2022 CarePartners Access (PPO)

CarePartners Access (PPO) H0342-001 is a 2022 Medicare Advantage Plan or Part-C by CarePartners of Connecticut available to residents in Connecticut. This plan includes additional prescription drug (Part-D) coverage. The CarePartners Access (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $4,900 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $4,900 out-of-pocket. This can be a extremely nice safety net.

CarePartners Access (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

CarePartners of Connecticut works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for CarePartners Access (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from CarePartners of Connecticut and not Original Medicare. With Medicare Advantage you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from CarePartners of Connecticut except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.

Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

2022 CarePartners of Connecticut Medicare Advantage Plan Costs

CarePartners Access (PPO) Part-C Premium

CarePartners of Connecticut charges a $0.00 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

H0342-001 Part-D Deductible and Premium

CarePartners Access (PPO) has a monthly drug premium of $0.00 and a $0.00 drug deductible. This CarePartners of Connecticut plan offers a $0.00 Part-D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by CarePartners of Connecticut above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0.00 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.

CarePartners of Connecticut Gap Coverage

In 2022 once you and your plan provider have spent $4430 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This CarePartners of Connecticut plan does not offer additional coverage through the gap.

H0342-001 Formulary or Drug Coverage

CarePartners Access (PPO) formulary is divided into Tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price. You can see complete 2022 CarePartners Access (PPO) H0342-001 Formulary here.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	$0	$10
Tier 2	$0	$15
Tier 3	$47	$47
Tier 4	$100	$100
Tier 5	33%	33%
Tier 6	$0	$0

*Initial Coverage Phase and 30 day supply

2021 CarePartners Access (PPO) Summary of Benefits

*This will be updated with 2022 data when available.

---

Additional Benefits

No

---

Comprehensive Dental

Diagnostic services	0-50% coinsurance
Diagnostic services	0-50% coinsurance (Out-of-Network)
Endodontics	0-50% coinsurance (Out-of-Network)
Endodontics	50% coinsurance
Extractions	50% coinsurance
Extractions	0-50% coinsurance (Out-of-Network)
Non-routine services	50% coinsurance
Non-routine services	0-50% coinsurance (Out-of-Network)
Periodontics	50% coinsurance
Periodontics	0-50% coinsurance (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services	0-50% coinsurance (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services	50% coinsurance
Restorative services	0-50% coinsurance (Out-of-Network)
Restorative services	50% coinsurance

---

Deductible

$1,000 annual deductible

---

Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	$60-250 copay
Diagnostic radiology services (e.g., MRI)	30% coinsurance (Out-of-Network)
Diagnostic tests and procedures	30% coinsurance (Out-of-Network)
Diagnostic tests and procedures	$0-45 copay
Lab services	$0-45 copay
Lab services	30% coinsurance (Out-of-Network)
Outpatient x-rays	$0-45 copay
Outpatient x-rays	30% coinsurance (Out-of-Network)

---

Doctor Visits

Primary	$0 copay
Primary	$20 copay per visit (Out-of-Network)
Specialist	$50 copay per visit (Out-of-Network)
Specialist	$45 copay per visit

---

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	$50 copay (Out-of-Network)
Foot exams and treatment	$45 copay
Routine foot care	Not covered

---

Ground Ambulance

$325 copay
$325 copay (Out-of-Network)

---

Hearing

Fitting/evaluation	$0 copay
Fitting/evaluation	$50 copay (Out-of-Network)
Hearing aids	$250-1,150 copay (Out-of-Network)
Hearing aids	$250-1,150 copay
Hearing exam	$50 copay (Out-of-Network)
Hearing exam	$45 copay

---

Inpatient Hospital Coverage

$795 per stay
30% per stay (Out-of-Network)

---

Medical Equipment/Supplies

Diabetes supplies	0-30% coinsurance per item (Out-of-Network)
Diabetes supplies	0-20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)	30% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	30% coinsurance per item (Out-of-Network)

---

Medicare Part B Drugs

Chemotherapy	30% coinsurance (Out-of-Network)
Chemotherapy	20% coinsurance
Other Part B drugs	20% coinsurance
Other Part B drugs	30% coinsurance (Out-of-Network)

---

Mental Health Services

Inpatient hospital - psychiatric	$1,763 per stay
Inpatient hospital - psychiatric	30% per stay (Out-of-Network)
Outpatient group therapy visit	30% coinsurance (Out-of-Network)
Outpatient group therapy visit	$0-40 copay
Outpatient group therapy visit with a psychiatrist	30% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$0-40 copay
Outpatient individual therapy visit	30% coinsurance (Out-of-Network)
Outpatient individual therapy visit	$0-40 copay
Outpatient individual therapy visit with a psychiatrist	$0-40 copay
Outpatient individual therapy visit with a psychiatrist	30% coinsurance (Out-of-Network)

---

MOOP

$7,550 In and Out-of-network $7,550 In-network

---

Option

No

---

Optional supplemental benefits

No

---

Outpatient Hospital Coverage

30% coinsurance per visit (Out-of-Network)
$0-250 copay per visit

---

Preventive Care

$0 copay
0-30% coinsurance (Out-of-Network)

---

Preventive Dental

Cleaning	$0 copay
Cleaning	0-50% coinsurance (Out-of-Network)
Dental x-ray(s)	0-50% coinsurance (Out-of-Network)
Dental x-ray(s)	$0 copay
Fluoride treatment	Not covered
Oral exam	$0 copay
Oral exam	0-50% coinsurance (Out-of-Network)

---

Rehabilitation Services

Occupational therapy visit	$0-40 copay
Occupational therapy visit	30% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit	30% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit	$0-40 copay

---

Skilled Nursing Facility

30% per stay (Out-of-Network)
$0 per day for days 1 through 20 $178 per day for days 21 through 100

---

Transportation

Not covered

---

Vision

Contact lenses	$0 copay (Out-of-Network)
Contact lenses	$0 copay
Eyeglass frames	$0 copay
Eyeglass frames	$0 copay (Out-of-Network)
Eyeglass lenses	$0 copay
Eyeglass lenses	$0 copay (Out-of-Network)
Eyeglasses (frames and lenses)	$0 copay
Eyeglasses (frames and lenses)	$0 copay (Out-of-Network)
Other	Not covered
Routine eye exam	$0 copay
Routine eye exam	30% coinsurance (Out-of-Network)
Upgrades	$0 copay
Upgrades	$0 copay (Out-of-Network)

---

Wellness Programs (e.g. fitness nursing hotline)

Covered

Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

Coverage Area for CarePartners Access (PPO)

(Click county to compare all available Advantage plans)

Go to top

Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.