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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 2025, 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 2025.
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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4900.00 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 a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $5 copay at preferred pharmacies and a $15 copay at standard pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The CarePartners of CT CareAdvantage Preferred (HMO) plan offers a wide array of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services range from no copay to a $310 copay. Emergency services and ambulance services also have copays. This plan provides coverage for primary care with no copay, along with hearing, vision, and dental services with copays or coinsurance. Additional benefits include home health services, and skilled nursing facility services with varying copays. The plan also includes coverage for a variety of other services, such as medical equipment and diagnostic services, with different copays and coinsurance amounts.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a copay of $395 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 are covered, including outpatient hospital services with a copay between $0 and $310, observation services with a $310 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services and outpatient blood services are also covered, with individual and group sessions for outpatient substance abuse costing a $20 copay.
Partial Hospitalization See details
Partial Hospitalization benefits are covered by the CarePartners of CT CareAdvantage Preferred (HMO) plan. The plan covers partial hospitalization, but does not specify the costs associated with this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by CarePartners of CT CareAdvantage Preferred (HMO). This includes both ground and air ambulance services, each with a $300 copay and no coinsurance, but 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. Emergency Services have a $125 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $40 copay, and Worldwide Emergency Transportation has a $300 copay.
Primary Care See details
CarePartners of CT CareAdvantage Preferred (HMO) covers primary care physician services with no copay, and chiropractic services with a $20 copay. The plan also covers other services such as occupational therapy, physician specialist services, and mental health services, with copays ranging from $0 to $45.
Preventive Services See details
Preventive Services are covered, including annual physical exams, additional preventive services, and other preventive services. Other preventive services include services such as glaucoma screening, which has a copay, while EKG following a Welcome Visit has a $30 copay.
Hearing Services See details
Hearing Services includes coverage for hearing exams with a $45 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with a copay between $250 and $1150, while inner ear, outer ear, and over the ear prescription hearing aids are not covered; OTC hearing aids are covered.
Vision Services See details
The CarePartners of CT CareAdvantage Preferred (HMO) plan covers vision services, including eye exams with a copay of $15-$45. Eyewear is covered, with a combined maximum benefit of $300 per year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames.
Dental Services See details
The CarePartners of CT CareAdvantage Preferred (HMO) plan covers dental services with a $3,000 annual maximum. Medicare dental services require prior authorization and a doctor's referral, with a $45 copay. Oral exams have a 0% - 20% coinsurance, and other services like dental x-rays, prophylaxis, and fluoride treatments are covered with varying limitations and coinsurance. Restorative, adjunctive general, endodontics, periodontics, prosthodontics, implant services, fixed prosthodontics, and oral and maxillofacial surgery are covered with 20% - 50% coinsurance. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the CarePartners of CT CareAdvantage Preferred (HMO) plan. Medicare Part B Insulin Drugs have a $35 copay, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the CarePartners of CT CareAdvantage Preferred (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with a 0-20% coinsurance. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a copay for diagnostic procedures/tests ranging from $0 to $45, and no copay for lab services. Diagnostic Radiological Services have a copay between $60 and $150, while Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the CarePartners of CT CareAdvantage Preferred (HMO) plan with no copay or coinsurance, but Additional Hours of Care and Personal Care Services are not covered. This benefit requires both authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $203. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes acupuncture, over-the-counter (OTC) items, and other services. Acupuncture is covered, and OTC items are covered with a maximum benefit coverage of $140 every three months; this plan also offers nicotine replacement therapy and Naloxone coverage as a Part C OTC benefit. Other services include medical stockings and sleeves, covered with 20% coinsurance. 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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