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CarePartners of CT CareAdvantage Preferred (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for CarePartners of CT CareAdvantage Preferred (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on CarePartners of CT CareAdvantage Preferred (HMO) in 2026, please refer to our full plan details page.
CarePartners of CT CareAdvantage Preferred (HMO) is a HMO 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 3.5 out of 5 stars in 2026.
It's important to know that CarePartners of CT CareAdvantage Preferred (HMO) 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 of CT CareAdvantage Preferred (HMO).
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 of CT CareAdvantage Preferred (HMO), 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 a $450.00 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 Maximum Out-Of-Pocket cost of $6750.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 of CT CareAdvantage Preferred (HMO) plan has an annual drug deductible of $450. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or standard mail order, while standard pharmacies charge a $5 copay for a one-month supply. Tier 2 generic drugs cost as little as a $2 copay for a one-month supply at preferred pharmacies, and Tier 6 vaccines are covered with no copay at both preferred and standard pharmacies. Higher-tier medications are subject to coinsurance rather than flat copays under this plan. Tier 3 preferred brand drugs carry a 20% coinsurance, and Tier 4 non-preferred drugs require 25% coinsurance across preferred, standard, and mail-order options. Specialty drugs in Tier 5 have a 26% coinsurance for a one-month supply at all participating pharmacies.
Additional Benefits
The CarePartners of CT CareAdvantage Preferred (HMO) plan offers comprehensive medical coverage with no copay for primary care physician visits and a $15 to $55 copay for specialist visits. Inpatient hospital stays require a $395 daily copay for the first few days followed by no copay, while outpatient hospital services feature a copay ranging from no copay up to $350. Emergency care is available with a $130 copay, which is waived if admitted, and urgent care carries a $50 copay. For specialized care, members benefit from no copay for routine hearing exams and over-the-counter hearing aids, while routine eye exams feature a copay ranging from no copay to $45. Vision benefits also include up to $300 annually for eyewear with no copay, and dental care features no copay for cleanings under a $2,000 annual limit. Additionally, home health services and the first 20 days of skilled nursing facility care are provided with no copay.
Inpatient Hospital See details
Inpatient hospital care is covered by CarePartners of CT CareAdvantage Preferred (HMO) with no coinsurance, featuring a $395 daily copay for days 1 to 6 of acute stays and days 1 to 5 of psychiatric stays, followed by no copay for subsequent days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered under this benefit.
Outpatient Services See details
CarePartners of CT CareAdvantage Preferred (HMO) covers outpatient services with no coinsurance, featuring a $0 to $350 copay for outpatient hospital services and a $350 copay per stay for observation services. Ambulatory surgical center and blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $40 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the CarePartners of CT CareAdvantage Preferred (HMO) plan with no copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by CarePartners of CT CareAdvantage Preferred (HMO), with ground and air ambulance services requiring a $300 copay and no coinsurance. Prior authorization is required for ambulance services, and while some transportation services are covered, trips to plan-approved health-related locations and any other health-related locations are not covered.
Emergency Services See details
CarePartners of CT CareAdvantage Preferred (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within one day. Urgently needed services require a $50 copay with no coinsurance, while worldwide emergency services are covered with no coinsurance and copays of $130 for emergency care, $50 for urgent care, and $300 for emergency transportation.
Primary Care See details
CarePartners of CT CareAdvantage Preferred (HMO) partially covers primary care services with no coinsurance, offering no copay for primary care physician visits and copays ranging from $15 to $55 for specialists, chiropractors, and therapists. While most primary care benefits are included, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by CarePartners of CT CareAdvantage Preferred (HMO), with most core services like annual physical exams and kidney disease education requiring no copay and no coinsurance. While some covered benefits require cost-sharing, such as a 20% coinsurance for home safety devices and a $30 copay for EKGs, several options are not covered, including personal emergency response systems, post-discharge medication reconciliation, readmission prevention, adult day health, home-based palliative care, in-home support, caregiver support, additional tobacco cessation counseling, enhanced disease management, telemonitoring, remote access technologies, and counseling services.
Hearing Services See details
CarePartners of CT CareAdvantage Preferred (HMO) covers Medicare-covered hearing exams for a $45 copay and routine exams or fittings with no copay, with no coinsurance required for either. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $250 to $1,150—excluding inner ear, outer ear, and over-the-ear types—while over-the-counter (OTC) hearing aids are covered with no copay and no coinsurance.
Vision Services See details
CarePartners of CT CareAdvantage Preferred (HMO) offers partially covered vision services, including one routine eye exam annually with a $0 to $45 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing up to a $300 annual maximum for contacts, lenses, frames, and upgrades.
Dental Services See details
CarePartners of CT CareAdvantage Preferred (HMO) offers partially covered dental services with a deductible and a $2,000 annual limit. Medicare-covered dental requires a $45 copay and no coinsurance, while other covered services have no copay and coinsurance ranging from 0% to 50% (including no coinsurance for cleanings and fluoride). Non-covered services include other diagnostic, other preventive, maxillofacial prosthetics, implants, and orthodontics.
Home Infusion bundled Services See details
CarePartners of CT CareAdvantage Preferred (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
CarePartners of CT CareAdvantage Preferred (HMO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by CarePartners of CT CareAdvantage Preferred (HMO) with no copays, though prior authorization is required for these services. Members will pay a 20% coinsurance for durable medical equipment, prosthetics, and diabetic footwear, while diabetic and medical supplies carry a coinsurance ranging from 0% (no coinsurance) to 20%.
Diagnostic and Radiological Services See details
CarePartners of CT CareAdvantage Preferred (HMO) covers diagnostic services with no coinsurance and copays ranging from no copay for lab services up to $55 for tests. Radiological services require prior authorization and feature no copay for outpatient X-rays, a minimum $60 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
CarePartners of CT CareAdvantage Preferred (HMO) covers home health services with no copay and no coinsurance. Prior authorization and a referral are required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the CarePartners of CT CareAdvantage Preferred (HMO) plan. While the plan technically indicates some services are covered with no copay and no coinsurance, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
CarePartners of CT CareAdvantage Preferred (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
CarePartners of CT CareAdvantage Preferred (HMO) offers partial coverage for other services, featuring acupuncture and over-the-counter items with no copay and no coinsurance. Meal benefits and other additional services are not covered under this plan.
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