2023 CCA Medicare Plan Benefits and Services
Compare benefits to decide which is best for you
With both plans, you have $0 medical deductibles and no referrals required for in-network providers.
Compare Plans
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Medicare Advantage PPO Plan
CCA Medicare Preferred
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Medicare Advantage PPO Plan
CCA Medicare Value
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Benefits
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Monthly Plan Payment1
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| $0 |
$0 – $292 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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| $4,500 | $4,500 | |
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Referrals
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| None required | None required | |
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Primary Care Copay
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$0 PLUS a $25 reward after your annual wellness visit (annual exam) |
$0 PLUS a $25 reward after your annual wellness visit (annual exam) |
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Specialist Copay
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| $30 | $30 | |
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Lab Services Copay
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| $0 | $0 | |
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Hospital Copay
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$300 copay per day (days 1–5) $0 per day (days 6-90) |
$200 copay per day (days 1–5) $0 per day (days 6-90) |
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Prescription Drugs2
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| $0 copay, $0 Tier 1 and Tier 2 prescription drugs (up to 100 days) | $0 copay, $0 Tier 1 and Tier 2 prescription drugs (up to 100 days) | |
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Dental
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| $0 copay routine dental services. Comprehensive dental coverage up to $2,250 a year, including dentures, crowns, and two implants per arch per year | $0 copay routine dental services. Comprehensive dental coverage up to $2,500 a year, including dentures, crowns, and two implants per arch per year | |
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Vision
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| $0 annual exam | $0 annual exam | |
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Eyewear
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| Up to $290 per year | Up to $300 per year | |
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Hearing
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| $0 annual exam | $0 annual exam | |
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Hearing Aids
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| Copays starting as low as $200 | $2,000 a year for hearing aids | |
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LOOK! Identity Theft Protection
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| Not covered | Covered3 | |
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Healthy Savings (OTC) Card4
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| $480 a year, $120 a quarter for OTC health products | $420 a year, $105 a quarter for OTC health products and approved food4 | |
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Meals5
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14 meals 7-day maximum post hospital discharge |
14 meals 7-day maximum post hospital discharge |
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Transportation
(scheduled by CCA) |
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| 12 one-way medical rides a year | 24 one-way medical rides a year | |
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Insulin Copay2
(for 30-day supply) |
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| $35 or less | $35 | |
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Routine Foot Care Copay
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| $30 copay, no visit limit | $30 copay, no visit limit | |
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Fitness Reimbursement
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| Silver&Fit® membership5 that also includes home fitness kits, plus $50 yearly allowance for sneakers on your Healthy Savings Card at participating locations | Silver&Fit® membership5 that also includes home fitness kits, plus $100 yearly allowance for sneakers on your Healthy Savings Card at participating locations | |
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Telehealth
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| $0 copay for Telehealth available via your provider or Teladoc®5 | $0 copay for Telehealth available via your provider or Teladoc®5 | |
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24-Hour Nurse Line
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| Speak with a registered Nurse (RN) 24 hours a day, 7 days a week. | Speak with a registered nurse (RN) 24 hours a day, 7 days a week. | |
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Medical Equipment
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| 20% coinsurance in and out of network | 20% coinsurance in and out of network | |
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Worldwide Emergency Coverage (outside the US)
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| $90 copay, $100k limit | $0 copay, $100k limit |
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 Value Evidence of Coverage document or the CCA Medicare Preferred Evidence of Coverage document.
CCA Medicare Preferred Benefit Documents
CCA Medicare Preferred (RI) – Annual Notice of Changes (2023)
CCA Medicare Plans (PPO) in RI – Summary of Benefits (2023)
CCA Medicare Preferred (RI) – Evidence of Coverage (2023)
CCA Medicare Advantage Plans (PPO) in RI – Star Ratings (2023)
CCA Medicare Value Benefit Documents
CCA Medicare Value (PPO) in RI – Annual Notice of Changes for (2023)
CCA Medicare Plans (PPO) in RI – Summary of Benefits (2023)
CCA Medicare Value (RI) – Evidence of Coverage (2023)
CCA Medicare Advantage Plans (PPO) in RI – Star Ratings (2023)
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.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).
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 Health for more information.
4 Certain restrictions may apply. Only at participating locations.
5 Participation limited based on medical criteria.
6 When you click this link, you will leave the CCA Health 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.
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