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You now have MORE benefits—starting at $0

With both plans, you have $0 medical deductibles and no referrals required for in-network providers.

Medicare Advantage PPO Plan
CCA Medicare Preferred
Medicare Advantage PPO Plan
CCA Medicare Value
Benefits
Monthly Plan Payment1 $0 $0 – $36.302
Do you qualify for Extra Help?
Medical Deductible $0 $0
Maximum Out-of-Pocket Costs $6,500 for use of in-network providers $6,500 for use of in-network providers
Referrals 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)
Specialist Copay $45 $45
Lab Services Copay $0 $0
Hospital Copay $370 per day (days 1–5)
$0 per day (days 6 or more)
$370 per day (days 1–5)
$0 per day (days 6 or more)
Prescription Drugs2 $0 copay for preferred generic prescription drugs, $195 yearly deductible $0 – $6.50 for Tier 1 preferred generic prescription drugs
$480 yearly deductible
Dental $0 copay for routine dental. Most comprehensive dental covered at 50%. Maximum coverage of $1,000 per year $0 copay for routine dental. Most comprehensive dental covered at 50%. Maximum coverage of $1,000 per year
Vision $0 annual exam $0 annual exam
Eyewear Up to $290 per year Up to $300 per year
Hearing $0 annual exam $0 annual exam
Hearing Aids Copays starting as low as $200 Up to $1,000 in coverage every three years
Identity Theft Protection3 Not covered Covered
Healthy Savings (OTC) Card4 Up to $200 per year for over-the-counter health products Up to $300 per year for health products and approved food items3
Transportation
(scheduled by CCA)
Not covered 12 one-way rides per year for medical appointments
Insulin Copay2
(for 30-day supply)
$35 or less $47 or less
In-home Support
(non-medical services)
Not covered 10 visits per year
Caregiver Support Not covered $50 reimbursement per year
Routine Foot Care Copay $45
Up to 6 visits per year
$45
Up to 6 visits per year
Fitness Reimbursement Up to $250 per year for fitness classes, gym memberships, weight management programs, and more! Up to $415 per year for fitness classes, gym memberships, weight management programs, and more!
Meals Not covered 14 meals post hospital discharge
Telehealth Covered. Copay varies depending on provider type Covered. Copay varies depending on provider type
Medical Equipment 20% 20%
24/7 Nurse Line Covered Covered
Worldwide Emergency Coverage (Outside the US) Covered Covered

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 Summary of Benefits 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) – Summary of Benefits (2022)

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

CCA Medicare Preferred (MA): Evidence of Coverage (2022)

Download:

CCA Medicare Value (MA): Evidence of Coverage (2022)

Download:

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)
8:00 am to 8:00 pm, 7 days a week