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CCHP Senior Program (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for CCHP Senior Program (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on CCHP Senior Program (HMO) in 2026, please refer to our full plan details page.
CCHP Senior Program (HMO) is a HMO plan offered by Chinese Hospital Association available for enrollment in 2025 to people living in Counties: SF, SM. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that CCHP Senior Program (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 CCHP Senior Program (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 CCHP Senior Program (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $21.00. 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 $3000.00 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 CCHP Senior Program (HMO) offers an enhanced alternative drug plan with no prescription drug deductible, meaning your coverage begins immediately. During the initial coverage phase, you will pay no copay for Tier 1 preferred generic drugs at preferred pharmacies, or a $7 copay at standard pharmacies. Tier 2 standard generic drugs carry a $45 copay, while Tier 3 preferred brand drugs require a $100 copay at both preferred and standard pharmacies. For Tier 4 non-preferred drugs, you will pay a 33% coinsurance across preferred, standard, and standard mail options. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs.
Additional Benefits
The CCHP Senior Program (HMO) provides robust coverage for essential medical needs with predictable out-of-pocket costs. Members enjoy no copay and no coinsurance for acute inpatient hospital stays and the first 20 days of skilled nursing facility care. For outpatient care, expect copays ranging from $100 to $310 for hospital services, a $265 copay for ambulance services, and a $90 copay for emergency visits, all with no coinsurance. Routine wellness benefits are highly accessible, featuring no copay and no coinsurance for preventive care and cardiac rehabilitation services. Routine dental, vision, and hearing exams require a low $20 copay, while prescription hearing aids carry copays between $600 and $2,075. Additionally, the plan offers up to 12 round-trip transportation rides per year to approved locations and a $30 monthly reimbursement for over-the-counter items.
Inpatient Hospital See details
CCHP Senior Program (HMO) provides partially covered inpatient hospital benefits with no coinsurance, featuring no copay for acute care stays and a $250 copay per day for the first 7 days of psychiatric stays, followed by no copay for days 8 to 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered under this plan.
Outpatient Services See details
CCHP Senior Program (HMO) covers outpatient services with no coinsurance, featuring copays of $100 to $310 for hospital and observation services, $300 for ambulatory surgical center visits, and $15 for substance abuse sessions. Most of these covered outpatient services require prior authorization and a doctor referral.
Partial Hospitalization See details
CCHP Senior Program (HMO) covers partial hospitalization benefits, though patients will need to obtain prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by CCHP Senior Program (HMO), with ground and air ambulance services requiring a $265 copay and no coinsurance. Transportation services are partially covered, offering up to 12 round trips per year to plan-approved health-related locations, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by the CCHP Senior Program (HMO) with a $90 copay and no coinsurance, while urgently needed services require a $45 copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $25,000 maximum with a $90 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Primary Care benefits are partially covered by the CCHP Senior Program (HMO), as podiatry services and routine chiropractic care are not covered. Covered services such as occupational therapy, physical therapy, and mental health specialty services require a $15 copay and no coinsurance.
Preventive Services See details
Preventive services are partially covered by CCHP Senior Program (HMO) with no copay and no coinsurance, though certain services require prior authorization and a doctor referral. Excluded sub-services include in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by the CCHP Senior Program (HMO) with a $20 copay and no coinsurance for exams and fittings, and a copay of $600 to $2,075 with no coinsurance for general prescription hearing aids. OTC hearing aids, alongside inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision Services are partially covered by CCHP Senior Program (HMO), which offers annual routine eye exams for a $20 copay and no coinsurance. Eyewear is covered up to a $150 limit every two years with no copay or coinsurance, though individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
CCHP Senior Program (HMO) partially covers dental services with no coinsurance, though fluoride treatments, maxillofacial prosthetics, and implant services are not covered. Medicare-covered dental services require a $20 copay, while other covered services range from no copay up to a $55 copay, with some comprehensive benefits offered as optional supplemental coverage.
Home Infusion bundled Services See details
Home infusion bundled services are covered by CCHP Senior Program (HMO) with prior authorization and step therapy guidelines. Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and coinsurance ranging from 0% to 20%.
Dialysis Services See details
CCHP Senior Program (HMO) covers dialysis services with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required to receive these covered services.
Medical Equipment See details
CCHP Senior Program (HMO) partially covers medical equipment, requiring a 20% coinsurance and no copay for durable medical equipment, prosthetic devices, and medical supplies. Diabetic supplies and diabetic therapeutic shoes or inserts are not covered by this plan, and prior authorization is required for covered equipment.
Diagnostic and Radiological Services See details
CCHP Senior Program (HMO) partially covers diagnostic and radiological services, requiring prior authorization and doctor referrals for all services. Diagnostic radiological services require a $200 copay and therapeutic radiological services carry a 20% coinsurance, while diagnostic procedures, lab services, and outpatient X-rays are not covered.
Home Health Services See details
Home Health Services are covered by CCHP Senior Program (HMO), requiring a doctor referral and prior authorization. Copay and coinsurance details for these services are not specified in the plan benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by CCHP Senior Program (HMO) with no copay and no coinsurance, but only some services are covered as Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered. Prior authorization and a doctor referral are required for these services.
Skilled Nursing Facility (SNF) See details
CCHP Senior Program (HMO) covers skilled nursing facility (SNF) services with no copay for days 1 through 20, a $110 daily copay for days 21 through 100, and no coinsurance. This benefit is partially covered because additional days beyond the Medicare-covered limit are not covered, and services require prior authorization and a doctor referral.
Other Services See details
Other Services under the CCHP Senior Program (HMO) are partially covered, as meal benefits and dual-eligible SNP services are not covered. Covered benefits include unlimited acupuncture treatments with a doctor referral and a $30 monthly reimbursement for over-the-counter items, though specific copay and coinsurance details are not specified.
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