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CarePartners Plans Compare

CarePartners Access (PPO) $0/mo Enroll in this Plan CareAdvantage Preferred (HMO) $0.00/mo Enroll in this Plan CareAdvantage Prime (HMO) $30.00/mo Enroll in this Plan

Plan Essentials

Plan Essentials Description
Deductible $1,000 combined in- and out-of-network $0 $0
Maximum Out of Pocket $7,550 combined in- and out-of-network $7,550 $5,900

Drugs and Drug Deductibles

Drugs Description Drug costs shown for Tier 1 and Tier 2 are reflective of Preferred Pharmacy pricing. Please use our Preferred Pharmacy Directory at carepartnersct.com/pharmacy to find a location near you. Drug costs shown for Tier 1 and Tier 2 are reflective of Preferred Pharmacy pricing. Please use our Preferred Pharmacy Directory at carepartnersct.com/pharmacy to find a location near you. Drug costs shown for Tier 1 and Tier 2 are reflective of Preferred Pharmacy pricing. Please use our Preferred Pharmacy Directory at carepartnersct.com/pharmacy to find a location near you.
Drug Deductible $0 $0 $0
Tier 1
Initial Coverage Stage $0 for 30 day retail supply; $0 for 90 day mail order supply $0 for 30 day retail supply; $0 for 90 day mail order supply $0 for 30 day retail supply; $0 for 90 day mail order supply
During Coverage Gap Stage 25% of the cost of the brand name drugs; 25% of the cost of the generic drugs 25% of the cost of the brand name drugs; 25% of the cost of the generic drugs 25% of the cost of the brand name drugs; 25% of the cost of the generic name drugs
During Catastrophic Coverage Stage The greater of $3.70 generic, $9.20 brand or 5% of cost The greater of $3.70 generic, $9.20 brand or 5% of cost The greater of $3.70 generic, $9.20 brand name or 5% of cost
Tier 2
Initial Coverage Stage $0 for 30 day retail supply; $0 for 90 day mail order supply $0 for 30 day retail supply; $0 for 90 day mail order supply $0 for 30 day retail supply; $0 for 90 day mail order supply
During Coverage Gap Stage 25% of the cost of the brand name drugs; 25% of the cost of the generic drugs 25% of the cost of the brand name drugs; 25% of the cost of the generic drugs 25% of the cost of the brand name drugs; 25% of the cost of the generic name drugs
During Catastrophic Coverage Stage The greater of $3.70 generic, $9.20 brand or 5% of cost The greater of $3.70 generic, $9.20 brand or 5% of cost The greater of $3.70 generic, $9.20 brand name or 5% of cost
Tier 3
Initial Coverage Stage $47 for 30 day retail supply; $94 for 90 day mail order supply $47 for 30 day retail supply; $94 for 90 day mail order supply $47 for 30 day retail supply; $94 for 90 day mail order supply
During Coverage Gap Stage 25% of the cost of the brand name drugs; 25% of the cost of the generic drugs 25% of the cost of the brand name drugs; 25% of the cost of the generic drugs 25% of the cost of the brand name drugs; 25% of the cost of the generic name drugs
During Catastrophic Coverage Stage The greater of $3.70 generic, $9.20 brand or 5% of cost The greater of $3.70 generic, $9.20 brand or 5% of cost The greater of $3.70 generic, $9.20 brand name or 5% of cost
Tier 4
Initial Coverage Stage $100 for 30 day retail supply; $200 for 90 day mail order supply $100 for 30 day retail supply; $200 for 90 day mail order supply $100 for 30 day retail supply; $200 for 90 day mail order supply
During Coverage Gap Stage 25% of the cost of the brand name drugs; 25% of the cost of the generic drugs 25% of the cost of the brand name drugs; 25% of the cost of the generic drugs 25% of the cost of the brand name drugs; 25% of the cost of the generic name drugs
During Catastrophic Coverage Stage The greater of $3.70 generic, $9.20 brand or 5% of cost The greater of $3.70 generic, $9.20 brand or 5% of cost The greater of $3.70 generic, $9.20 brand name or 5% of cost
Tier 5
Initial Coverage Stage 33% of cost for 30 day retail or mail order supply 33% of cost for 30 day retail supply 33% of cost for 30 day retail supply
During Coverage Gap Stage 25% of the cost of the brand name drugs; 25% of the cost of the generic drugs 25% of the cost of the brand name drugs; 25% of the cost of the generic drugs 25% of the cost of the brand name drugs; 25% of the cost of the generic name drugs
During Catastrophic Coverage Stage The greater of $3.70 generic, $9.20 brand or 5% of cost The greater of $3.70 generic, $9.20 brand or 5% of cost The greater of $3.70 generic, $9.20 brand name or 5% of cost
Tier 6
Vaccines $0 $0 $0

Routine Doctor Visits & Checkups

Routine Visits Description
PCP Co-Pay INN: $0; OON: $20 per visit after deductible $0 per visit $0 per visit
Telehealth Medicare-covered services plus additional telehealth services. Additional telehealth services include but are not limited to: primary care physician services, specialist services, individual sessions for mental health and psychiatric services, opioid treatment program services, observation services, and individual sessions for outpatient substance abuse. Applicable office visit costshare applies for non-opioid treatment program telehealth services. Opioid treatment program services cost-share applies to telehealth services rendered as part of an opioid treatment program services episode. Medicare-covered services plus additional telehealth services. Additional telehealth services include but are not limited to: primary care physician services, specialist services, individual sessions for mental health and psychiatric services, opioid treatment program services, observation services, and individual sessions for outpatient substance abuse. Applicable office visit costshare applies for non-opioid treatment program telehealth services. Opioid treatment program services cost-share applies to telehealth services rendered as part of an opioid treatment program services episode. Medicare-covered services plus additional telehealth services. Additional telehealth services include but are not limited to: primary care physician services, specialist services, individual sessions for mental health and psychiatric services, opioid treatment program services, observation services, and individual sessions for outpatient substance abuse. Applicable office visit costshare applies for non-opioid treatment program telehealth services. Opioid treatment program services cost-share applies to telehealth services rendered as part of an opioid treatment program services episode.
Cardiovascular Screening INN: $0; OON: 30% $0 per annual visit $0 per annual visit
Cancer Screening (Colorectal, Prostate, Breast) INN: $0; OON: 30% $0 per annual visit $0 per annual visit
Routine Vision Exam INN: $0; OON: 30% after deductible $15 per annual visit $15 per annual visit
Eyewear Benefit $150 allowance per calendar year $150 annual allowance through EyeMed $150 annual allowance through EyeMed
Routine Hearing Exam INN: $0; OON: $50 per visit after deductible $45 per annual visit $40 per annual visit

Specialty Visits, Surgery & Exams

Specialty Visits Description
Specialist Co-Pay INN: $45 per visit; OON: $50 per visit after deductible $45 per visit $40
Physical/Occupational/Speech Therapy INN: $40 per visit; OON: 30% after deductible $40 per visit $40
Lab Services INN: $0; OON: 30% after deductible FIT Tests: $0; Others: $5 per day FIT Tests: $0; Others: $5 per day
X-rays INN: $10 per day; OON: 30% after deductible $10 per day $10 per day
Diagnostic Tests INN: $40 per day; OON: 30% after deductible $30 per day $15 per day
Diagnostic Radiology Services INN: Ultrasound: $60 per day; Others: $250 per day; OON: 30% after deductible Ultrasound: $60 per day; Others: $250 per day Ultrasound: $60 per day; Others: $250 per day
Outpatient Services INN: Colonoscopies: $0; Others: $250 per day after deductible; OON: 30% after deductible Colonoscopy: $0; Others: $350 per day Colonoscopies: $0; Others: $275 per day

Unforseen Care, Emergency Services & Hospital Stays

Unforeseen Care Description
Urgent Care $45 per visit PCP: $0; Specialist: $45 per visit PCP: $0; Specialist: $40 per visit
Ambulance Rides and Services INN: $325 per one-way trip; OON: $325 per one-way trip after deductible $300 per day $250 per day
Emergency Room Visits $90 per visit $90 per visit $90 per visit
Inpatient Hospital Coverage INN: $795 per stay after deductible; OON: 30% per stay after deductible $475 per day for days 1-4; $0 per day for day 5 and beyond $375 per day for days 1-4; $0 per day for day 5 and beyond

Benefits

Embedded Dental Benefits $1,000 yearly maximum. $0 for preventive services such as cleanings and oral exams, 50% coinsurance for restorative services such as fillings and simple extractions, and 50% coinsurance for major services such as dentures, bridges, and crowns. No waiting period. $1,500 yearly maximum. $0 for preventive services such as cleanings and oral exams, 50% coinsurance for restorative services such as fillings and simple extractions, and 50% coinsurance for major services such as dentures, bridges, and crowns. $100 deductible on restorative and major services. No waiting period. $750 yearly maximum. $25 copay for preventive services such as cleaning and oral exams, and 50% coinsurance for restorative services such as fillings and simple extractions. $100 deductible on restorative services. No waiting period.
CarePerks Health & Wellness Allowance Not Covered. $325 CarePerks health and wellness allowance. ($150 reimbursement towards weight management programs like WeightWatchers, Jenny Craig, and hospital-based programs. $175 wellness benefit good towards a fitness tracker once every 3 years, a membership at a qualified health club or fitness facility, yoga classes, memory fitness and nutritional programs). Not included.
SilverSneakers Membership INN: You receive a SilverSneakers fitness membership at no additional cost giving you access to 16,000+ gyms nationwide, trained instructors, classes and health and nutrition tips with exercise videos. OON: You pay $0 for at-home exercise kits. You receive a SilverSneakers fitness membership at no additional cost giving you access to 16,000+ gyms nationwide, trained instructors, classes and health and nutrition tips with exercise videos. You receive SilverSneakers fitness membership at no additional cost giving you access to 16,000+ gyms nationwide, trained instructors, classes and health and nutrition tips with exercise videos.
Over-The-Counter (OTC) Bonus $50 per calendar quarter to use towards covered OTC items. No rollover of unused calendar quarter balance. See Evidence of Coverage (EOC) for more information. $25 every calendar quarter for the purchase of covered over-the-counter (OTC) items such as bandages and toothbrushes. $40 every calendar quarter for the purchase of covered over-the-counter (OTC) items such as bandages and toothbrushes.
Hearing Aid Benefit $250 Standard Level
$475 Superior Level
$650 Advanced Level
$850 Advanced Plus Level
$1,150 Premier Level
$250 Standard Level
$475 Superior Level
$650 Advanced Level
$850 Advanced Plus Level
$1,150 Premier Level
$250 Standard Level
$475 Superior Level
$650 Advanced Level
$850 Advanced Level
$1,150 Premier Level
Weight Management Programs Not Covered. See “CarePerks Health & Wellness Allowance” above. $150 Reimbursement. You are reimbursed up to $150 towards programs fees related to weight management programs like WeightWatchers, Jenny Craig, and hospital based programs.
Wellness Allowance Not Covered. See “CarePerks Health & Wellness Allowance” above. Not included.
Acupuncture INN: $10 per visit; OON: $50 per visit after deductible $10 per visit $10 per visit

Embedded Dental Benefits

Individual Annual Deductible

$0

$100 on Class 2 and 3 Services

$100 on Class 2 Services ($100 on Class 2 and 3 Services with CarePartners of Connecticut Dental Option).

Calendar Year Maximum

The plan pays up to the calendar year maximum of $1,000.

The plan pays up to the calendar year maximum of $1,500.

The plan pays up to the calendar year maximum of $750 ($1,000 with CarePartners of Connecticut Dental Option).

Periodic Oral Evaluation

$0 copay; Once every 36 months (includes the initial dental history and charting of teeth)

$0 copay; Once every 36 months (includes the initial dental history and charting of teeth)

$25 copay; Once every 36 months (includes the initial dental history and charting of teeth)

Comprehensive Oral Exam

$0 copay; Two per year (when oral conditions indicate need).

$0 copay; Two per year (when oral conditions indicate need).

$25 copay; Two per year. (when oral conditions indicate need).

Intra Oral Bitewing X-ray (X-ray of Crowns of Teeth)

50% coinsurance; Once every 60 months.

50% coinsurance after deductible; Once every 60 months.

50% coinsurance after deductible; Once every 60 months. (20% coinsurance after deductible with CarePartners of Connecticut Dental Option).

Intra Oral X-ray - Entire Mouth (Panoramic & Full Mouth)

50% coinsurance; As needed.

50% coinsurance after deductible; As needed.

50% coinsurance after deductible; As needed. (20% coinsurance after deductible with CarePartners of Connecticut Dental Option).

Single Tooth X-ray Images

50% coinsurance; Once every 24 months per surface per tooth.

50% coinsurance after deductible; Once every 24 months per surface per tooth.

50% coinsurance after deductible; Once every 24 months per surface per tooth. (20% coinsurance after deductible with CarePartners of Connecticut Dental Option).

Silver Filling and White Fillings (Front Teeth)

50% coinsurance; Once every 6 months (following active periodontal therapy, not to be combined with regular cleanings)

50% coinsurance after deductible; Once every 6 months (following active periodontal therapy, not to be combined with regular cleanings)

50% coinsurance after deductible; Once every 6 months (following active periodontal therapy, not to be combined with regular cleanings). (20% coinsurance after deductible with CarePartners of Connecticut Dental Option).

Periodontal Cleaning

50% coinsurance; Once per tooth. 

50% coinsurance after deductible; Once per tooth. 

50% coinsurance after deductible; Once per tooth. (20% coinsurance after deductible with CarePartners of Connecticut Dental Option).

Simple Extractions

50% coinsurance; Once per tooth.

50% coinsurance after deductible; Once per tooth.

Not covered. (50% coinsurance after deductible with CarePartners of Connecticut Dental Option).

Surgical Extractions

50% coinsurance; Once per tooth.

50% coinsurance after deductible; Once per tooth.

Not covered. (50% coinsurance after deductible with CarePartners of Connecticut Dental Option).

Bridge or Denture Repair

50% coinsurance; Once every 24 months per bridge or denture. 

50% coinsurance after deductible; Once every 24 months per bridge or denture. 

Not covered. (50% coinsurance after deductible with CarePartners of Connecticut Dental Option).

Dentures (Complete or Partial)

50% coinsurance; Once per arch within 84 months.

50% coinsurance after deductible. Once per arch within 84 months.

Not covered. (50% coinsurance after deductible with CarePartners of Connecticut Dental Option).

Crowns and Onlays (Initial Placement)

50% coinsurance; Once within 84 months per tooth (when teeth cannot be restored with regular filings due to fracture or decay)

50% coinsurance after deductible; Once within 84 months per tooth (when teeth cannot be restored with regular filings due to fracture or decay)

Not covered. (50% coinsurance after deductible with CarePartners of Connecticut Dental Option).

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