A non-government entity
Champion Ally (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Champion Ally (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Champion Ally (HMO) in 2026, please refer to our full plan details page.
Champion Ally (HMO) is a HMO plan offered by Champion Health Plans-USA, LLC. available for enrollment in 2026 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 Ally (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 Champion Ally (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 Champion Ally (HMO), 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 Maximum Out-Of-Pocket cost of $199.00 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:
Sign up for Champion Ally (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Champion Ally (HMO) Medicare plan offers an enhanced alternative drug benefit with no prescription drug deductible. During the initial coverage phase, you pay a $3.00 copay for Tier 1 preferred generics, a $47.00 copay for Tier 2 standard generics, and a $100.00 copay for Tier 3 preferred brands at a standard pharmacy. For Tier 4 non-preferred drugs, you will pay a 33% coinsurance, while Tier 5 specialty drugs feature no copay. These cost-sharing rates apply for a 30-day supply until your total yearly drug costs reach $2,100.00. After reaching this threshold, you enter the catastrophic coverage phase where you pay nothing for covered Medicare Part D prescription drugs.
Additional Benefits
The Champion Ally (HMO) plan delivers comprehensive healthcare coverage with no copays or coinsurance for primary care, specialist visits, preventive services, and diagnostic lab tests. If you require hospital care, inpatient acute stays have no copay, while outpatient hospital services require a $100 copay and emergency room visits carry a $70 copay. Psychiatric inpatient care has a $100 daily copay for the first 10 days, after which there is no copay. For dental, vision, and hearing needs, the plan features an annual dental limit of $3,000 with no copays for preventive care and a $335 yearly allowance for eyeglasses. Routine hearing exams have no copay, and prescription hearing aids are available for a $149 copay. The plan also covers up to 24 one-way transportation trips per year with no copay or coinsurance, though skilled nursing facility stays require a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by Champion Ally (HMO), which offers acute care with no copay or coinsurance, and psychiatric care with a $100 daily copay for days 1 to 10 and no copay or coinsurance for days 11 to 90. Additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Champion Ally (HMO) covers outpatient services with no coinsurance, featuring a $100 copay for outpatient hospital services and no copay for observation, ambulatory surgical center, 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
Partial hospitalization benefits are covered by Champion Ally (HMO) with no copay and no coinsurance. Prior authorization and a doctor referral are required to access these services.
Ambulance and Transportation Services See details
Champion Ally (HMO) covers ambulance services and partially covers transportation services, with prior authorization required for ambulance transport. Ground ambulance services require a copay ranging from no copay to $125 with no coinsurance, while air ambulance services require a 20% coinsurance with no copay. Transportation benefits include up to 24 one-way trips per year to plan-approved locations at no copay or coinsurance, though rides to any health-related location are not covered.
Emergency Services See details
Champion Ally (HMO) covers emergency services with a $70 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with no copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $10,000 maximum, but worldwide emergency transportation is not covered.
Primary Care See details
Champion Ally (HMO) partially covers primary care benefits with no copay and no coinsurance for covered services, although podiatry services are not covered. Covered services include primary care visits, specialist care, chiropractic care, mental health services, physical therapy, and telehealth.
Preventive Services See details
Preventive Services are partially covered by Champion Ally (HMO) with no copay and no coinsurance for covered care, such as annual physical exams and kidney disease education. Sub-services that are not covered include in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, tobacco cessation, disease management, telemonitoring, and counseling.
Hearing Services See details
Champion Ally (HMO) covers annual routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with a $149 copay and no coinsurance for up to two devices every three years, but inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Champion Ally (HMO) partially covers vision services with no copay and no coinsurance, providing one annual routine eye exam and a $335 yearly limit for eyeglasses. Contact lenses, individual eyeglass lenses, and individual eyeglass frames are not covered.
Dental Services See details
Champion Ally (HMO) partially covers dental services up to a $3,000 annual maximum, offering preventive care with no copays or coinsurance, and comprehensive treatments with no copays and coinsurance ranging from 20% to 40%. Specific services including adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Champion Ally (HMO) covers Home Infusion bundled services with prior authorization, offering Medicare Part B insulin drugs for no copay to a $24 copay and no coinsurance. Chemotherapy, radiation, and other Medicare Part B drugs are covered with no copay and coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Dialysis Services are covered by Champion Ally (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Champion Ally (HMO) covers durable medical equipment and prosthetics with no copay and 0% to 20% coinsurance, though prior authorization is required. Diabetic supplies, therapeutic shoes, and inserts are also covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Champion Ally (HMO) with no copay and no coinsurance for all lab services, diagnostic procedures, radiological services, and outpatient X-rays. Diagnostic services require prior authorization and a doctor referral.
Home Health Services See details
Champion Ally (HMO) covers Home Health Services with no copay and no coinsurance. To access this benefit, a doctor referral and prior authorization are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under Champion Ally (HMO). The plan does not provide coverage, copays, or coinsurance for any associated sub-services, including intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Champion Ally (HMO), as additional days beyond the standard Medicare-covered limit are not covered. For covered stays, there is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and no coinsurance.
Other Services See details
Champion Ally (HMO) provides partial coverage for Other Services, offering up to 50 acupuncture treatments per year with no copay and no coinsurance. Over-the-counter (OTC) items, meal benefits, and dual eligible SNPs with highly integrated services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved