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.
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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 | $4,500 for use of in-network providers | $4,500 for use of in-network providers |
| Referrals | None required | None required |
| 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 | $30 | $30 |
| Lab Services Copay | $0 | $0 |
| Hospital Copay |
$300 per day (days 1–5) $0 per day (days 6 or more) |
$300 per day (days 1–5) $0 per day (days 6 or more) |
| Prescription Drugs2 |
$0 copay for Tier 1 and 2 generic prescription drugs No 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 $1,500 per year | $0 copay for routine and comprehensive dental, including dentures & crowns. Maximum coverage of $2,000 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 |
| LOOK! Identity Theft Protection | Not covered | Covered3 |
| Healthy Savings (OTC) Card4 | Up to $240 per year for over-the-counter health products | Up to $200 per year for over-the-counter health products |
| LOOK! Grocery Delivery Program | Not covered | Up to $25 worth of groceries per month via CCA program3 |
| Meals |
14 meals 7-day maximum post hospital discharge |
14 meals 7-day maximum post hospital discharge |
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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 | $30 | $20 |
| Fitness Reimbursement | Up to $300 per year for fitness classes, gym memberships, weight management programs, and more! | Up to $435 per year for fitness classes, gym memberships, weight management programs, and more! |
| Telehealth | Covered. Copay varies depending on provider type | Covered. Copay varies depending on provider type |
| Medical Equipment | 20% | 20% |
| Worldwide Emergency Coverage (outside the US) | Covered with $90 copay | Covered |
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.
Learn more about CCA Medicare plan benefits
CCA Medicare Plans (PPO) in RI – Summary of Benefits (2022)
CCA Medicare Preferred (RI) – Evidence of Coverage (2022)
CCA Medicare Value (RI) – Evidence of Coverage (2022)
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).
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.
5When 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.