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You’re connected to a wide range of care—at $0 to you1

The information above is based on in-network costs. For detailed information on CCA Medicare Maximum benefits, see the Evidence of Coverage below.

  • $0 monthly plan payment and medical deductibles1

  • $0 prescription and over-the-counter drugs2

  • $0 annual eye exam and up to $350 a year for eyewear

  • $0 copay for routine foot care, up to 4 visits per year

  • 50 one-way medical and non-medical3 rides a year

  • Speak with a registered nurse (RN) 24 hours a day, 7 days a week

  • Silver&Fit® membership4 that includes a fitness membership with access to an in network fitness center of your choosing, Fit at Home programming for at-home fitness, home fitness kits and more

  • $0 doctor’s office visits and hospital stays5PLUS a $25 reward added to your Healthy Savings card after your annual wellness visit6

  • $0 dental, including comprehensive services5 Maximum coverage of $4,000 per year7

  • Healthy Savings card: $750 every calendar quarter to purchase plan-approved OTC items such as hand sanitizer, masks, first-aid supplies, dental care, cold symptom supplies, and others at in-network retailers.8

    Some members with qualifying chronic conditions may be able to use these funds for approved food and utilities, too3

  • $0 copay for routine hearing exam – 1 per year

    $4,000 annual allowance for two hearing aids (one per ear)

CCA Medicare Maximum Benefit Documents

CCA Medicare Maximum (HMO D-SNP) (RI) – Annual Notice of Changes (2024)

A document that tells you about the changes to the plan’s benefits, coverage, and rules for 2024.

CCA Medicare Maximum (HMO D-SNP) (RI) – Summary of Benefits (2024)

A brief summary of the benefits and services covered by your CCA Medicare Maximum plan.

CCA Medicare Maximum (HMO D-SNP) (RI) – Evidence of Coverage (2024)

A detailed document to explain how your CCA Medicare Maximum works and what care and services are covered.

CCA Medicare Maximum (HMO D-SNP) (RI) – Star Ratings (2024)

Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next. This document tells you our ratings from Medicare.

CCA Medicare Maximum (HMO D-SNP) (RI) – Disenrollment Form (2024)

If you request disenrollment, you must continue to get all medical care from CCA Health Rhode Island (CCA Health) Medicare Maximum (HMO D-SNP) until the effective date of disenrollment. Contact us to verify your disenrollment before you seek medical services outside of our network. We will notify you of your effective date after we get this form from you.

CCA Health (RI) – Comprehensive Needs Assessment Form

If you prefer to print and mail it, please send to:

Commonwealth Care Alliance
101 Wason Ave, 3rd floor
Springfield, MA 01107

1 You have to continue to pay your Medicare Part B Premium unless your Part B premium is paid for you by Medicaid.

For covered drugs, prior authorization and restrictions apply. See your Evidence of Coverage for more information.

3 The non-medical transportation, approved food, and utility benefits are part of a special supplemental program for the chronically ill. Not all members qualify. Certain restrictions may apply. Only at participating locations. Contact the plan for more information.

4 The Silver&Fit® program is provided by American Specialty Health Fitness, Inc. (ASH Fitness), a subsidiary of American Specialty (ASH). Silver&Fit are trademarks of ASH and used with permission herein. Certain restrictions apply. Participating in-network locations only.

5 Prior authorization is required.

6 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.

7 Coverage limitations apply. Refer to the Evidence of Coverage for full benefit information.

8 Certain restrictions apply. Participating locations only. Contact the plan for more information.

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.

CCA Medicare Maximum (HMO D-SNP) is a health plan with a Medicare contract and a contract with the State Medicaid program. Enrollment depends on contract renewal.

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 to 8 pm, 7 days a week, from October 1 to March 31. (April 1 to September 30: 8 am to 8 pm, Monday to Friday, and 8 am to 6 pm, Saturday and Sunday.) The call is free.

We’re here to support you

833-346-9222 (TTY 711)
8 am – 8 pm, 7 days a week