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CCA Medicare Excel (HMO)

H9861 - 001 - 0

Plan Not Rated

CCA Medicare Excel (HMO) is a Medicare Advantage Plan by CCA Health Michigan.

This page features plan details for 2023 CCA Medicare Excel (HMO) H9861 – 001 – 0.

IMPORTANT: This page features the 2023 version of this plan. See the 2025 version using the link below:

No 2025 version found. You can use the location links below to find 2025 plans in your area.

Locations

CCA Medicare Excel (HMO) is offered in the following locations.

Genesee County, Michigan

Lapeer County, Michigan

Macomb County, Michigan

Click to see more locations

Plan Overview

CCA Medicare Excel (HMO) offers the following coverage and cost-sharing.

Insurer:	CCA Health Michigan
Health Plan Deductible:	$0.00
MOOP:	$4,500 In-network
Drugs Covered:

Ready to sign up for CCA Medicare Excel (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Premium Breakdown

CCA Medicare Excel (HMO) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.

Part B	Part C	Part B Give Back	Total
$164.90	$0.00	$0.00	$

Please Note:

Your Part B premium may differ based on factors including late enrollment, income, and disability status.

Additional Benefits

CCA Medicare Excel (HMO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

In-Network: No

Dental (comprehensive)

Diagnostic services:	Not covered (no limits)
Endodontics:	75% coinsurance (limits may apply) (authorization required) (referral not required)
Extractions:	50% coinsurance (limits may apply) (authorization required) (referral not required)
Non-routine services:	Not covered (no limits)
Periodontics:	$0 copay (limits may apply) (authorization required) (referral not required)
Prosthodontics, other oral/maxillofacial surgery, other services:	0-50% coinsurance (limits may apply) (authorization required) (referral not required)
Restorative services:	50% coinsurance (limits may apply) (authorization required) (referral not required)

Dental (preventive)

Cleaning:	$0 copay (limits may apply) (authorization not required) (referral not required)
Dental x-ray(s):	$0 copay (limits may apply) (authorization not required) (referral not required)
Fluoride treatment:	$0 copay (limits may apply) (authorization not required) (referral not required)
Oral exam:	$0 copay (limits may apply) (authorization not required) (referral not required)

Diagnostic procedures/lab services/imaging

Diagnostic radiology services (e.g., MRI):	$0-100 copay (authorization required) (referral not required)
Diagnostic tests and procedures:	$20 copay (authorization required) (referral not required)
Lab services:	$0 copay (authorization required) (referral not required)
Outpatient x-rays:	$35 copay (authorization required) (referral not required)

Doctor visits

Primary:	$0 copay
Specialist:	$30 copay per visit (authorization required) (referral not required)

Emergency care/Urgent care

Emergency:	$90 copay per visit (always covered)
Urgent care:	$45 copay per visit (always covered)

Foot care (podiatry services)

Foot exams and treatment:	$30 copay (authorization required) (referral not required)
Routine foot care:	Not covered

Ground ambulance

$205 copay

Health plan deductible

$0.00

Health plan deductibles (other)

In-Network: No

Hearing

Fitting/evaluation:	$0 copay (no limits) (authorization not required) (referral not required)
Hearing aids:	$0 copay (limits may apply) (authorization not required) (referral not required)
Hearing exam:	$0 copay (authorization not required) (referral not required)

Hospital coverage (inpatient)

$295 per day for days 1 through 6
$0 per day for days 7 through 90 (authorization required) (referral not required)

Hospital coverage (outpatient)

$200 copay per visit (authorization required) (referral not required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$4,500 In-network

Medical equipment/supplies

Diabetes supplies:	$0 copay (authorization required)
Durable medical equipment (e.g., wheelchairs, oxygen):	20% coinsurance per item (authorization required)
Prosthetics (e.g., braces, artificial limbs):	20% coinsurance per item (authorization required)

Medicare Part B drugs

Chemotherapy:	20% coinsurance (authorization required)
Other Part B drugs:	20% coinsurance (authorization required)

Mental health services

Inpatient hospital – psychiatric:	$295 per day for days 1 through 6 $0 per day for days 7 through 90 (authorization required) (referral not required)
Outpatient group therapy visit:	$0 copay (authorization required) (referral not required)
Outpatient group therapy visit with a psychiatrist:	$0 copay (authorization required) (referral not required)
Outpatient individual therapy visit:	$0 copay (authorization required) (referral not required)
Outpatient individual therapy visit with a psychiatrist:	$0 copay (authorization required) (referral not required)

Optional supplemental benefits

Preventive care

$0 copay (authorization not required) (referral not required)

Rehabilitation services

Occupational therapy visit:	$30 copay (authorization required) (referral not required)
Physical therapy and speech and language therapy visit:	$30 copay (authorization required) (referral not required)

Skilled Nursing Facility

$0 per day for days 1 through 20
$170 per day for days 21 through 100 (authorization required) (referral not required)

Transportation

$0 copay (no limits) (authorization required) (referral not required)

Vision

Contact lenses:	$0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglass frames:	$0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglass lenses:	$0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglasses (frames and lenses):	$0 copay (limits may apply) (authorization not required) (referral not required)
Other:	Not covered (no limits)
Routine eye exam:	$0 copay (limits may apply) (authorization not required) (referral not required)
Upgrades:	$0 copay (limits may apply) (authorization not required) (referral not required)

Wellness programs (e.g., fitness, nursing hotline)

Covered (authorization not required) (referral not required)