CCA Senior Care Options: Guide to Benefits

If you or a loved one is 65+ with both Medicare and MassHealth (Medicaid) in Massachusetts, Commonwealth Care Alliance’s Senior Care Options (SCO) plan is designed to bring your benefits under one roof—with a care team that coordinates your medical, pharmacy, behavioral health, and long-term supports. In simple terms: one plan, one card, and help navigating care so you can focus on living well.

This article is based on the official CCA Senior Care Options (SCO) 2025 Summary of Benefits PDF. It breaks down the detailed information in the document into an easy-to-understand guide so seniors and families in Massachusetts can quickly see what’s covered, what’s free, and how CCA SCO supports everyday health and independence.

What is CCA Senior Care Options (SCO)?

CCA SCO is a special type of plan that contracts with both Medicare and MassHealth. It’s for people age 65 and older who have Medicare and MassHealth Standard and no other comprehensive health insurance. It’s built around a network of doctors, hospitals, pharmacies, long-term services and supports (LTSS) providers—and care coordinators who help you manage it all.

In the plan, Long-term Services and Supports (LTSS) means help with everyday tasks like bathing, dressing, toileting, cooking, and taking medicine, usually at home or in the community.

Read: ADLs and IADLs Explained: Why They Matter for Senior Care

Who qualifies and where is it available?

Eligibility: 65+, enrolled in Medicare and MassHealth Standard (Medicaid), and not covered by any other comprehensive health insurance.
Service Area: CCA SCO is available across many MA counties (e.g., Bristol, Essex, Franklin, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk, Worcester).
Premiums & Deductibles: Members with MassHealth do not pay monthly plan premiums or deductibles (including the Part B premium).

Headline savings most people care about

$0 for most medical care. In 2025, CCA SCO lists a $0 cost share for things like:

Emergency room and urgent care: $0; you can get emergency care anywhere in the U.S. (urgent care can be out-of-network if you can’t get to a network provider).
Inpatient/outpatient hospital & surgeries: $0 (with some prior authorization rules).
Doctor visits, wellness & preventive care: $0 preventive screenings and wellness visits.
Imaging, labs, and tests: $0 (some advanced tests may require prior authorization; labs generally don’t, except genetic testing).

$0 prescription drugs. Tiers 1–5 (from preferred generics to specialty drugs) show $0 for a 31-day supply; many non-specialty prescriptions can be filled as 100-day supplies at $0 via mail order or retail. (Quantity limits and prior authorizations can apply.)

Telehealth through network providers or Teladoc for general medical issues (flu, allergies, rash, sore throat, etc.) is $0 and available 24/7 by phone or video.

Urgent Care at Home (instED®)

instED® brings urgent care to you—fully covered by your CCA plan. After a quick nurse triage by phone, a trained paramedic can treat many urgent issues in your home (examples: UTI symptoms, flu-like illness, sinus/bronchitis, asthma/wheezing, dizziness, minor skin/wound infections, nausea/vomiting). Availability varies by area. For life-threatening emergencies, call 911.

Everyday benefits that make life easier

1) Transportation: medical and non-medical rides

Medical rides to approved appointments (taxi or chair car) up to 50 miles each way are $0 when you use the plan’s transportation vendor.
Non-medical rides (like groceries, church, community events) are also $0—up to 10 one-way trips per month, up to 50 miles each way, using the approved vendor.

2) Healthy Savings Card — $475/quarter (SCO only)

Get $475 every quarter for plan-covered OTC items; qualifying SSBCI members may use it for utilities and plan-covered food. Use the card at participating retailers such as CVS, Walgreens, Walmart/Walmart.com, Stop & Shop, Star Market, Shaw’s, Rite Aid, Dollar General, H Mart, Hannaford, Price Chopper, PriceRite, Save-A-Lot, plus many independent pharmacies and markets. Retailers can change—check the NationsBenefits portal for the latest list.
Heads-up: materials note additional chains targeted for 2026 (e.g., Sam’s Club, Food Lion, Wegmans, PrimeRx)—subject to change.

3) Fitness and healthy aging

Gym membership via Silver&Fit® at a standard network facility, $0 (one facility per month).
Fit at Home, one home fitness kit/year, and Healthy Aging Coaching (remote sessions that guide activity, nutrition, lifestyle, aging well, condition management).
Annual Wellness Visit Reward: after you complete your annual wellness visit or annual physical, a $25 reward is added to your Healthy Savings Card. (Routine follow-ups don’t count.)

4) Dental, vision, and hearing

Dental:

Preventive care (cleanings, fluoride, periodic oral evaluation) is $0.
Restorative & emergency care (diagnostic exams, X-rays, fillings, deep cleanings, crowns, complete/partial dentures) are $0; some services may need prior authorization.
Periodontics: deep cleaning 1x/24 months; maintenance 1x/3 months (medically necessary gum surgery requires prior authorization).
Prosthodontics: dentures 1x/60 months without prior auth; implants may be covered with limits and prior authorization. Use a CCA network dental provider.

Vision:

Eye exam: routine annual eye exam $0 with participating VSP provider (diagnostic/non-routine exams may require prior authorization).
Eyewear allowance: $350 per calendar year for eyeglasses or contacts (frames/lenses/upgrades); one frames-and-lenses replacement allowed every 24 months. Must use participating VSP provider for the $350 allowance.

Hearing:

Hearing exams $0 (use CCA plan provider for non-routine; NationsHearing for routine).
Hearing aids: $0; up to $500 per aid, per ear, per calendar year; prior authorization required if an aid costs more than $500. (Use NationsHearing for routine.)

5) Behavioral health, substance use, palliative care

Behavioral health outpatient services are $0 (some advanced treatments—like TMS or esketamine—require prior authorization). Inpatient behavioral health is $0 but generally requires prior authorization (emergency and inpatient SUD admissions excepted).
Substance use disorder services are $0 with network providers (no prior authorization).
Palliative Care (Life Choices): $0 services focused on quality of life for serious illness; no prior authorization when provided by the program or a network provider.

6) Support for living at home (and higher-level settings when needed)

Home health and Personal Care Attendant (PCA) services support independent living at $0 (with prior authorization).
Adult Foster Care (AFC) and Group Adult Foster Care (GAFC) are covered at $0 (prior authorization required).
Skilled nursing/nursing home care is covered at $0 (prior authorization required; if MassHealth assigns a Patient Paid Amount for custodial care, you must pay that portion).

7) Durable medical equipment & rehab

DME such as wheelchairs, walkers, oxygen, and nebulizers is $0 (usually requires prior authorization).
Rehabilitation (PT/OT/ST) is $0; prior authorization kicks in after 20 OT/PT visits and 35 speech therapy visits.

8) Worldwide emergency coverage

Traveling? The plan covers emergency services, emergency transportation, and urgently needed care outside the U.S. up to a $100,000 maximum for all services combined.

How CCA helps coordinate your care

A major advantage of SCO is coordination. If a needed service isn’t available in-network, CCA SCO will pay for an out-of-network provider so you can still get what you need. The plan also explains when prior authorization is required and when it is not (e.g., no prior auth for emergency/urgent care; prior auth for certain planned services or DME).

What about the fine print?

A few friendly reminders to set expectations:

The Summary of Benefits is not the full contract. For a complete description and rules, read your Evidence of Coverage (EOC).
Enrollment depends on contract renewal, as with all Medicare-Medicaid plans.
The OTC/Healthy Savings allowance doesn’t roll over to the next quarter; for food and utility flexibility, you must meet SSBCI criteria (certain chronic conditions, and other restrictions apply).
Use network partners where required (e.g., VSP for routine vision allowance, NationsHearing for routine hearing).
Always check whether a service needs prior authorization before you schedule it; many day-to-day services don’t, but certain procedures and equipment do.

Why many Massachusetts seniors like CCA SCO

Simple costs: A $0 label appears again and again—hospital stays, doctor visits, ER/urgent care, imaging/labs, drugs (all tiers), telehealth, rides, dental/vision/hearing basics, home support, and more. That consistency reduces surprise bills and helps you budget.
Help to stay independent: With LTSS, home health/PCA, transportation, DME, AFC/GAFC, and rehab, the plan scaffolds daily life so you can remain safely at home as long as possible.
Wellness extras that add up: The quarterly OTC allowance (with optional food/utilities for SSBCI members), fitness memberships and kits, and a small wellness visit reward make healthy habits easier—and cheaper.
Access when you need it, where you are: $0 ER/urgent care nationwide, Teladoc 24/7, and up to $100,000 for emergencies abroad.
Clear dental/vision/hearing: Coverage is spelled out with allowances and frequency limits, so you can plan cleanings, glasses/contacts, and hearing aids with fewer surprises.

FAQ: Frequently asked “Is this covered?” moments (short answers)

▶Can I get rides to the grocery store or church?

Yes—10 one-way trips/month, up to 50 miles each way, $0, via the plan’s vendor.

▶Do my prescriptions really cost $0?

The Summary shows $0 for all tiers; check the drug list for limitations or prior auth. Many non-specialty meds allow 100-day supplies at $0.

▶What if my specialist isn’t in network?

If the plan can’t provide a needed service in-network, it will pay for an out-of-network provider.

▶Can I see a doctor online at night?

Yes—Teladoc is 24/7 for common issues, $0.

▶Is there help if I’m seriously ill?

Yes—Palliative Care (Life Choices) at $0 focuses on comfort and quality of life.

▶Does the plan help with food or utility bills?

Possibly—SSBCI-approved members can direct their $475 quarterly allowance toward covered food and utilities. Not everyone qualifies.

Bottom line

CCA Senior Care Options aims to simplify care and lower costs for Massachusetts seniors with Medicare + MassHealth. If you value $0 routine care and drugs, no-cost rides, a generous OTC card, and comprehensive support to live at home, this plan’s 2025 benefits are hard to overlook. Always review your personal needs, check provider participation, and confirm any prior authorization rules before scheduling services.

Disclaimer

This article summarizes the CCA Senior Care Options (HMO D-SNP) 2025 Summary of Benefits and is not a complete description of coverage. Benefits, limitations, service areas, provider networks, and prior authorization requirements apply. Refer to the official Evidence of Coverage (EOC) for full details. Enrollment depends on contract renewal.

We cannot guarantee that this review fully reflects the exact benefits of CCA Senior Care Options. Actual coverage and benefits may differ based on your personal situation and plan details. We do not take responsibility for discrepancies. Please contact Commonwealth Care Alliance (CCA) directly if you have any questions about your coverage.

For official information or a copy of the EOC, contact CCA Member Services at 866-610-2273 (TTY 711) or visit ccama.org/sco.

Sources: CCA Senior Care Options (HMO D-SNP) Summary of Benefits 2025.
Key excerpts cited throughout: plan definition and coordination (FAQ), eligibility and costs, transportation (medical and non-medical), OTC/SSBCI allowance, fitness benefits, dental/vision/hearing details, behavioral health and SUD coverage, palliative care, DME/rehab, telehealth, emergency/urgent care, and worldwide coverage.

CCA Senior Care Options, Senior Education

Review the Benefits of CCA Senior Care Options (SCO) in Massachusetts