CCA Medicare Plan Benefits and Services
Compare 2023 benefits to decide which is best for you
Compare Plans
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Medicare Advantage HMO Plan
CCA Medicare Excel
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Medicare Advantage HMO Plan
CCA Medicare Ultima
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Benefits
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Monthly Plan Premium1
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| $0 | $40 or less | |
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Annual Medical Deductible
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| $0 | $0 | |
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Maximum Out-of-Pocket Costs
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| No more than $4,500 annually | No more than $4,500 annually | |
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In-Network Referrals
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| None required | None required | |
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In-Network Primary Care Copay
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| $0 | $0 | |
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In-Network Specialist Copay
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| $30 | $0 | |
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Inpatient Hospital Stays
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Inpatient: $295 per day for days 1–6; $0 for days 7 and beyond |
Inpatient: $295 per day for days 1–6; $0 for days 7 and beyond |
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Preventative Care
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| $0 | $0 | |
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Prescription Drugs2
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| $0 for Tier 1 and Tier 2, Preferred Retail | $0 for Tier 1 and Tier 2, Preferred Retail | |
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Dental Services
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| $0 copay for routine and preventive dental services. Comprehensive dental care coverage $3,500 annual maximum6 | $0 copay for routine and preventive dental services. Comprehensive dental care coverage $3,500 annual maximum6 | |
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Vision Services
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| $250 flex card for routine eye exams and eyewear | $250 flex card for routine eye exams and eyewear | |
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Hearing Services
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$0 routine exam $2,000 per year for two hearing aids (one per ear) |
$0 routine exam $2,000 per year for 2 hearing aids (1 per ear) |
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Over-the-Counter Benefit3
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$200 every three months for approved Medicare OTC items Amounts do not rollover from one quarter to the next |
$200 every three months for approved Medicare OTC items Amounts do not rollover from one quarter to the next |
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| Covered | Covered | |
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In-home Support (non medical)
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| 60 hours per year | 60 hours per year | |
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Caregiver Support
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| Members can move to an assisted living facility for up to 14 days post-hospitalization with prior authorization | Members can move to an assisted living facility for up to 14 days post-hospitalization with prior authorization | |
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Meals5
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| 14 meals (7 days) post hospital discharge6 | 14 meals (7 days) post hospital discharge6 | |
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Telehealth
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| Coverage and copays vary depending on the type of provider | Coverage and copays vary depending on the type of provider | |
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Transportation
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Round trip medical transportation from home to PCP office or Behavioral Health specialist after hospitalization
Prior authorization may be required |
Round trip medical transportation from home to PCP office or Behavioral Health specialist after hospitalization
Prior authorization may be required |
The above chart reflects in-network costs. Costs may vary depending on plan type, product, or service. See the CCA Medicare Ultima plan and CCA Medicare Excel plan documents below for additional benefit coverage.
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 Ultima, 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.gov4 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 Plan Benefit Documents
CCA Medicare Ultima (HMO) and CCA Medicare Excel (HMO) (MI) – Summary of Benefits (2023)
CCA Medicare Ultima (HMO) and CCA Medicare Excel (HMO) (MI) – Evidence of Coverage (2023)
CCA Medicare Ultima Plan (HMO) (MI) – ANOC (2023)
CCA Medicare Excel Plan (HMO) (MI) – ANOC (2023)
CCA Medicare Excel Low Income Subsidy CA – Premium Summary (2023)
CCA Health MI – Medicare Star Ratings (2023)
1 You have to continue to pay your Medicare Part B Premium unless your Part B premium is paid for you by Medicaid.
2 If you qualify for Extra Help, your costs may be lower.
3 Certain restrictions may apply. Only at participating locations.
4 When you click this link, you will leave the CCA Health website.
5 Participation limited based on medical criteria.
6 Prior authorization required.
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.
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.
CCA Medicare Excel (HMO) and CCA Medicare Ultima (HMO) are health plans with Medicare contracts. Enrollment depends on contract renewal.
Check out our benefits for 2024
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Medicare Advantage HMO-POS Plan
CCA Medicare Excel
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Benefits
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Monthly Plan Premium1
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| $0 | |
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Annual Medical Deductible
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| $0 | |
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Maximum Out-of-Pocket Costs
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| No more than $3,800 annually | |
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In-Network Referrals
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| None required | |
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In-Network Primary Care Copay
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| $0 | |
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In-Network Specialist Copay
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| $10 | |
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Inpatient Hospital Stays2
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Inpatient: $295 per day for days 1–7; $0 for days 8 and beyond |
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Preventive Care
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| $0 | |
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Prescription Drugs
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| $0 for Tier 1 and Tier 2, Preferred Retail | |
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Dental Services
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| $0 copay for routine and preventive dental services. Comprehensive dental care2 coverage $2,000 annual maximum3 | |
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Vision Services
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| $300 flex card for routine eye exams and eyewear3 | |
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Hearing Services
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$0 routine exam3 $1,500 per year for two hearing aids (one per ear) |
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Healthy Savings Card4
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| $240 every calendar quarter to buy plan-approved over-the-counter products | |
| Covered | |
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Home Healthcare2
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| $0 copay | |
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Transportation2
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| $0 copay per one-way trip (up to 12 per year to plan-approved locations, maximum of 20 miles) |
The above reflects in-network costs. Costs may vary depending on plan type, product, or service. See the CCA Medicare Excel plan documents below for additional benefit coverage.
Do you qualify for Extra Help?
Eligible Medicare beneficiaries who have limited income may qualify for a government program called Extra Help.
To check if you qualify for Extra Help, visit SSA.gov6 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 Plan Benefit Documents
CCA Medicare Excel (HMO POS) (MI) – Summary of Benefits (2024)
CCA Medicare Excel (HMO POS) (MI) – Evidence of Coverage (2024)
CCA Medicare Excel Plan (HMO POS) (MI) – ANOC (2024)
CCA Medicare Excel (HMO POS) (MI) – Low Income Subsidy Premium Summary (2024)
CCA Health (MI) – Medicare Star Ratings (2024)
1 You have to continue to pay your Medicare Part B Premium unless your Part B premium is paid for you by Medicaid.
2 Prior authorization is required.
3 Coverage limitations apply. Refer to the Evidence of Coverage for full benefit information.
4 Certain restrictions apply. Participating locations only. Contact the plan for more information.
5 The Silver&Fit® program is provided by American Specialty Health Fitness, Inc. (ASH Fitness), a subsidiary of American Specialty (ASH). Silver&Fit are trademarks of ASH and used with permission herein. Certain restrictions apply. Participating in-network locations only.
6 Clicking on this link will direct you away from the CCA Health Michigan 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.
CCA Medicare Excel (HMO POS) is a health plan with a Medicare contract. Enrollment depends on contract renewal.
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