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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 2025, 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 2.5 out of 5 stars in 2025.
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 $6700.00 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) has an enhanced alternative drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions. For preferred generic drugs, the copay is $7.00, and for standard generic drugs, the copay is $40.00. For preferred brand drugs, the copay is $60.00, and for non-preferred drugs, you pay 33% coinsurance.
Additional Benefits
The CCHP Senior Program (HMO) offers a variety of benefits to help cover your healthcare needs. The plan includes coverage for inpatient hospital stays, outpatient services, and emergency services, with copays varying depending on the service. Primary care, preventive, hearing, vision, and dental services are also included, with copays for exams and other services. Additional benefits offered by the plan include coverage for ambulance and transportation services, home infusion, dialysis, medical equipment, diagnostic and radiological services, home health services, cardiac rehabilitation, and skilled nursing facility stays. Some services, such as acupuncture and over-the-counter items, are also covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $100 copay for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, you will pay a $250 copay for days 1-7 and no copay for days 8-60. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services and observation services, are covered with a copay of $100-$310. Ambulatory Surgical Center services have a $300 copay, and outpatient substance abuse services have a copay of $15 for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered and requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and air ambulance services have a $265 copay, with no coinsurance. Transportation services to a plan-approved health-related location are covered for 12 round trips per year, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the CCHP Senior Program (HMO). Emergency Services and Worldwide Emergency Coverage have a $90 copay, while Urgently Needed Services have a $45 copay; there is no coinsurance for any of these services. Worldwide Emergency Transportation is not covered.
Primary Care See details
The CCHP Senior Program (HMO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $15 copay, while occupational therapy services, physician specialist services, individual and group mental health specialty services, individual and group psychiatric services, and physical therapy and speech-language pathology services all have a $15 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The CCHP Senior Program (HMO) plan covers preventive services, including annual physical exams, kidney disease education, and other preventive services like glaucoma screening and diabetes self-management training. Additional services such as in-home safety assessments, personal emergency response systems, and medical nutrition therapy are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with a $20 copay, and fitting/evaluation for hearing aids with no copay. Prescription Hearing Aids (all types) are covered, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with a $20 copay and routine eye exams with a $20 copay. Eyewear is covered with a combined maximum benefit of $150 every two years, and contact lenses and eyeglasses (lenses and frames) are covered. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a $20 copay, and other dental services including oral exams, dental x-rays, other diagnostic dental services, and prophylaxis (cleaning), each with 2 visits per year. Fluoride treatment, maxillofacial prosthetics, implant services, prosthodontics fixed, and orthodontics are not covered, and restorative services, endodontics, prosthodontics removable, oral and maxillofacial surgery are offered as an optional, supplemental benefit. Periodontics has a copay between $0 and $55.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the CCHP Senior Program (HMO) plan, requiring prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and no copay, while DME for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance and no copay. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, though Diagnostic Procedures/Tests and Lab Services are not covered. Diagnostic Radiological Services have a copay of at most $200, and Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the CCHP Senior Program (HMO) with no copay and no coinsurance, but require both authorization and referral. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the following sub-services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor's referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the CCHP Senior Program (HMO) plan, but require prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $110. Additional days beyond Medicare-covered SNF stays, and non-Medicare-covered SNF stays, are not covered.
Other Services See details
The CCHP Senior Program (HMO) covers acupuncture with a $5 copay, and over-the-counter items with a maximum benefit coverage amount of $40.00 every month. Meal benefit, Dual Eligible SNPs with Highly Integrated Services, 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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