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Champion Advantage (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Champion Advantage (HMO-POS C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Champion Advantage (HMO-POS C-SNP) in 2026, please refer to our full plan details page.
Champion Advantage (HMO-POS C-SNP) is a HMO-POS C-SNP plan offered by Champion Health Plans-USA, LLC. available for enrollment in 2025 to people living in Central & Southern California. The overall rating for this plan is not yet available for 2026.
It's important to know that Champion Advantage (HMO-POS C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Champion Advantage (HMO-POS C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Champion Advantage (HMO-POS C-SNP).
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 Champion Advantage (HMO-POS C-SNP), 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 combined Maximum Out-Of-Pocket cost of $499.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $499.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 Champion Advantage (HMO-POS C-SNP) plan features an Enhanced Alternative drug benefit with no prescription drug deductible. During the initial coverage phase, you pay standard pharmacy copays of $3.00 for preferred generics, $47.00 for standard generics, and $100.00 for preferred brand drugs until total drug costs reach $2,100.00. For other tiers at a standard pharmacy, Tier 4 non-preferred drugs require a 33% coinsurance, while Tier 5 specialty drugs have no copay. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase where you pay nothing for covered Medicare Part D prescriptions.
Additional Benefits
The Champion Advantage (HMO-POS C-SNP) plan offers comprehensive medical coverage with no copay or coinsurance for primary care and specialist visits. Members also pay no copay or coinsurance for many diagnostic tests, preventative services, and home health visits. For acute inpatient hospital stays and urgent care, there is no copay, while emergency room visits require a $150 copay. Vision and hearing exams are available with no copay, and the plan provides up to a $335 annual allowance for eyeglasses. Dental care features no copays for preventive services, though comprehensive dental has a 20% to 40% coinsurance up to a $3,000 limit. Additionally, the plan covers up to 24 annual one-way transportation trips to plan-approved locations at no cost to the member.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by Champion Advantage (HMO-POS C-SNP) with no coinsurance, requiring prior authorization and doctor referrals. Patients pay no copay for acute care, but psychiatric stays require a $100 daily copay for days 1 through 10 (no copay for days 11 through 90), while additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Champion Advantage (HMO-POS C-SNP) covers outpatient services with no coinsurance, requiring a $100 copay for outpatient hospital services and no copay for ambulatory surgical center, observation, outpatient substance abuse, and outpatient blood services. Prior authorization and doctor referrals are required for most of these covered outpatient benefits.
Partial Hospitalization See details
Champion Advantage (HMO-POS C-SNP) covers partial hospitalization benefits with no copay and no coinsurance. Prior authorization and a doctor referral are required to receive these covered services.
Ambulance and Transportation Services See details
Champion Advantage (HMO-POS C-SNP) partially covers ambulance and transportation services, as transportation to any health-related location is not covered. Ground ambulance services require a copay ranging from no copay to $125 with no coinsurance, air ambulance services require 20% coinsurance with no copay, and up to 24 annual one-way trips to plan-approved locations are covered with no copay or coinsurance.
Emergency Services See details
Champion Advantage (HMO-POS C-SNP) covers emergency services for a $150 copay and no coinsurance, and urgently needed services with no copay and no coinsurance. Worldwide emergency services are partially covered up to a $10,000 limit, as worldwide emergency transportation is not covered.
Primary Care See details
Primary Care benefits are partially covered by Champion Advantage (HMO-POS C-SNP) with no copay and no coinsurance for most services, including primary care and specialist visits. However, routine chiropractic care and podiatry services are not covered under this plan.
Preventive Services See details
Preventive services are partially covered by Champion Advantage (HMO-POS C-SNP) with no copay and no coinsurance for covered options like annual physicals, kidney disease education, and fitness benefits. However, sub-services such as in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, smoking cessation, disease management, telemonitoring, and counseling are not covered. Prior authorization is required for select covered services, including annual physical exams and kidney disease education.
Hearing Services See details
Champion Advantage (HMO-POS C-SNP) partially covers hearing services, offering routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids (all types) are covered with a $149 copay and no coinsurance, though OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by Champion Advantage (HMO-POS C-SNP), which offers routine eye exams and eyeglasses with no copay, deductible, or coinsurance up to a $335 annual limit. Contact lenses, eyeglass lenses, and eyeglass frames are not covered.
Dental Services See details
Champion Advantage (HMO-POS C-SNP) partially covers dental services with no copays, no coinsurance for Medicare dental, and 20% to 40% coinsurance for comprehensive services up to a $3,000 annual limit. While preventive care like cleanings and exams is covered, adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under Champion Advantage (HMO-POS C-SNP) with prior authorization, featuring a copay of no copay to $24 and no coinsurance for Medicare Part B insulin drugs. Other covered Part B chemotherapy, radiation, and miscellaneous drugs require no copay and carry a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered under the Champion Advantage (HMO-POS C-SNP) plan. Specific copay and coinsurance costs are not detailed in the plan's summary, so members should contact the plan provider to confirm their exact out-of-pocket expenses.
Medical Equipment See details
Champion Advantage (HMO-POS C-SNP) covers medical equipment, including durable medical equipment and prosthetics, with no copay and 0% to 20% coinsurance, subject to prior authorization. Diabetic supplies and therapeutic shoes or inserts are also covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Champion Advantage (HMO-POS C-SNP) with no copay and no coinsurance for diagnostic tests, lab services, therapeutic radiology, and outpatient X-rays. Diagnostic services require prior authorization and a doctor referral.
Home Health Services See details
Home Health Services are covered under Champion Advantage (HMO-POS C-SNP) with no copay and no coinsurance. Prior authorization and a doctor referral are required to access these services.
Cardiac Rehabilitation Services See details
Champion Advantage (HMO-POS C-SNP) provides Cardiac Rehabilitation Services where some services are covered, but specific sub-services—including Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services—are not covered. Because these services are not covered in practice, there is no copay or coinsurance coverage available for them under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by Champion Advantage (HMO-POS C-SNP) with no copay and no coinsurance for days 1 through 20, and a $218 daily copay and no coinsurance for days 21 through 100. Prior authorization and a doctor referral are required for these services, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered under the Champion Advantage (HMO-POS C-SNP) plan, as acupuncture, over-the-counter (OTC) items, meal benefits, and highly integrated dual eligible services are all excluded from coverage.
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