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CareAdvantage

Preferred (HMO)

The CareAdvantage Preferred (HMO) Plan is our $0 premium plan, designed for those who want a low cost Medicare option without compromising on coverage. Plan highlights:

  • $0 monthly premium and $0 medical deductible
  • $1,500 of dental coverage—one of the state's leading dental benefits
  • $0 tier 6 vaccines, Rx deductible and select generic drugs
  • $325 CarePerks health and wellness allowance
  • Prescription drug coverage also included
  • No in-network referrals required

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1-844-267-1361
(TTY: 711)

To see plans available in your area, please enter your zip code.

$0.00 per month
Enroll in this Plan
See what you can save:
Select a scenario below to see how your CareAdvantage Preferred (HMO) plan can save you more than Original Medicare.

Plan Essentials

Deductible

$0

Maximum Out of Pocket Cost

$7,550

Routine Doctor Visits and Checkups

PCP Co-Pay

$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.

Cardiovascular Screening

$0 per annual visit

Cancer Screening (Colorectal, Prostate, Breast)

$0 per annual visit

Routine Vision Exam

$15 per annual visit

Eyewear Benefit

$150 annual allowance through EyeMed

Routine Hearing Exam

$45 per annual visit

Specialty Visits, Surgery, and Exams

Specialist Co-Pay

$45 per visit

Physical, Occupational, and Speech Therapy

$40 per visit

Laboratory Services

FIT Tests: $0; Others: $5 per day

X-Rays

$10 per day

Diagnostic Tests

$30 per day

Diagnostic Radiology Services

Ultrasound: $60 per day; Others: $250 per day

Outpatient Surgery

Colonoscopy: $0; Others: $350 per day

Unforeseen Care, Emergency Services, and Hospital Stays

Urgent Care

PCP: $0; Specialist: $45 per visit

Ambulance Rides and Services

$300 per day

Emergency Room Visits

$90 per visit

Inpatient Hospital Coverage

$475 per day for days 1-4; $0 per day for day 5 and beyond

Drugs and Drug Deductibles

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

Tier 1

Initial Coverage Stage
$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
During Catastrophic Coverage Stage
The greater of $3.70 generic, $9.20 brand or 5% of cost

Tier 2

Initial Coverage Stage
$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
During Catastrophic Coverage Stage
The greater of $3.70 generic, $9.20 brand or 5% of cost

Tier 3

Initial Coverage Stage
$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
During Catastrophic Coverage Stage
The greater of $3.70 generic, $9.20 brand or 5% of cost

Tier 4

Initial Coverage Stage
$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
During Catastrophic Coverage Stage
The greater of $3.70 generic, $9.20 brand or 5% of cost

Tier 5

Initial Coverage Stage
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
During Catastrophic Coverage Stage
The greater of $3.70 generic, $9.20 brand or 5% of cost

Tier 6

Vaccines
$0

Benefits

Embedded Dental Benefits

$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.

CarePerks Health & Wellness Allowance

$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).

SilverSneakers Membership

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.

Over-The-Counter (OTC) Bonus

$25 every calendar quarter for the purchase of covered over-the-counter (OTC) items such as bandages and toothbrushes.

Hearing Aid Benefit

You are covered for up to 2 hearing aids per year, 1 aid per ear. Different copays apply.
$250 Standard Level
$475 Superior Level
$650 Advanced Level
$850 Advanced Plus Level
$1,150 Premier Level

Weight Management Programs

See “CarePerks Health & Wellness Allowance” above.

Wellness Allowance

See “CarePerks Health & Wellness Allowance” above.

Acupuncture

$10 per visit

Embedded Dental Benefits

Access to thousands of dentists across the region. No waiting period. Services must be performed by providers in the Dominion PPO network. For more detailed plan information see your Evidence of Coverage (EOC).

Individual Annual Deductible

$100 on Class 2 and 3 Services

Calendar Year Maximum

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

Periodic Oral Evaluation

$0 copay; Two per year.

Comprehensive Oral Exam

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

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

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

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

50% coinsurance after deductible; Once every 60 months.

Single Tooth X-ray Images

50% coinsurance after deductible; As needed.

Silver Filling and White Fillings (Front Teeth)

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

Periodontal Cleaning

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

Simple Extractions

50% coinsurance after deductible; Once per tooth. 

Surgical Extractions

50% coinsurance after deductible; Once per tooth.

Bridge or Denture Repair

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

Dentures (Complete or Partial)

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

Crowns and Onlays (Initial Placement)

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

Deductible

$0

Maximum Out of Pocket Cost

$7,550

PCP Co-Pay

$0 per visit

Cardiovascular Screening

$0 per annual visit

Cancer Screening (Colorectal, Prostate, Breast)

$0 per annual visit

Routine Vision Exam

$15 per annual visit

Eyewear Benefit

$150 annual allowance through EyeMed

Routine Hearing Exam

$45 per annual visit

Specialist Co-Pay

$45 per visit

Physical, Occupational, and Speech Therapy

$40 per visit

Laboratory Services

FIT Tests: $0; Others: $5 per day

X-Rays

$10 per day

Diagnostic Procedures

$30 per day

Diagnostic Radiology Services

Ultrasound: $60 per day; Others: $250 per day

Outpatient Surgery

Colonoscopy: $0; Others: $350 per day

Urgent Care

PCP: $0; Specialist: $45 per visit

Ambulance Rides and Services

$300 per day

Emergency Room Visits

$90 per visit

Inpatient Hospital Coverage

$475 per day for days 1-4; $0 per day for day 5 and beyond
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

Tier 1

Preferred Generic Drugs
$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
During Catastrophic Coverage Stage
The greater of $3.70 generic, $9.20 brand or 5% of cost

Tier 2

Non-Preferred Generic Drugs
$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
During Catastrophic Coverage Stage
The greater of $3.70 generic, $9.20 brand or 5% of cost

Tier 3

Preferred Brand Name Drugs
$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
During Catastrophic Coverage Stage
The greater of $3.70 generic, $9.20 brand or 5% of cost

Tier 4

Non-Preferred Drugs (includes Brand Name and Generic)
$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
During Catastrophic Coverage Stage
The greater of $3.70 generic, $9.20 brand or 5% of cost

Tier 5

Specialty Drugs
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
During Catastrophic Coverage Stage
The greater of $3.70 generic, $9.20 brand or 5% of cost

Weight Management Programs

SilverSneakers Membership

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.

Preventive Dental Allowance

Hearing Aid Benefit

You are covered for up to 2 hearing aids per year, 1 aid per ear. Different copays apply.
$250 Standard Level
$475 Superior Level
$650 Advanced Level
$850 Advanced Plus Level
$1,150 Premier Level