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Champion Select (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Champion Select (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 Select (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
Champion Select (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 2025.
It's important to know that Champion Select (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 Select (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 Select (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 Select (HMO-POS C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $13.20. 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 Select (HMO-POS C-SNP) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay 25% coinsurance for most drugs when using a standard pharmacy. The plan provides a $0 copay for specialty tier drugs when using a standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, and you will pay nothing for your Part D drugs.
Additional Benefits
The Champion Select (HMO-POS C-SNP) plan offers a wide range of benefits with varying cost-sharing. Many services, including primary care visits, preventive services, and home health services, come with no copay. The plan also covers inpatient hospital stays with no copay for the initial days, along with coverage for emergency services, ambulance services, and outpatient services. The plan includes coverage for hearing and vision services with no copays for exams, and a combined maximum benefit for eyewear. Dental services are covered up to a maximum, with some services requiring coinsurance. Additionally, the plan covers home infusion, medical equipment, diagnostic services, and skilled nursing facility stays.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization and a doctor's referral. For Inpatient Hospital-Acute, there is no copay for days 1-90. For Inpatient Hospital Psychiatric, the copay is $100 for days 1-10, no copay for days 11-60, and $329 for days 61-90. Additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a $100 copay, observation services with no copay, ambulatory surgical center services with no copay, and outpatient substance abuse services with no copay. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Champion Select (HMO-POS C-SNP) plan, with no copay required. Prior authorization and a doctor referral are required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Champion Select (HMO-POS C-SNP), with a copay of $0-$125 for ground ambulance services and a coinsurance of 0%-20% for air ambulance services. Transportation services to a plan-approved health-related location are covered for up to 100 one-way trips per year, and transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Champion Select (HMO-POS C-SNP) plan. Emergency Services has a $140 copay, and Urgently Needed Services has no copay; all have no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $10,000.
Primary Care See details
The Champion Select (HMO-POS C-SNP) plan offers primary care physician services, chiropractic services, physician specialist services, mental health specialty services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services with no copay. Occupational therapy services have a copay, and podiatry services are not covered.
Preventive Services See details
Preventive services, including Medicare-covered zero-dollar preventive services, are covered. An annual physical exam is covered with no copay, while the plan also covers additional preventive services such as health education, personal emergency response systems, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, all with no copay.
Hearing Services See details
The Champion Select (HMO-POS C-SNP) plan covers hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a $149 copay, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and neither are OTC hearing aids.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams and eyewear have no copay. Eyewear includes eyeglasses (lenses and frames) and upgrades, and has a combined maximum plan benefit of $335 every year. Contact lenses, eyeglass lenses, and eyeglass frames are not covered.
Dental Services See details
The Champion Select (HMO-POS C-SNP) plan covers dental services, with a maximum benefit of $3000 per year. Oral exams are covered with 2 visits allowed, and other dental services like dental x-rays, cleanings, fluoride treatments, and other preventive dental services are also covered with specific limitations. Restorative Services, Endodontics, Periodontics, Prosthodontics, removable, Maxillofacial Prosthetics, and Oral and Maxillofacial Surgery are covered with a coinsurance between 20% and 40%. However, Adjunctive General Services, Implant Services, Prosthodontics (fixed), and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Champion Select (HMO-POS C-SNP) plan and require prior authorization. Medicare Part B Insulin Drugs have a copay between $0 and $24, while Other Medicare Part B Drugs and Medicare Part B Chemotherapy/Radiation Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Champion Select (HMO-POS C-SNP) plan. The copay and coinsurance are not listed in the provided information.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment (DME), Prosthetics, and Medical Supplies, is covered by the Champion Select (HMO-POS C-SNP) plan. DME has a coinsurance between 0% and 20%, and no copay. Prosthetic Devices have a coinsurance between 0% and 20%, and Medical Supplies have a coinsurance between 0% and 20%. Diabetic equipment is also covered, with no copay for diabetic supplies and diabetic therapeutic shoes/inserts, but with some services having a copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, lab services, and all radiological services, are covered with a doctor referral and prior authorization. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Champion Select (HMO-POS C-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not the sub-services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. A doctor referral and prior authorization are required, and there is a copay for covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Champion Select (HMO-POS C-SNP) plan, with a doctor referral and prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services for the Champion Select (HMO-POS C-SNP) plan includes coverage for over-the-counter items with a maximum benefit of $400 every three months, while acupuncture, meal benefits, dual eligible SNPs with highly integrated services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing services, case management, institution for mental disease services for individuals 65 or older, services in an intermediate care facility for individuals with intellectual disabilities, 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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