CCA Medicare Preferred and CCA Medicare Value benefits
You now have MORE benefits—starting at $0
With both plans, you have $0 medical deductibles and no referrals required for in-network providers.
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Benefits
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| 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 |
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Transportation (scheduled by CCA) |
Not covered | 12 one-way rides per year for medical appointments |
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Insulin Copay2 (for 30-day supply) |
$35 or less | $47 or less |
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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)
CCA Medicare Preferred (MA): Evidence of Coverage (2022)
CCA Medicare Value (MA): Evidence of Coverage (2022)
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.