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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 CAR, CHU, CLA and WAS counties. 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) Medicare plan features a $0 drug deductible, meaning your prescription coverage begins immediately with no out-of-pocket deductible costs. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs at standard pharmacies and through standard mail order. Standard generic medications under Tier 2 are also highly affordable, costing just a $3.00 copay for a one-month supply at a standard pharmacy or a $6.00 copay for a three-month mail-order supply. For brand-name medications, Tier 3 preferred brands require a $47.00 copay for a one-month supply, while Tier 4 non-preferred brands carry a $100.00 copay. Opting for a three-month mail-order supply can help lower your prescription expenses, reducing the copay to $94.00 for Tier 3 and $200.00 for Tier 4. High-cost specialty drugs classified under Tier 5 require a 33% coinsurance for a one-month supply at standard pharmacies.
Additional Benefits
The Champion Advantage (HMO-POS C-SNP) plan offers robust medical coverage featuring no copay or coinsurance for primary care visits, specialist consultations, telehealth, and preventive care. Inpatient acute hospital stays and outpatient ambulatory surgical center services also have no copay, though outpatient hospital visits require a $100 copay. Emergency room visits carry a $150 copay that is waived upon admission, while urgent care services and up to 24 one-way transportation trips are available with no copay. For specialty benefits, the plan covers routine dental, vision, and hearing exams with no copay. Vision benefits include a $335 annual allowance for eyeglasses, while dental benefits cover preventive care with no copay up to a $3,000 yearly limit and comprehensive services with a 20% to 40% coinsurance. Furthermore, members pay no copay or coinsurance for dialysis, home health, and diabetic supplies, while durable medical equipment requires a 0% to 20% coinsurance.
Inpatient Hospital See details
Inpaitent hospital care is covered by Champion Advantage (HMO-POS C-SNP) with no coinsurance, although upgrades, additional days, and non-Medicare-covered stays are not covered. Acute hospital stays have no copay for days 1 to 90, while psychiatric stays require a $100 daily copay for days 1 to 10 and no copay for days 11 to 90.
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 services, observation services, outpatient substance abuse sessions, and outpatient blood services. Prior authorization and referrals are required for most of these covered outpatient benefits.
Partial Hospitalization See details
Champion Advantage (HMO-POS C-SNP) covers partial hospitalization services with no copay and no coinsurance. Prior authorization and a referral are required to receive these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Champion Advantage (HMO-POS C-SNP), featuring ground ambulance services with a $0.00 to $125.00 copay and coinsurance, and air ambulance services with a 20% coinsurance and a copay. Transportation benefits are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Champion Advantage (HMO-POS C-SNP) covers emergency services with a $150 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with no copay or coinsurance. Worldwide emergency and urgent care are partially covered up to a $10,000 limit with no copay or coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Primary care benefits are partially covered by Champion Advantage (HMO-POS C-SNP), offering no copay and no coinsurance for primary care visits, specialist services, mental health care, therapies, and telehealth. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Champion Advantage (HMO-POS C-SNP) provides partially covered preventive services with no copay and no coinsurance, including annual physicals, kidney disease education, and diabetes training. Sub-services that are not covered include 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.
Hearing Services See details
Champion Advantage (HMO-POS C-SNP) covers Medicare-covered and routine hearing exams with no copay, no coinsurance, and no deductible. Prescription hearing aids are partially covered with a $149 copay and no coinsurance, but OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription models, are not covered.
Vision Services See details
Champion Advantage (HMO-POS C-SNP) provides partially covered vision services with no copay, no coinsurance, and no deductible, featuring one routine eye exam per year and eyeglasses with a $335 annual maximum benefit. Other eye exam services, contact lenses, individual eyeglass lenses, and individual eyeglass frames are not covered.
Dental Services See details
Champion Advantage (HMO-POS C-SNP) partially covers dental services up to a $3,000 annual maximum, featuring no copay and no coinsurance for preventive and diagnostic care. Covered comprehensive services require no copay but carry a 20% to 40% coinsurance, while adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Champion Advantage (HMO-POS C-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a copay of $0.00 to $24.00 and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Champion Advantage (HMO-POS C-SNP) plan with no copay and no coinsurance.
Medical Equipment See details
Champion Advantage (HMO-POS C-SNP) covers medical equipment with no copay and 0% to 20% coinsurance for durable medical equipment, prosthetics, and medical supplies. Diabetic equipment, supplies, and therapeutic shoes or inserts are fully covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Champion Advantage (HMO-POS C-SNP) covers diagnostic and radiological services with no copay and no coinsurance for diagnostic tests, lab services, radiological services, and outpatient X-rays. Prior authorization and referrals are required for diagnostic services.
Home Health Services See details
Home Health Services are covered under the Champion Advantage (HMO-POS C-SNP) plan with no copay and no coinsurance. Members will need to obtain a referral and prior authorization before receiving these services.
Cardiac Rehabilitation Services See details
Champion Advantage (HMO-POS C-SNP) provides coverage for some cardiac rehabilitation services with no copay and no coinsurance, although standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. Prior authorization and a referral are required for the covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Champion Advantage (HMO-POS C-SNP) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization and referrals are required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Champion Advantage (HMO-POS C-SNP) has some services covered under other services, but acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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