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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 2025, 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 3 out of 5 stars in 2025.
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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $9550.00 (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 $9550.00 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:
Sign up for CarePartners Access (PPO)
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Drug Coverage
The CarePartners Access (PPO) plan has no deductible for prescription drugs. In the initial coverage phase, you'll pay a $5 copay for preferred generic drugs at preferred pharmacies, and 25% coinsurance for standard generic drugs. For preferred brand drugs, you'll pay 50% coinsurance, while non-preferred drugs have a 33% coinsurance. The specialty tier drugs have no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The CarePartners Access (PPO) plan offers a variety of benefits, including inpatient and outpatient hospital care, with copays ranging from $0 to $395 depending on the specific service. Emergency, urgent, and worldwide emergency services have copays between $40 and $325. Primary care, preventive, hearing, vision, and dental services are also covered, with varying copays and maximum benefits for certain services like eyewear and dental. Additional benefits include ambulance services with a $325 copay, home health services with no copay, and home infusion with copays and coinsurance depending on the type of drug. The plan covers diagnostic and radiological services, dialysis services with a 20% coinsurance, and medical equipment with a 0-20% coinsurance. Other services such as acupuncture and over-the-counter items are also covered, with specific limitations on coverage for some services.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care. For Inpatient Hospital-Acute, you will pay a $395 copay for days 1-5, and no copay for days 6-90. Inpatient Hospital Psychiatric has the same cost sharing, with a $395 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered by CarePartners Access (PPO). Outpatient Hospital Services have a copay between $0 and $395, while Observation Services have a copay of $395. Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Substance Abuse services have a copay of $20 for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the CarePartners Access (PPO) plan. There is no additional information about the cost of this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the CarePartners Access (PPO) plan. Ground and Air Ambulance Services each have a $325 copay, with no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the CarePartners Access (PPO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $40 copay, but there is no coinsurance for either. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $40 copay, and Worldwide Emergency Transportation has a $325 copay.
Primary Care See details
CarePartners Access (PPO) covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $30 copay, physician specialist services with a $45 copay, mental health specialty services with a $0-$20 copay, other health care professional services with a $0-$45 copay, psychiatric services with a $0-$20 copay, physical therapy and speech-language pathology services with a $30 copay, additional telehealth benefits with a $0-$395 copay, and opioid treatment program services with a $20 copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, annual physical exams, health education, medical nutrition therapy, wigs for chemotherapy-related hair loss, alternative therapies, therapeutic massage, nutritional/dietary benefits, fitness benefits, home and bathroom safety devices, kidney disease education, and other preventive services. Additional Preventive Services may have a coinsurance, while EKG following Welcome Visit has a $40 copay.
Hearing Services See details
CarePartners Access (PPO) covers hearing exams with a $45 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. The plan also covers OTC hearing aids with a maximum benefit of $102 every three months. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
CarePartners Access (PPO) covers vision services, including eye exams with a copay between $0 and $45, and eyewear with a combined maximum benefit of $250 every year. Routine eye exams have no copay, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services are covered, including Medicare dental services with a $45 copay. Other dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics, are also covered. This plan has a maximum benefit of $1500 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the CarePartners Access (PPO) plan. You will pay a 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetics/Medical Supplies with a 0-20% coinsurance, and Diabetic Equipment with varying coinsurance based on the specific service. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $45, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $60 and $150, and Therapeutic Radiological Services have a 20% coinsurance. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the CarePartners Access (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the CarePartners Access (PPO) plan. Specifically, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the CarePartners Access (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $203 per day; additional days beyond Medicare-covered SNF stays, and non-Medicare-covered stays, are not covered.
Other Services See details
Other Services includes acupuncture, which is covered with no limitations on the number of treatments, and Over-the-Counter (OTC) items, which have a maximum benefit coverage amount of $102 every three months. Other 1 includes medical stockings and sleeves, which have a 20% coinsurance. Other services such as meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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