2023 CCA Medicare Excel Plan and CCA Medicare Ultima Plan Benefits
You now have MORE benefits—starting at $0
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 Payment1
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| $0 |
$40 or less2 Do you qualify for Extra Help? |
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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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Hospital Copay
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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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Flu Vaccine
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| $0 | $0 | |
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Diabetic Screenings
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| $0 | $0 | |
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Prescription Drugs2
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$0 deductible $0 Tier 1 and 2 |
$0 deductible $0 Tier 1 and 2 |
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Dental
(Coverage Through Delta Dental)4 |
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| Up to $3,500 a year | Up to $3,500 a year | |
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Vision
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$0 annual exam $250 flex card for routine eye exams and eyewear |
$0 annual exam $250 flex card for routine eye exams and eyewear |
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Hearing
(coverage through NationsHearing) |
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$0 annual exam $2,000 per year for 2 aids |
$0 annual exam $2,000 per year for 2 aids |
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Over-the-Counter Coverage3
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| Up to $800 per year for over-the-counter health products | Up to $800 per year for over-the-counter health products | |
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Insulin Copay2
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| $10 30-day; $30 90-day | $10 30-day; $30 90-day | |
| Covered | Covered | |
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Respite Care / Caregiver Support
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| 2 weeks of care at American House senior living facility after hospitalization | 2 weeks of care at American House senior living facility after hospitalization | |
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In-Home Support (non-medical) – Papa Health
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| 60 hours per year | 60 hours per year | |
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Meals5
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| 14 meals (7 days) post hospital discharge | 14 meals (7 days) post hospital discharge | |
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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
(scheduled by CCA Health) |
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| 1 trip after each hospitalization to primary care physician / behavioral health specialist | 1 trip after each hospitalization to primary care physician / behavioral health specialist |
The above chart reflects in-network costs. Costs may vary depending on plan type, product, or service. For details on out-of-network costs, see the CCA Medicare Excel plan and CCA Medicare Ultima plan 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 Cardinal 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.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 Advantage Plans Low Income Subsidy – Premium Summary (2023) MI
CCA Health MI – Medicare Star Ratings (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 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.
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.
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.