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 Payment1
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| $0 | $20 | $50 | |
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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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Referrals
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| None required in-network | None required in-network | None required in-network | |
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Primary Care Copay
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$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) |
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Specialist Copay
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| $40 | $40 | $0 | |
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Lab Services
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| $0 | $0 | $0 | |
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X-rays Copay
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| $0 | $15 | $15 | |
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Hospital Copay
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| $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 | |
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Prescription Drugs2
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| $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 | |
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Dental
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| $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 | |
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Vision
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| $0 annual exam | $0 annual exam | $0 annual exam | |
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Eyewear
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| Up to $290 per year | Up to $300 per year | $200 a year | |
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Hearing
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| $0 annual exam | $0 annual exam | $0 annual exam | |
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Hearing Aids
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| Copays starting as low as $200 | $2,000 per year | $1,000 per year | |
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Identity Theft Protection3
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| Not covered | Covered | Covered | |
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Healthy $avings (OTC) Card3,4
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| $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 | |
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Transportation
(scheduled by CCA) |
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| Not covered | 24 one-way rides per year for medical appointments | 40 one-way medical and non-medical rides per year | |
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Insulin Copay2
(for 31-day supply) |
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| $35 or less | $35 or less | $35 or less | |
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In-home Support
(non-medical services) |
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| Not covered | Not covered | 60 hours per year through Papa’s Pals | |
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Caregiver Support
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| Not covered | Not covered | Not covered | |
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Routine Foot Care Copay
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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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Fitness
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| Silver&Fit® membership5 that also includes home fitness kits, plus $50 yearly allowance for sneakers on your Healthy Savings Card at participating locations | Silver&Fit® membership5 that also includes home fitness kits, plus $100 yearly allowance for sneakers on your Healthy Savings Card at participating locations | $50 yearly allowance for sneakers at participating locations | |
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Meals
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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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Telehealth
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| $0 copay for Telehealth available via your provider or Teladoc®5 | $0 copay for Telehealth available via your provider or Teladoc®5 | $0 copay for Telehealth available via your provider or Teladoc®5 | |
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Medical Equipment
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| 20% | 20% | $0 copay | |
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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)
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.