CCA Medicare Preferred and CCA Medicare Value Benefits
A wide range of benefits—starting at $01
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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In Network Benefits
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Monthly Plan Payment1
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| $0 | $29 | |
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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 Provider
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$0 copay PLUS a $25 reward added to member Healthy Savings card after your annual wellness visit or physical exam2 |
$0 copay PLUS a $25 reward added to member Healthy Savings card after your annual wellness visit or physical exam2 |
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Specialist
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| $30 copay | $30 copay | |
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Lab Services3
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| $0 | $0 | |
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Inpatient Hospital3
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$300 copay per day (days 1–5) $0 per day (days 6 or more) |
$200 copay per day (days 1–5) $0 per day (days 6 or more) |
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Prescription Drugs
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| $0 copay, $0 Tier 1 and Tier 2 prescription drugs (3 month supply) | $0 copay, $0 Tier 1 and Tier 2 prescription drugs (3 month supply) | |
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Dental4
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| $0 copay for routine and preventive dental services up to the annual benefit maximum. Dental care coverage up to $3,000 a year for services, including dentures, crowns, and four implants per year3 | $0 copay for routine and preventive dental services up to the annual benefit maximum. Dental care coverage up to $3,000 a year for services, including dentures, crowns, and four implants per year3 | |
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Vision Services
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| $0 routine exam (1 per year) | $0 routine exam (1 per year) | |
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Eyewear
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| $0 copay for base lenses and $400 annual allowance for frames or contact lenses | $0 copay for base lenses and $400 annual allowance for frames or contact lenses | |
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Hearing Services
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| $0 routine exam (1 per year) | $0 routine exam (1 per year) | |
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Hearing Aids
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| 2 hearing aids (1 per ear) every year with tiered copays starting at $200 | $2,000 a year for two hearing aids (1 per ear) | |
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Identity Theft Protection
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| Covered5 | Covered5 | |
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Healthy Savings Card6
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| $150 every calendar quarter to purchase plan-approved over-the-counter items | $160 every calendar quarter to purchase plan-approved over-the-counter items. Members with certain qualifying chronic conditions may be able to use these funds to purchase plan-approved food as well5 | |
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Meals3
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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
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| 12 one-way medical rides a year | 24 one-way medical rides a year | |
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Insulin Copay
(for 30-day supply) |
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| $35 | $35 | |
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Routine Foot Care Copay3
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| $30 copay | $30 copay | |
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Fitness Reimbursement
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| Silver&Fit® membership7 that includes access to an in-network fitness center, Fit at Home programming, an at-home fitness kit and more | Silver&Fit® membership7 that includes access to an in-network fitness center, Fit at Home programming, an at-home fitness kit and more | |
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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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Durable Medical Equipment3
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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, $100,000 limit per year | $0 copay, $100,000 limit per year |
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 (PPO) (RI) – Evidence of Coverage (2024)
CCA Medicare Preferred (PPO) (RI) – Annual Notice of Changes (2024)
CCA Medicare Preferred and Value (PPO) (RI) – Summary of Benefits (2024)
CCA Medicare Advantage Plans (PPO) (RI) – Star Ratings (2024)
CCA Medicare Preferred and Medicare Value (RI) – Low Income Subsidy Premium Summary (2024)
CCA Health RI Medicare Preferred (PPO) Disenrollment Form (2024)
CCA Medicare Value Benefit Documents
CCA Medicare Value (PPO) (RI) – Evidence of Coverage (2024)
CCA Medicare Value (PPO) (RI) – Annual Notice of Changes (2024)
CCA Medicare Advantage Plans (PPO) (RI) – Star Ratings (2024)
CCA Medicare Preferred and Medicare Value (RI) – Low Income Subsidy Premium Summary (2024)
CCA Health RI Medicare Value (PPO) Disenrollment Form (2024)
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.gov8 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 have to continue to pay your Medicare Part B Premium.
2 It may take several months for your reward to be processed and added to your Healthy Savings card. Certain restrictions apply. Participating locations only. Contact the plan for more information.
3 Prior authorization is required.
4 Coverage limitations apply. Refer to the Evidence of Coverage for full benefit information.
5 The benefits mentioned are part of a special supplemental program for the chronically ill. Certain restrictions apply. Not all members qualify. Contact the plan for more information.
6 Certain restrictions apply. Participating locations only. Contact the plan for more information.
7 When you click this link, you will leave the Commonwealth Care Alliance website. 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. Restrictions may apply. Only at participating in-network locations.
8 When you click this link, you will leave the Commonwealth Care Alliance website.
The CCA Medicare Preferred and CCA Medicare Value plans allow members with qualifying chronic conditions to receive $100 annual allowance for sneakers.
CCA Medicare Value (PPO) and CCA Medicare Preferred (PPO) are health plans with a Medicare contract. Enrollment depends on contract renewal.
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.
You can get this document for free in other formats, such as large print, braille, or audio. Call 833-346-9222 (TTY 711), 8 am – 8 pm, 7 days a week. The call is free.