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Champion Choice (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Champion Choice (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 Choice (HMO C-SNP) in 2026, please refer to our full plan details page.
Champion Choice (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 Choice (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 Choice (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 Choice (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 Choice (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $12.00. 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 a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 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 Choice (HMO C-SNP) Medicare plan offers an Enhanced Alternative drug benefit with a $615.00 prescription drug deductible. During the initial coverage phase at standard pharmacies, there is no copay for Tier 1 preferred generic and Tier 5 specialty drugs. For Tier 2 standard generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, you will pay a 25% coinsurance. If you qualify for the Low-Income Subsidy, also known as Extra Help, your Part D cost is reduced to $12.00. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Champion Choice (HMO C-SNP) plan offers comprehensive coverage with no copay and no coinsurance for primary care, preventive services, home health care, and routine dental exams. For specialist visits, outpatient hospital services, and diagnostic radiology, members will pay no copay and a 20% coinsurance. Emergency care is available with a $115 copay, while urgent care services require no copay or coinsurance. This plan also features valuable supplemental benefits, including up to 36 one-way transportation trips annually and a $3,000 annual dental maximum. Routine vision and hearing exams are provided with no copay or coinsurance, and prescription hearing aids are covered with a $149 copay. Additionally, skilled nursing facility stays require no copay or coinsurance for the first 20 days, followed by a $218 copay for days 21 through 100.
Inpatient Hospital See details
Champion Choice (HMO C-SNP) partially covers inpatient acute and psychiatric hospital services, which require prior authorization and a doctor referral, with cost-sharing following Medicare-defined copays and deductibles. Additional days, non-Medicare-covered stays, and acute hospital upgrades are not covered.
Outpatient Services See details
Champion Choice (HMO C-SNP) covers outpatient services, with outpatient hospital, observation, ambulatory surgical center, and individual substance abuse sessions requiring a 20% coinsurance and no copay. Outpatient blood services and group substance abuse sessions are provided with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Champion Choice (HMO C-SNP) with no copay and no coinsurance. A doctor referral and prior authorization are required to receive these services.
Ambulance and Transportation Services See details
Champion Choice (HMO C-SNP) partially covers ambulance and transportation services, with transportation to any health-related location excluded from coverage. Ground ambulance services range from no copay to a $125 copay and no coinsurance to 20% coinsurance, air ambulance services require a copay and 20% coinsurance, and plan-approved transportation is covered for up to 36 one-way trips annually.
Emergency Services See details
Champion Choice (HMO C-SNP) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with no copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $10,000 limit, though worldwide emergency transportation is not covered.
Primary Care See details
Champion Choice (HMO C-SNP) partially covers Primary Care benefits, as podiatry services are not covered. Covered services such as primary care, chiropractic, occupational therapy, and telehealth have no copay and no coinsurance, while specialist visits, physical therapy, opioid treatment, and individual mental health sessions require a 20% coinsurance and no copay.
Preventive Services See details
Champion Choice (HMO C-SNP) partially covers preventive services with no copay and no coinsurance for covered care such as annual physical exams and health education. Sub-services that are not covered include in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs for chemo-related hair loss, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, tobacco cessation counseling, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Hearing services are partially covered by Champion Choice (HMO C-SNP), which offers annual routine hearing exams and fitting evaluations with no copay or coinsurance. Up to two prescription hearing aids (all types) are covered every three years with a $149 copay and no coinsurance, but OTC hearing aids as well as inner-ear, outer-ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Champion Choice (HMO C-SNP) partially covers vision services with no deductible, copay, or coinsurance for covered services, which include one routine eye exam per year and eyeglasses (lenses and frames). A combined annual maximum of $500 is available for eyewear, though contact lenses, eyeglass lenses, and eyeglass frames are not covered.
Dental Services See details
Champion Choice (HMO C-SNP) covers dental services up to a $3,000 annual limit, providing preventive care like cleanings and exams with no copay or coinsurance. Comprehensive services are partially covered with no copay and 20% to 40% coinsurance, though implants, orthodontics, adjunctive general services, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Champion Choice (HMO C-SNP) covers home infusion bundled services with prior authorization, offering Medicare Part B insulin with no coinsurance and a copay ranging from no copay to $35. Medicare Part B chemotherapy, radiation, and other 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 Choice (HMO C-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Champion Choice (HMO C-SNP) covers medical equipment with no copay and coinsurance ranging from no coinsurance to 20% for durable medical equipment, prosthetics, and medical supplies. 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 partially covered under Champion Choice (HMO C-SNP), as lab services and outpatient X-ray services are not covered. Covered diagnostic procedures, diagnostic radiological services, and therapeutic radiological services require no copay and a 20% coinsurance.
Home Health Services See details
Champion Choice (HMO C-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization and a doctor referral are required to access these benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Champion Choice (HMO C-SNP) plan, as all associated sub-services, including intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD), are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Champion Choice (HMO C-SNP), requiring prior authorization and a doctor referral, while additional days beyond Medicare-covered stays are not covered. Stays feature no copay or coinsurance for days 1 through 20, and a $218 copay with no coinsurance for days 21 through 100.
Other Services See details
Other Services are partially covered by Champion Choice (HMO C-SNP), which offers acupuncture with no copay and no coinsurance for up to 50 treatments per year. Over-the-counter items, meal benefits, and dual eligible SNPs with highly integrated services are not covered.
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