 6 visits per year $40 copay. Up to 6 visits per year
Fitness
Silver and Fit® membership that also includes home fitness kits, plus $50 yearly allowance for sneakers at participating locations Silver and Fit® membership that also includes home fitness kits, plus $100 yearly allowance for sneakers at participating locations $50 yearly allowance for sneakers at participating locations
Meals
14 meals (7 days) covered after each discharge 14 meals (7 days) covered after each discharge 14 meals (7 days) covered after each discharge
Telehealth
$0 copay for telehealth $0 copay for telehealth $0 copay for telehealth
Medical Equipment
20% 20% $0 copay
24/7 Nurse Line
Covered Covered Covered
Worldwide Emergency Coverage (outside the US)
$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 PreferredCCA 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).

Learn More About Your Health Plan Benefits

CCA Medicare Plans (PPO) in MA – Summary of Benefits (2023)

A brief summary of the benefits and services covered by your CCA Medicare Preferred & CCA Medicare Value plans.

CCA Medicare Preferred (MA) – Evidence of Coverage (2023)

A detailed document to explain how your Medicare Preferred plan works and what care and services are covered.

CCA Medicare Preferred (MA) – Annual Notice of Changes (2023)

CCA Medicare Value (MA) – Evidence of Coverage (2023)

A detailed document to explain how your Medicare Value plan works and what care and services are covered.

CCA Medicare Value (MA) – Annual Notice of Changes (2023)

CCA Medicare Premier (MA) – Evidence of Coverage (2023)

CCA Medicare Preferred, Medicare Value, and Medicare Premier Low Income Subsidy – Premium Summary (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. 

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.

We’re here to support you

866-610-2273 (TTY 711)
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