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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 Premium1
$0 $20 $50
Annual 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
Primary Care Provider
$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)
Specialist
$40 copay $40 copay $0 copay
Lab Services2
$0 copay $0 copay $0 copay
Outpatient X-rays2
$0 copay $15 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 1–5, $0 copay for days 6–90 $330 copay per day for days 1–5, $0 copay for days 6–90
Annual Prescription (Part D) Deductible
$0 $200 drug deductible, $0 Tier 1 and Tier 2 prescription drugs (up to 100 days) $0
Dental
$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
Vision Services
$0 routine exam $0 routine exam $0 routine exam
Eyewear
$290 allowance for for frames or contact lenses $300 allowance for for frames or contact lenses $200 allowance for for frames or contact lenses
Hearing Services
$0 routine exam $0 routine exam $0 routine exam
Hearing Aids
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)
Healthy Savings card (OTC)4
$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
Transportation
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
In-Home Support
(non-medical services)2
Not covered Not covered 60 hours per year through Papa Health
Caregiver Support
Not covered Not covered Not covered
Routine Foot Care Copay2
$40 copay. Up to 6 visits per year $40 copay. Up to 6 visits per year $40 copay. Up to 6 visits per year
Meals2
14 meals (7 days) covered after each discharge 14 meals (7 days) covered after each discharge 14 meals (7 days) covered after each discharge
Medical Equipment2
20% 20% $0 copay
Annual Wellness Visit Reward
$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
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).

CCA Medicare Advantage Plans Benefit Documents

CCA Medicare Advantage 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, CCA Medicare Premium 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)

A document that tells you about the changes to the plan’s benefits, coverage, and rules for 2023.

CCA MA Medicare Preferred (PPO) Disenrollment Form

If you request disenrollment, you must continue to get all medical care from Commonwealth Care Alliance Massachusetts (CCA) Medicare Preferred (PPO) 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 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 MA Medicare Value (PPO) Disenrollment Form

If you request disenrollment, you must continue to get all medical care from Commonwealth Care Alliance Massachusetts (CCA) Medicare Value (PPO) 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 Medicare Premier (MA) – Evidence of Coverage (2023)

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

CCA MA Medicare Premier (PPO) Disenrollment Form

If you request disenrollment, you must continue to get all medical care from Commonwealth Care Alliance Massachusetts (CCA) Medicare Premier (PPO) 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 Medicare Advantage Plans Low Income Subsidy – Premium Summary (2023)

A notice for members who qualify for extra help paying for their prescription drug coverage.

CCA Medicare Advantage Plans (PPO) in MA – Star Ratings (2023)

Medicare rates health plans on their services every year. This document tells you our ratings from Medicare.

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.

We’re here to support you

866-610-2273 (TTY 711)
April to September, 8 am – 8 pm, Monday – Friday