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CarePartners Access (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for CarePartners Access (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on CarePartners Access (PPO) in 2026, please refer to our full plan details page.
CarePartners Access (PPO) is a PPO plan offered by Point32Health, Inc. available for enrollment in 2025 to people living in All Counties Except Fairfield County. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that CarePartners Access (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about CarePartners Access (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For CarePartners Access (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan has a $250.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $550.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $10100.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10100.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The CarePartners Access (PPO) Medicare plan features an annual drug deductible of $550. Under this plan, Tier 1 preferred generic drugs have no copay when filled at a preferred pharmacy or through standard mail order, while standard pharmacies charge a $5 copay for a one-month supply. Tier 2 generic drugs require a low $2 copay for a one-month supply at preferred pharmacies and standard mail order, compared to a $12 copay at standard pharmacies. For brand-name and specialty medications, the plan transitions from flat copays to percentage-based cost sharing. Members pay a 20% coinsurance for Tier 3 preferred brand drugs and a 25% coinsurance for Tier 4 non-preferred drugs and Tier 5 specialty drugs. Additionally, Tier 6 vaccines are covered with no copay at both preferred and standard pharmacies.
Additional Benefits
CarePartners Access (PPO) offers comprehensive medical coverage with affordable out-of-pocket costs, including no copay and no coinsurance for primary care visits and routine preventive services. Specialist visits require a $55 copay, while inpatient hospital stays have a daily copay of $485 for the first five days and no copay for subsequent days. Emergency room visits carry a $115 copay, which is waived if you are admitted, and outpatient hospital services range from no copay to a $435 copay. This plan also features strong supplemental benefits, including no copay for routine vision and dental services, alongside a $250 annual eyewear allowance and a $750 maximum benefit for non-Medicare dental care. Routine hearing exams and over-the-counter items are available with no copay, while durable medical equipment and dialysis services generally require a 20% coinsurance. Prescription hearing aids are covered with copays ranging from $250 to $1,150, helping you easily manage your specialized healthcare expenses.
Inpatient Hospital See details
Inpatient hospital services are covered by CarePartners Access (PPO) with no coinsurance, requiring prior authorization for acute stays. For acute care, there is a $485 daily copay for days 1 through 5 and no copay for days 6 and beyond, while psychiatric stays have a $395 daily copay for days 1 through 5 and no copay for days 6 through 90. Upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
CarePartners Access (PPO) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services have a copay ranging from no copay to $435, observation services require a $435 copay per stay, and outpatient substance abuse sessions have a $40 copay.
Partial Hospitalization See details
Partial hospitalization is covered by CarePartners Access (PPO) with no copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by CarePartners Access (PPO), with ground and air ambulance services requiring a $325 copay and no coinsurance, subject to prior authorization. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
CarePartners Access (PPO) covers emergency services with a $115 copay (waived if admitted to the hospital within one day) and no coinsurance, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $115, $40, and $325 respectively.
Primary Care See details
CarePartners Access (PPO) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $55 copay and no coinsurance. Other covered benefits like physical therapy, chiropractic, and mental health services feature copays ranging from $0 to $55 with no coinsurance, though podiatry and routine chiropractic services are not covered.
Preventive Services See details
CarePartners Access (PPO) preventive services feature no copay and no coinsurance for annual physicals, kidney disease education, and Medicare-covered preventive services, while home safety devices require a 20% coinsurance and no copay, and an EKG after a welcome visit has a $40 copay and no coinsurance. Additional preventive benefits are partially covered, excluding health education, PERS, medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, and counseling.
Hearing Services See details
Hearing services are partially covered by CarePartners Access (PPO), featuring hearing exams with a $45 copay (no copay for routine exams) and OTC hearing aids with no copay, both with no coinsurance. Prescription hearing aids are partially covered with copays ranging from $250 to $1,150 and no coinsurance, though inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
CarePartners Access (PPO) provides partially covered vision services, featuring eye exams with no coinsurance and a copay ranging from no copay for a routine annual exam up to $45, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, offering up to a $250 annual combined limit for contacts, lenses, frames, and upgrades.
Dental Services See details
CarePartners Access (PPO) covers Medicare-covered dental services with a $45 copay and no coinsurance, while other preventive and comprehensive dental services are covered with no copay and no coinsurance. A combined annual maximum benefit of $750 applies to both in-network and out-of-network non-Medicare dental services, including cleanings, exams, and orthodontics.
Home Infusion bundled Services See details
CarePartners Access (PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other Part B drugs require a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the CarePartners Access (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by CarePartners Access (PPO) with no copay, although prior authorization is required. Covered durable medical equipment, prosthetics, and diabetic therapeutic shoes carry a 20% coinsurance, while medical and diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
CarePartners Access (PPO) covers diagnostic and radiological services, with prior authorization required for both. Diagnostic services require no coinsurance, featuring no copay for lab services and a $0 to $55 copay for diagnostic tests, while radiological services range from no copay for X-rays to a minimum $60 copay for diagnostic radiology and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
CarePartners Access (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
CarePartners Access (PPO) covers cardiac rehabilitation services with no copay and no coinsurance, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice.
Skilled Nursing Facility (SNF) See details
CarePartners Access (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Other Services under CarePartners Access (PPO) are partially covered, offering over-the-counter (OTC) items with no copay and no coinsurance, which includes coverage for nicotine replacement therapy and naloxone. Acupuncture, meal benefits, and other miscellaneous services in this category are not covered.
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