CCA Senior Care Options (D-SNP HMO), Franklin County, MA
Plan H2225-001-0, CCA Senior Care Options, is a D-SNP Special Needs Plan, with a HMO provider network. Delivery of healthcare services and costs are significantly different than in Original Medicare, and the plan offers additional benefits that are not included with Medicare Part A and Part B.
This plan is rated 4.5 (Good+) stars by CMS. See MedicareWire's review below. You must meet all qualification requirements to join this D-SNP plan.
GET NOTIFIED: 2024 Medicare Special Needs Plan Notification.
What You Need to Know
- CCA Senior Care Options is a HMO health plan for dual-eligible (Medicare and Medicaid) beneficiaries.
- This is a zero-dollar D-SNP cost-sharing plan. Members have no copays when they use Medicare-approved healthcare services.
- To qualify, you must have both Medicare Part A and Part B, you must live in the plan's service area (Franklin County), and you must qualify for full Medicaid.
- It includes prescription drug coverage (Medicare Part D).
- The annual Part D deductible is $505.00. You pay this amount before cost-sharing begins.
- People who qualify for Medicare "Extra Help," can get additional assistance to help pay their Medicare Part D monthly premium, deductible, and copayments.
- The plan offers the same health insurance benefits as Original Medicare and some additional benefits that Original Medicare does not cover.
- If you don't qualify to join CCA Senior Care Options, you might want to compare Medicare Advantage plans available in Franklin County, Massachusetts. Another popular option is to add one of the many Medicare supplements available in Massachusetts and a stand-alone prescription drug plan.
- 2024 costs and benefits for CCA Senior Care Options will be available in early October. Get Notification.
| H2225-001-0 Plan Basics | |
|---|---|
| Plan ID: | H2225-001-0 |
| Plan Type: | D-SNP |
| Network Type: | HMO |
| Plan Year: | 2023 |
| Premium: | $36.30/mo Plus your Part B premium. |
| Health Plan Deductible: | $0.00 |
| Out-of-Pocket Maximum: | $8,300 In-network |
| Drug Plan Benefit: | Basic $505.00 deductible |
| Rx Gap Coverage: | No |
| Supplemental Benefits: | None |
| Availability: | Franklin County, MA |
| Insured By: | Commonwealth Care Alliance, Inc. |
Health Plan Costs & Benefits
CCA Senior Care Options is a Health Maintenance Organization (HMO) plan. HMO plan members usually receive health care services through the plan’s local network of providers. Referrals are almost always required to see a specialist and other providers. However, CCA Senior Care Options does allow out-of-network care for emergencies and out-of-area dialysis.
Premiums, deductibles, and copays vary widely from plan to plan. It is very important to compare costs and apply them to your personal financial and healthcare needs.
Monthly Premium
CCA Senior Care Options's total monthly premium in Franklin County is $36.30. This includes your prescription coverage, as well. Plus, you must continue to pay your monthly Medicare Part B premium.
Annual Deductible
CCA Senior Care Options's annual health plan deductible is $0.00. This does not include the deductible for the prescription drug plan (if any), which is detailed below.
Maximum Out-of-Pocket Limit
The Maximum Out-of-Pocket (MOOP) with this Commonwealth Care Alliance, Inc. plan is $8,300 in-network. Unlike Original Medicare, Medicare Advantage plans must set an annual Maximum Out-of-Pocket (MOOP) limit on inpatient and outpatient healthcare services. Once you reach this amount of spending on your copayments, all of your Medicare Part A and Part B services will be covered at no additional charge for the remainder of the year. MOOP does not include monthly premiums, prescriptions, or other extra benefits.
Health Plan Out-of-Pocket Costs
The following table is a summary of the most common out-of-pocket costs you will incur if you join this Commonwealth Care Alliance, Inc. plan:
| Healthcare Service | Member Cost |
|---|---|
| Health plan deductible | $0 |
| Maximum out-of-pocket enrollee responsibility (does not include prescription drugs) | $8,300 In-network |
| Doctor Visits | |
| Specialist | $0 copay |
| Wellness programs (e.g., fitness, nursing hotline) | Covered |
| Preventive care | $0 copay |
| Mental Health Services | |
| Outpatient individual therapy visit with a psychiatrist | $0 copay (authorization required) |
| Outpatient individual therapy visit | $0 copay (authorization required) |
| Outpatient group therapy visit | $0 copay (authorization required) |
| Inpatient hospital - psychiatric | $0 copay (authorization required) |
| Rehabilitation Services | |
| Occupational therapy visit | $0 copay (authorization required) |
| Medical Equipment / Supplies | |
| Diabetes supplies | $0 copay (authorization required) |
| Durable medical equipment (e.g., wheelchairs, oxygen) | $0 copay (authorization required) |
| Diagnostic Procedures / Lab Services / Imaging | |
| Outpatient x-rays | $0 copay (authorization required) |
| Lab services | $0 copay (authorization required) |
| Diagnostic tests and procedures | $0 copay (authorization required) |
| Medicare Part B Drugs | |
| Other Part B drugs | $0 copay (authorization required) |
| Foot Care (podiatry Services) | |
| Routine foot care | Not covered |
| Hearing | |
| Fitting/evaluation | Not covered |
| Hearing exam | $0 copay |
| Hearing aids - outer ear | Not covered |
| Hearing aids - inner ear | Not covered |
| Preventive Dental | |
| Fluoride treatment | Not covered |
| Cleaning | Not covered |
| Oral exam | Not covered |
| Comprehensive Dental | |
| Prosthodontics, other oral/maxillofacial surgery, other services | Not covered |
| Non-routine services | Not covered |
| Diagnostic services | Not covered |
| Extractions | Not covered |
| Restorative services | Not covered |
| Periodontics | Not covered |
| Vision | |
| Contact lenses | $0 copay (limits may apply) |
| Upgrades | Not covered |
| Routine eye exam | Not covered |
| Other | Not covered |
| Eyeglasses (frames and lenses) | $0 copay (limits may apply) |
| Eyeglass frames | Not covered |
| Emergency Care / Urgent Care | |
| Urgent care | $0 copay |
| Ground ambulance | $0 copay |
| Inpatient hospital coverage | $0 copay |
| Outpatient hospital coverage | $0 copay |
| Skilled Nursing Facility | $0 copay |
| Optional supplemental benefits | No |
Feel free to download our CCA Senior Care Options Summary of Benefits information.
Prescription Drug Plan Costs & Benefits
CCA Senior Care Options includes an basic benefit Medicare Part D plan (PDP). This simply means that the plan covers the minimum amount required by the Centers for Medicare & Medicaid Services, whereas enhanced benefit plans cover more.
Basic plans typically have less cost-sharing by the plan than plans with an enhanced benefit. But, close to a third of all enhanced plans charge more than the average for preferred brand name drugs, and over 50% charge more for non-preferred brand drugs. For most people, a basic plan is their best bet, due to lower premiums and lower cost-sharing, even if the plan has a deductible.
Prescription Drug Plan Premium
Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. The following table outlines the prescription drug plan premium details of this plan.
| Basic Part D Premium: | $36.30 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $36.30 |
| Part D Premium with Full LIS Assistance: | $0.00 |
| Part D Premium with 75% LIS Assistance: | $9.10 |
| Part D Premium with 50% LIS Assistance: | $18.20 |
| Part D Premium with 25% LIS Assistance: | $27.20 |
For more information about the Low-Income Subsidy (aka, "Extra Help") program, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $505.00. This is the amount you must pay at the pharmacy before Commonwealth Care Alliance, Inc. begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, CCA Senior Care Options has copayments (a fixed dollar amount) and/or coinsurances (a percentage amount) that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Tier | Preferred | Standard |
|---|---|---|
| 1 (Preferred Generic) | N/A | 25% |
| 2 (Generic) | N/A | 25% |
| 3 (Preferred Brand) | N/A | 25% |
| 4 (Non-Preferred Brand) | N/A | 25% |
| 5 (Specialty Tier) | N/A | 25% |
CMS Rating Marks and Our Review
Each year the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage D-SNP's in nine broad categories. MedicareWire does not recommend joining a plan with an overall rating of less than 3.0. (3 stars)
On its way to 5 stars, this D-SNP plan is worth considering. Here's why. Staying healthy is the best way to save money on health care, and in MedicareWire's judgement, CCA Senior Care Options does a good job keeping its members in top health through preventive care, including screenings, tests, and vaccines. This plan is good at managing its member's chronic (long-term) health conditions. Medicare beneficiaries enrolled in this Commonwealth Care Alliance, Inc. plan enjoy a good member experience. Complaints and changes in plan performance are one way we can measure quality, and this plan scores good at both. If you're concerned about how this health plan will treat you when you call for assistance, don't be. Members say it's good.
| CMS Measure | Star Rating |
|---|---|
| 2023 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
How to Qualify to Enroll in
CCA Senior Care Options
To qualify for enrollment in CCA Senior Care Options in Franklin County, you must be eligible for both Medicare and Medicaid. To be eligible for Medicare, you must be age 65 or older, or have Social Security Disability Insurance for 24 months. To be eligible for Medicaid, your income and assets must be at or below Massachusetts's state thresholds.
Before enrolling in CCA Senior Care Options, or any other dual-eligible SNP, be sure to ask the following questions:
- What costs should I expect to pay out-of-pocket (premiums, deductibles, copayments)?
- Will I be able to use my doctors? Are they in the plan's network?
- Are the plan's in-network providers and facilities in convenient locations?
- Does the plan provide coverage for services I receive from out-of-network providers?
- Do I need a referral to see a specialist?
- Are my medications on the Part D plan's formulary? What if I can't afford my medications?
- What special accommodations does the plan make for persons with disabilities?
- Does the plan offer free meal delivery after a stay in the hospital?
- What help is offered for caregivers? Is adult day care covered?
- Does the plan offer a prepaid card for over the counter medications and covered groceries?
Additional D-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
Contact Commonwealth Care Alliance, Inc.
Call 1-855-728-0510 (TTY 711) to speak with a licensed insurance agent (Mon-Fri, 8am-9pm , Sat 8am-8pm EST) and learn more about this Special Needs Plan and other plans on this site. You may also Enroll Online using our safe and secure online enrollment website or take advantage of the following plan resources:
| Plan Website: | http://www.commonwealthcarealliance.org/become-a-member |
|---|---|
| Formulay Information: | http://www.commonwealthcarealliance.org/members/pharmacy-program |
| Pharmacy Information: | Commonwealth Care Alliance, Inc. Pharmacy Page |
| Prospective Members: | (866)275-1222 |
| TTY Users: | (711)- |
If you qualify for Medicare but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Centene Corporation, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna-HealthSpring, Humana, Molina Healthcare, Mutual of Omaha, Oscar Health Insurance, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, and UnitedHealthcare.
Citations & References
- Commonwealth Care Alliance, Inc., http://www.commonwealthcarealliance.org/become-a-member, Last Accessed October 13, 2022
- Medicaid.gov, "Medicaid & CHIP in Massachusetts", Last Accessed January 20, 2023
- CMS.gov, "Dual Eligible Special Needs Plans (D-SNPs)", Last Accessed January 20, 2023
- CMS.gov, Landscape Source Files, Last Accessed January 21, 2023
- CMS.gov, Medicare Part C & D Performance, Last Accessed January 21, 2023
- CMS.gov, Plan Benefits Package, Last Accessed January 21, 2023