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CareAdvantage

Prime (HMO)

The CareAdvantage Prime (HMO) Plan is designed for people looking for greater coverage at a lower cost. Plan highlights:

  • $30 monthly premium which includes prescription drug coverage
  • $0 medical deductible
  • Lower copays for specialist visits and services
  • Low out-of-pocket max
  • No in-network referrals required

Have Questions? Call Now:

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

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

$30.00 per month
Enroll in this Plan
(Adds $15.00 to the monthly premium)Read more about the dental option
See what you can save:
Select a scenario below to see how your CareAdvantage Prime (HMO) Plan can save you more than Original Medicare.

Plan Essentials

Deductible

$0

Maximum Out of Pocket Cost

$5,900

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

$40 per annual visit

Specialty Visits, Surgery, and Exams

Specialist Co-Pay

$40

Physical, Occupational, and Speech Therapy

$40

Laboratory Services

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

X-Rays

$10 per day

Diagnostic Tests

$15 per day

Diagnostic Radiology Services

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

Outpatient Surgery

Colonoscopies: $0; Others: $275 per day

Unforeseen Care, Emergency Services, and Hospital Stays

Urgent Care

PCP: $0; Specialist: $40 per visit

Ambulance Rides and Services

$250 per day

Emergency Room Visits

$90 per visit

Inpatient Hospital Coverage

$375 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 name drugs
During Catastrophic Coverage Stage
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
During Coverage Gap Stage
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 name 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 name drugs
During Catastrophic Coverage Stage
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
During Coverage Gap Stage
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 name 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 name drugs
During Catastrophic Coverage Stage
The greater of $3.70 generic, $9.20 brand name or 5% of cost

Tier 6

Vaccines
$0

Benefits

Embedded Dental Benefits

$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 included.

SilverSneakers Membership

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

$40 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 Level
$1,150 Premier Level

Weight Management Programs

$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 included.

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. Additional dental coverage is available for an additional $15 monthly premium. For more detailed plan information see your Evidence of Coverage (EOC).

Individual Annual Deductible

$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 $750 ($1,000 with CarePartners of Connecticut Dental Option).

Periodic Oral Evaluation

$25 copay; Two per year.

Comprehensive Oral Exam

$25 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)

$25 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. (20% coinsurance after deductible with CarePartners of Connecticut Dental Option).

Single Tooth X-ray Images

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

Silver Filling and White Fillings (Front Teeth)

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

Periodontal Cleaning

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).

Simple Extractions

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

Surgical Extractions

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

Bridge or Denture Repair

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

Dentures (Complete or Partial)

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

Crowns and Onlays (Initial Placement)

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

Deductible

$0

Maximum Out of Pocket Cost

$5,900

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

$40 per annual visit

Specialist Co-Pay

$40

Physical, Occupational, and Speech Therapy

$40

Laboratory Services

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

X-Rays

$10 per day

Diagnostic Procedures

$15 per day

Diagnostic Radiology Services

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

Outpatient Surgery

Colonoscopies: $0; Others: $275 per day

Urgent Care

PCP: $0; Specialist: $40 per visit

Ambulance Rides and Services

$250 per day

Emergency Room Visits

$90 per visit

Inpatient Hospital Coverage

$375 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 name drugs
During Catastrophic Coverage Stage
The greater of $3.70 generic, $9.20 brand name 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 name drugs
During Catastrophic Coverage Stage
The greater of $3.70 generic, $9.20 brand name 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 name drugs
During Catastrophic Coverage Stage
The greater of $3.70 generic, $9.20 brand name 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 name drugs
During Catastrophic Coverage Stage
The greater of $3.70 generic, $9.20 brand name 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 name drugs
During Catastrophic Coverage Stage
The greater of $3.70 generic, $9.20 brand name or 5% of cost

Weight Management Programs

SilverSneakers Membership

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.

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 Level
$1,150 Premier Level