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Champion Connect (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Champion Connect (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 Connect (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
Champion Connect (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 2025.
It's important to know that Champion Connect (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 Connect (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 Connect (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 Connect (HMO-POS C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $21.30. 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 $590.00 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 combined Maximum Out-Of-Pocket cost of $9350.00 (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 $9350.00 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 Connect (HMO-POS C-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay either a copay or coinsurance for your prescriptions. For drugs in the standard pharmacy, you will pay no copay for preferred generic drugs and specialty tier drugs, and 25% coinsurance for standard generic, preferred brand, and non-preferred drugs. This plan may have a reduced premium if you qualify for the low-income subsidy (LIS).
Additional Benefits
The Champion Connect (HMO-POS C-SNP) plan offers a variety of benefits, including inpatient hospital stays with a deductible, and outpatient services with varying copays or coinsurance. Emergency and urgently needed services have either a copay or no cost, while primary care, preventive, and home health services are available at no copay. This plan also covers hearing, vision, and dental services with limits and varying costs, as well as ambulance and transportation services. Additionally, you'll find coverage for medical equipment, diagnostic services, and home infusion, with copays or coinsurance depending on the specific service.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered with a $1,712 deductible, and no copay for days 1-90 for acute care and days 1-60 for psychiatric care; however, additional days, non-Medicare covered stays, and upgrades are not covered. Prior authorization and a doctor referral are required.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $125 copay, Observation Services with 20% coinsurance, and Ambulatory Surgical Center (ASC) Services with no copay. Outpatient Substance Abuse Services are covered with no copay for individual and group sessions, and Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Champion Connect (HMO-POS C-SNP) plan, with no copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Champion Connect (HMO-POS C-SNP) plan, including ground and air ambulance services. Ground ambulance services have a 20% coinsurance and no copay, while air ambulance services have a 20% coinsurance and a copay. Transportation Services to a plan-approved health-related location are covered for up to 168 one-way trips per year, with various modes of transportation available. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Champion Connect (HMO-POS C-SNP) plan, with a $110 copay, and no coinsurance. Urgently Needed Services have no copay and no coinsurance. Worldwide Emergency Services are covered, with a maximum plan benefit coverage of $10,000.
Primary Care See details
The Champion Connect (HMO-POS C-SNP) plan covers primary care physician services and chiropractic services with no copay. Physician specialist services have a 0%-20% coinsurance, while mental health and psychiatric services have no copay for individual and group sessions. Other health care professionals have a 0%-20% coinsurance, and physical therapy and speech-language pathology services have no copay. Additional telehealth benefits and opioid treatment program services also have no copay. Routine chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, Annual Physical Exams with no copay, and additional services like Health Education and Personal Emergency Response System (PERS) with no copay. This plan also covers Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing Services include 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. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay, and routine eye exams are limited to 1 per year. Eyewear has no copay, and a combined maximum benefit of $500 per year. Contact lenses, eyeglass lenses, and eyeglass frames are not covered.
Dental Services See details
The Champion Connect (HMO-POS C-SNP) plan covers dental services, with a maximum benefit of $3,000 per year. Oral exams, dental x-rays, cleanings, fluoride treatments, and other preventive dental services are covered, with varying limitations. Restorative services have a coinsurance of 20-40%, while endodontics has a 20% coinsurance, periodontics, removable prosthodontics, and maxillofacial prosthetics have a 40% coinsurance, and oral and maxillofacial surgery has a 20% coinsurance. Adjunctive general services, implant services, prosthodontics, fixed, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a copay between $0 and $24, Medicare Part B Chemotherapy/Radiation Drugs with a coinsurance between 0% and 20%, and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Champion Connect (HMO-POS C-SNP) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by the Champion Connect (HMO-POS C-SNP) plan. Durable Medical Equipment (DME) has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Champion Connect (HMO-POS C-SNP) plan. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Lab Services have no copay, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Champion Connect (HMO-POS C-SNP) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Champion Connect (HMO-POS C-SNP) plan. This includes Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
Other Services for Champion Connect (HMO-POS C-SNP) includes coverage for Over-the-Counter (OTC) Items with a maximum benefit of $500 every three months, while acupuncture, meal benefits, and several other services are not covered. Additional services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others are not covered.
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