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You now have MORE benefits—starting at $0

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Medicare Advantage HMO Plan
CCA Medicare Excel
Medicare Advantage HMO Plan
CCA Medicare Ultima
Benefits
Monthly Plan Payment1
$0 $40 or less2
Do you qualify for Extra Help?
Medical Deductible
$0 $0
Maximum Out-of-Pocket Costs
No more than $4,500 annually No more than $4,500 annually
In-Network Referrals
None required None required
In-Network Primary Care Copay
$0 $0
In-Network Specialist Copay
$30 $0
Hospital Copay
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
Flu Vaccine
$0 $0
Diabetic Screenings
$0 $0
Prescription Drugs2
$0 deductible
$0 Tier 1 and 2
$0 deductible
$0 Tier 1 and 2
Dental
(Coverage Through Delta Dental)4
Up to $3,500 a year Up to $3,500 a year
Vision
$0 annual exam
$250 flex card for routine eye exams and eyewear
$0 annual exam
$250 flex card for routine eye exams and eyewear
Hearing
(coverage through NationsHearing)
$0 annual exam
$2,000 per year for 2 aids
$0 annual exam
$2,000 per year for 2 aids
Over-the-Counter Coverage3
Up to $800 per year for over-the-counter health products Up to $800 per year for over-the-counter health products
Insulin Copay2
$10 30-day; $30 90-day $10 30-day; $30 90-day
Covered  Covered 
Respite Care / Caregiver Support
2 weeks of care at American House senior living facility after hospitalization 2 weeks of care at American House senior living facility after hospitalization
In-Home Support (non-medical) – Papa Health
60 hours per year 60 hours per year
Meals5
14 meals (7 days) post hospital discharge 14 meals (7 days) post hospital discharge
Telehealth
Coverage and copays vary depending on the type of provider Coverage and copays vary depending on the type of provider
Transportation
(scheduled by CCA Health)
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)

A detailed document to explain how your CCA Medicare Ultima and CCA Medicare Excel work and what care and services are covered.

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

A notice for members who qualify for extra help paying for their prescription drug coverage.

CCA Health MI – Medicare Star Ratings (2023)

Medicare rates health plans on their services every year. This document tells you our ratings from Medicare.

You may need to continue to pay your Medicare Part B premium.
If you qualify for Extra Help, your costs may be lower.
Certain restrictions may apply. Only at participating locations.
When you click this link, you will leave the CCA Health website.
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. 

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