CCA Medicare Advantage Plans Benefits
Check out all your benefits!
With each plan, you have $0 medical deductibles and no referrals required for in-network providers.
Compare Plans
|
Medicare Advantage PPO Plan
CCA Medicare Preferred
(PPO) |
Medicare Advantage PPO Plan
CCA Medicare Value
(PPO) |
|---|
|
Benefits
|
||
|
Monthly Premium1
|
||
| $0 | $20 | |
|
Medical Deductible
|
||
| $0 | $0 | |
|
Maximum Out-of-Pocket Costs
|
||
| $5,950 for use of in-network providers | $5,000 for use of in-network providers | |
|
Primary Care Provider
|
||
| $0 copay | $0 copay | |
|
Specialist
|
||
| $40 copay | $35 copay | |
|
Lab Services2
|
||
| $0 copay | $0 copay | |
|
Outpatient X-rays2
|
||
| $0 copay | $0 copay | |
|
Inpatient Hospital2
|
||
| $370 copay per day for days 1–5, $0 copay for days 6–90 | $275 copay per day for days 1–7, $0 copay for days 8–90 | |
|
Annual Prescription (Part D) Deductible
|
||
| $0 |
$200 for Tiers 3, 4, and 5 Deductible does not apply to insulin |
|
|
Dental
|
||
|
$0 copay for routine preventive and comprehensive dental services up to the annual maximum benefit amount. Dental care coverage up to $2,300 a year for services including dentures, crowns, and 4 implants per year2 |
$0 copay for routine preventive and comprehensive dental services up to the annual maximum benefit amount. Dental care coverage up to $2,300 a year for services including dentures, crowns, and 4 implants per year2 |
|
|
Vision Services
|
||
| $0 routine exam | $0 routine exam | |
|
Eyewear
|
||
| Frames and lenses covered one per year. $350 allowance toward frames, lenses, contact lenses and upgrades | Frames and lenses covered one per year. $350 allowance toward frames, lenses, contact lenses and upgrades | |
|
Hearing Services
|
||
| $0 routine exam, 1 per year | $0 routine exam, 1 per year | |
|
Hearing Aids
|
||
| Copays starting as low as $200 2 aids (1 per ear) | $2,000 per year for 2 aids (1 per ear) | |
|
Healthy Savings card (OTC)4
|
||
| $220 added every calendar quarter for covered over-the-counter (OTC) products |
$335 added every calendar quarter for covered over-the-counter (OTC) products. Can also cover Healthy Foods for specific qualifying members3 |
|
|
Transportation
|
||
| Not covered | Up to 24 one-way medical-only trips per year to plan-approved | |
|
Caregiver Support
|
||
| Not covered | Not covered | |
|
Routine Foot Care Copay2
|
||
| $40 copay, up to 6 visits | $40 copay, up to 6 visits | |
|
Post-Discharge Meals2
|
||
| 14 meals (7 days) covered after each discharge | 14 meals (7 days) covered after each discharge | |
|
Durable Medical Equipment2
|
||
| 20% | 20% | |
|
Annual Wellness Visit Reward
|
||
| $25 reward for an annual wellness visit or physical exam6 | $25 reward for an annual wellness visit or physical exam6 | |
|
24/7 Nurse Line
|
||
| Covered | Covered | |
|
Worldwide Emergency Coverage (outside the US)
|
||
| $90 copay, $100,000 limit | $0 copay, $100,000 limit | |
|
Fitness Benefit
|
||
| Silver&Fit® membership7 that includes access to an in-network fitness center, Fit at Home programming, an at-home fitness kit, and more | Silver&Fit® membership7 that includes access to an in-network fitness center, Fit at Home programming, an at-home fitness kit, and more |
The above chart reflects in-network costs. Costs may vary depending on plan type, product or service. For detailed information on CCA Medicare Preferred and CCA Medicare Value 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).
Medicare Advantage Plans
CCA Medicare Preferred and Value (MA) – Summary of Benefits (2024)
CCA Medicare Preferred (MA) – Evidence of Coverage (2024)
CCA Medicare Preferred (MA) – Annual Notice of Changes (2024)
CCA Medicare Preferred (MA) – Disenrollment Form (2024)
CCA Medicare Preferred and Value Low Income Subsidy (MA) – Premium Summary (2024)
CCA Medicare Preferred and Value (PPO) (MA) – Star Ratings (2024)
CCA Medicare Preferred and Value (MA) – Summary of Benefits (2024)
CCA Medicare Value (MA) – Evidence of Coverage (2024)
CCA Medicare Value (MA) – Annual Notice of Changes (2024)
CCA Medicare Value (MA) – Disenrollment Form (2024)
CCA Medicare Preferred and Value Low Income Subsidy (MA) – Premium Summary (2024)
CCA Medicare Preferred and Value (PPO) (MA) – Star Ratings (2024)
1 You must continue to pay your Medicare Part B premium.
2 Prior authorization may be required. Coverage limitations may apply.
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. Certain restrictions apply. Only at participating locations.
7 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.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
Have a Friend Interested in CCA? Let Us Know
Submit This Form on Your Friend’s Behalf
