CarePartners

2024 Access (PPO) Plan

The CarePartners Access (PPO) Plan is our $0 premium plan, designed for those who want a low cost Medicare option without compromising on coverage or restrictions of a network. This plan gives you the freedom to access any doctor or hospital. Plan highlights:

  • NEW $1,200 Dental Flex Advantage Spending Card!
  • $0 monthly premium which includes prescription drug coverage
  • $0 Tier 1 and Tier 2 Rx drugs at preferred pharmacies, plus $0 Tier 6 vaccines
  • $65/quarter for over-the-counter health items
  • No referrals required

Questions about our PPO plan? Call now: 1-844-404-5251 (TTY: 711)

Flex Advantage Spending Card

The Flex Advantage spending card allows CarePartners of Connecticut PPO Plan members to see any dentist in the country who accepts Visa® — no network, cost sharing, or other restrictions to worry about. Learn more about the Flex Advantage spending card by clicking the link below.

 

Learn About Flex Advantage Spending Card
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$0.00 per month
Enroll Now

Drugs and Drug Deductibles

Drug costs shown for Tier 1 and Tier 2 are reflective of Preferred Pharmacy pricing. Tier 1 and Tier 2 drugs include enhanced coverage of certain drugs such as select erectile dysfunction (ED) drugs, vitamins and minerals, and cough/cold products. Please use our Preferred Pharmacy Directory at carepartnersct.com/pharmacy to find a location near you.

Drug Deductible

$0

Gap Coverage: Once you and your plan have spent $5,030 on covered drugs combined, you're in the Coverage Gap Stage where the 30-day supply costs are: $0 for Tier 6vaccine drugs, $35 for covered insulin drugs, and 25% of the cost for Part D generic and brand name drugs, plus a portion of the dispensing fee for Tiers 1-5.

Catastrophic Coverage: Once you've spent $8,000 in out-of-pocket prescription costs you are in the Catastrophic Coverage Stage. If you reach the Catastrophic Coverage Stage, you pay nothing for covered Part D drugs and for excluded drugs that are covered under our enhanced benefit.

Tier 1 - Preferred Generic Drugs

Initial Coverage Stage

$0 for 30 day retail supply; $0 for 90 day mail order supply

Tier 2 - Non-Preferred Generic Drugs

Initial Coverage Stage

$0 for 30 day retail supply; $0 for 90 day mail order supply

Tier 3 - Preferred Brand Name Drugs

Initial Coverage Stage

$47 ($35 for insulin) for 30 day retail supply; $94 ($70 for insulin) for 90 day mail order supply

Tier 4 - Non-Preferred Drugs (includes Brand Name and Generic)

Initial Coverage Stage

$100 ($35 for insulin) for 30 day retail supply; $200 ($70 for insulin) for 90 day mail order supply

Tier 5 - Specialty Drugs

Initial Coverage Stage

33% of cost for 30 day retail or mail order supply

Tier 6 - Vaccines

$0

Plan Essentials

Deductible

$0 (combination of in and out-of-network costs) 

Maximum Out of Pocket

$6,350 for in-network costs; $9,550 for a combination of in and out-of-network costs

Routine Doctor Visits and Checkups

Primary Care Provider (PCP)

In-Network: $0; Out-of-Network: $50 per visit

Telehealth

In-Network: Includes Medicare covered services and additional telehealth services. $0 copay for e-visits, virtual visits, and remote patient monitoring with your PCP or Specialist. For all other telehealth visits, copay is the same as corresponding in-person visit copay.

Out-of-Network: Includes Medicare covered services; cost share is the same as corresponding in-person visit copay. Additional telehealth services not covered. 

Laboratory Services

In-Network: $0. Prior Authorization may be required for in-network services; Out-of-Network: 40% coinsurance.

Routine Vision Exam

In-Network: $0 per annual visit; Out-of-Network $65 per annual visit

Routine Hearing Exam

In-Network: $0 per annual visit; Out-of-Network: $65 per annual visit after deductible

Specialty Visits, Surgery, and Exams

Specialist Copay

In-Network: $45 per visit; Out-of-Network: $65 per visit.

X-Rays

In-Network: $10 per day. Prior Authorization may be required for in-network services; Out-of-Network: 40% coinsurance.

Diagnostic Procedures

In-Network: $40 per day. Prior Authorization may be required for in-network services; Out-of-Network: 40% coinsurance.

Diagnostic Radiology Services

In-Network: Ultrasound: $60 per day; Others: $250 per day; Prior Authorization may be required for in-network services; Out-of-Network: 40% coinsurance

Outpatient Surgery

In-Network: Colonoscopy: $0; Others (Ambulatory Surgical Center, ASC): $295 per day; Others (Non-ASC): $395 per day; Prior Authorization may be required for in-network services 

Out-of-Network: 40% coinsurance

Physical, Occupational, and Speech Therapy

In-Network: $30 per visit; Out-of-Network: 40% coinsurance.

Cardiovascular Screening

In-Network: $0; Out-of-Network: 40% coinsurance

Cancer Screening (Colorectal, Prostate, Breast)

In-Network: $0; Out-of-Network: 40%

Colonoscopy

In-Network: $0; Out-of-Network: 40% coinsurance

Unforeseen Care, Emergency Services, and Hospital Stays

Urgent Care

$45 per visit for urgently needed services provided to treat a non-emergency, unforeseen medical illness, injury, or condition that requires immediate medical care.

Emergency Room Visits

$90 per visit

Inpatient Hospital Coverage

In-Network: $395 per day for days 1-5; $0 after day 5; Prior Authorization may be required for in-network services; Out-of-Network: 40% coinsurance

Ambulance Rides and Services

In-Network and Out-of-Network: $325 per one-way trip. Coverage for medically necessary Ambulance Services. Prior authorization may be required for non-emergency transportation. Includes worldwide emergency transportation coverage.

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Embedded Dental Visa Flex Advantage Spending Card

Access PPO members receive a yearly dental benefit amount of $1,200, which can be used to pay for non-cosmetic and non-Medicare-covered dental procedures. The full amount is loaded onto your Flex Advantage spending card at the beginning of the year. Just swipe your Flex Advantage spending card to pay for covered dental services up to the annual limit at any dentist in the country who accepts Visa. The balance does not carry over, so try to use it all before the end of the year. *Restrictions apply. Refer to your Evidence of Coverage (EOC) for details.

Benefits

CarePerks Wellness Allowance

Not included.

CarePerks Weight Management Programs

Not included.

SilverSneakers Membership

In-Network: 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. Out-of-Network: You pay $0 for at-home exercise kits.

Over-The-Counter (OTC) Bonus

$65 per calendar quarter to spend on Medicare approved health-related OTC items. Members receive quarterly credit on the Flex Advantage spending card to use towards covered OTC items at participating retailers and plan approved online stores. No rollover of unused quarterly balances. See Evidence of Coverage (EOC) for more information.

Acupuncture

In-Network: $20 per visit
Out-of-Network: $65 per visit 

 

Covers up to 12 visits in 90 days for members with chronic lower back pain. 8 additional visits covered for those demonstrating an improvement. No more than 20 visits administered annually.

Hearing Aid Benefit

You are eligible for up to 2 covered hearing aids per year, 1 aid per ear. To be covered, the hearing aids must be on the Hearing Care Solutions formulary and must be purchased through Hearing Care Solutions. Different copays apply.

$250 Standard Level

$475 Superior Level

$650 Advanced Level

$850 Advanced Plus Level

$1,150 Premier Level

Out-of-Network: Hearing aid must be ordered only through Hearing Care Solutions

 

Eyewear Benefit

$150 allowance per calendar year for standard eyeglasses (prescription lenses, frames, or a combination of lenses and frames) and/or contact lenses purchased from any provider.