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Champion Care (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Champion Care (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Champion Care (HMO C-SNP) in 2026, please refer to our full plan details page.
Champion Care (HMO C-SNP) is a HMO C-SNP 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 Care (HMO 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 Care (HMO 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 Care (HMO 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 Care (HMO 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 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:
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Drug Coverage
The Champion Care (HMO C-SNP) Medicare plan offers an Enhanced Alternative drug benefit with no prescription drug deductible. During the initial coverage phase, standard pharmacy copays for a 30-day supply are $3 for preferred generics, $47 for standard generics, and $100 for preferred brands. Non-preferred drugs require a 33% coinsurance, while specialty tier drugs have no copay. Once your total yearly drug costs reach $2,100, you enter the catastrophic coverage phase where you pay nothing for Medicare Part D covered drugs. If you qualify for the low-income subsidy, your Part D premium can be reduced to zero dollars. This plan helps manage prescription costs through clear cost-sharing phases and potential premium assistance.
Additional Benefits
Champion Care (HMO C-SNP) offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, specialist services, diagnostic tests, and preventive care. For urgent situations, members benefit from no copay on urgent care and a $70 copay for emergency services, while acute inpatient hospital stays require no copay or coinsurance. Outpatient hospital procedures carry a $100 copay, and the plan includes up to 24 one-way trips for plan-approved transportation with no copay. Additional benefits feature dental coverage up to a $3,000 annual limit with no copay for preventive services and a 20% to 40% coinsurance for comprehensive care. Routine hearing and vision exams also require no copay, with members receiving up to $335 annually for eyewear and a low $149 copay for prescription hearing aids. Skilled nursing care is covered with no copay for the first 20 days, though it is important to note that cardiac rehabilitation, over-the-counter items, and meal benefits are not covered.
Inpatient Hospital See details
Champion Care (HMO C-SNP) partially covers inpatient hospital services, excluding upgrades, additional days, and non-Medicare-covered stays. Acute care is provided with no copay and no coinsurance, while psychiatric care requires a $100 daily copay for days 1 through 10 and no copay for days 11 through 90, with no coinsurance for either service.
Outpatient Services See details
Champion Care (HMO C-SNP) covers outpatient services with no coinsurance, including a $100 copay for outpatient hospital services and no copay for observation, ambulatory surgical center, outpatient substance abuse, and blood services. Prior authorization and doctor referrals are required for most of these outpatient procedures.
Partial Hospitalization See details
Champion Care (HMO C-SNP) covers partial hospitalization benefits with no copay and no coinsurance. Prior authorization and a doctor referral are required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Champion Care (HMO C-SNP), as transportation to any health-related location is not covered. Prior authorization is required for ambulance services, which feature a $0 to $125 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Plan-approved transportation is covered for up to 24 one-way trips per year with no copay or coinsurance.
Emergency Services See details
Champion Care (HMO C-SNP) covers emergency services with a $70 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 maximum limit, but worldwide emergency transportation is not covered.
Primary Care See details
Primary Care benefits are partially covered by Champion Care (HMO C-SNP) with no copay and no coinsurance for covered services, though podiatry services are not covered. Covered services include primary care provider visits, specialist services, chiropractic care, mental health services, and physical therapy.
Preventive Services See details
Champion Care (HMO C-SNP) provides partially covered preventive services with no copay and no coinsurance for covered benefits such as annual physical exams and health education. Excluded services under this benefit include in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home palliative care, in-home support, additional smoking cessation counseling, disease management, telemonitoring, and counseling.
Hearing Services See details
Champion Care (HMO C-SNP) partially covers hearing services, providing routine hearing exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids (all types) are covered with a $149 copay and no coinsurance for up to two aids every three years, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription aids are not covered.
Vision Services See details
Champion Care (HMO C-SNP) partially covers Vision Services with no copay and no coinsurance, featuring one routine eye exam per year and a $335 annual limit for covered eyewear. Contact lenses, eyeglass lenses, and eyeglass frames are not covered by this plan.
Dental Services See details
Champion Care (HMO C-SNP) partially covers dental services up to a $3,000 annual limit, offering covered preventive care with no copay and no coinsurance, and comprehensive services with no copay and 20% to 40% coinsurance. While services like exams, cleanings, and restorative care are covered, adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Champion Care (HMO C-SNP) covers Home Infusion bundled Services, which require prior authorization. Covered Medicare Part B insulin drugs have no copay to a $24 copay, while chemotherapy, radiation, and other Part B drugs range from no coinsurance to 20% coinsurance.
Dialysis Services See details
Champion Care (HMO C-SNP) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Champion Care (HMO C-SNP), with durable medical equipment, prosthetics, and medical supplies requiring no copay and coinsurance ranging from no coinsurance to 20%. 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 Care (HMO C-SNP) with no copay and no coinsurance for diagnostic procedures, lab services, radiological services, and outpatient X-rays. Prior authorization and a doctor referral are required for diagnostic services.
Home Health Services See details
Champion Care (HMO C-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization and a doctor referral are required to access these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under Champion Care (HMO C-SNP), as no sub-services are covered by the plan. This lack of coverage, meaning no copay or coinsurance is provided, applies to cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by Champion Care (HMO C-SNP) with no copay for days 1 to 20, a $218 daily copay for days 21 to 100, and no coinsurance. Prior authorization and a doctor referral are required for these services, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Champion Care (HMO C-SNP) partially covers other services, offering up to 50 acupuncture treatments per year with no copay and no coinsurance. Over-the-counter items, meal benefits, and dual eligible SNPs with highly integrated services are not covered.
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