Benefits & Costs

You do not pay a monthly premium for your CareAdvantage benefits.**

There is no co-payment ($0) for covered medical services, vision services, and preventive/diagnostic dental services. There is a co-pay for non-preventive dental services ($10 to $20). Co-pays for your prescription drugs range from $0 to $6.50, depending on your income.

**Medicare Part B premium for CareAdvantage members (dual-eligibles) is covered by Medi-Cal.

Dental Co-pay

• $0 co-pay for routine cleaning/ x-rays
• $10 to $20 for non-preventive services

Comprehensive coverage includes preventive and restorative dentistry, oral surgery, root canals, dentures, partials, crowns and bridges.

Delta Dental

Call Delta Dental for Questions About Your Dental Benefits: 1-877-580-1042
Monday through Friday, 7:00 a.m. to 7:00 p.m.
TTY: 1-800-735-2922.

For a complete description of covered and not covered dental services, see pages 64 - 70 in the CareAdvantage Evidence of Coverage

Vision Co-pay - $0

Covers annual eye exam, glaucoma screening, and eye care services from an optometrist.

• Includes one free ($0) pair of eyeglasses with frames, or contact lenses (choose one)
• $150 cap every year

Taxi Rides Co-pay - $0

Schedule a Taxi Ride

To schedule a taxi ride for your medical and dental appointments, call 1-877-356-1080, TTY 800-735-2929, or dial 7-1-1

For pre-approval requirements and restrictions, see pages 71 - 72 in the CareAdvantage Evidence of Coverage

Prescriptions Co-pay - $0 to $6.50

You are covered for brand and generic medications prescribed by your doctor, drugs that are given to you while you are in a hospital or nursing facility, and drug injections related to dialysis and chemotherapy. Your co-pay depends on your income and drug payment stage.

For detailed information about drug payment stages and co-payments, see pages 95 - 96 in the CareAdvantage Evidence of Coverage

Preventive Services Co-pay - $0

Other Benefits

The Medical Benefits Chart on page 41 in the CareAdvantage Evidence of Coverage provides complete information on all benefits and covered services, including conditions for limitations and exclusions.

The Summary of Benefits is a chart with descriptions of some of the services covered, including co-pays.

2012 CareAdvantage Summary of Benefits

English	Spanish	Chinese	Russian	Tagalog