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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:

  • $29 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)

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$29.00 per month
Enroll in this Plan
(Adds $16.00 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 Plan can save you more than original Medicare.

Plan Essentials

Deductible

$0

Maximum Out of Pocket Cost

$4,900

Routine Doctor Visits and Checkups

Doctor 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

Routine Hearing Exam

$40 per annual visit

Specialty Visits, Surgery, and Exams

Specialist Co-Pay

$40

Physical, Occupational, and Speech Therapy

$40

Laboratory Services

$0 - $5

X-Rays

$0 - $10

Diagnostic Procedures

$0 - $15

Diagnostic Radiology Services

$60 - $250

Outpatient Surgery

$275 per day

Unforeseen Care, Emergency Services, and Hospital Stays

Urgent Care

$0 - $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 $3.60 generic, $8.95 brand name or 5% of cost

Tier 2

Initial Coverage Stage
$10 for 30 day retail supply; $20 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 $3.60 generic, $8.95 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 $3.60 generic, $8.95 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 $3.60 generic, $8.95 brand name or 5% of cost

Tier 5

Initial Coverage Stage
33% of cost
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 $3.60 generic, $8.95 brand name or 5% of cost

Tier 6

Vaccines
$0

Benefits

Embedded Dental Benefits

$750 dental benefit that includes coverage for preventive visits with $25 copay and 50% coinsurance after deductible for fillings, simple extractions, and more. (Limited network under Dominion National).

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.

Deductible

$0

Maximum Out of Pocket Cost

$4,900

Doctor 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

Routine Hearing Exam

$40 per annual visit

Specialist Co-Pay

$40

Physical, Occupational, and Speech Therapy

$40

Laboratory Services

$0 - $5

X-Rays

$0 - $10

Diagnostic Procedures

$0 - $15

Diagnostic Radiology Services

$60 - $250

Outpatient Surgery

$275 per day

Urgent Care

$0 - $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 $3.60 generic, $8.95 brand name or 5% of cost

Tier 2

Non-Preferred Generic Drugs
$10 for 30 day retail supply; $20 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 $3.60 generic, $8.95 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 $3.60 generic, $8.95 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 $3.60 generic, $8.95 brand name or 5% of cost

Tier 5

Specialty Drugs
33% of cost
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 $3.60 generic, $8.95 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