CCA Medicare Maximum Benefits
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.
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$0 monthly plan payment and medical deductibles1
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$0 prescription and over-the-counter drugs2
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$0 annual eye exam and up to $350 a year for eyewear
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$0 copay for routine foot care, up to 4 visits per year
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50 one-way medical and non-medical3 rides a year
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Speak with a registered nurse (RN) 24 hours a day, 7 days a week
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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
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$0 doctor’s office visits and hospital stays5—PLUS a $25 reward added to your Healthy Savings card after your annual wellness visit6
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$0 dental, including comprehensive services5 Maximum coverage of $4,000 per year7
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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
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$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)
CCA Medicare Maximum (HMO D-SNP) (RI) – Summary of Benefits (2024)
CCA Medicare Maximum (HMO D-SNP) (RI) – Evidence of Coverage (2024)
CCA Medicare Maximum (HMO D-SNP) (RI) – Star Ratings (2024)
CCA Medicare Maximum (HMO D-SNP) (RI) – Disenrollment Form (2024)
CCA Health (RI) – Comprehensive Needs Assessment Form
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.
2 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.
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