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Champion Select (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Champion Select (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 Select (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
Champion Select (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 Select (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 Select (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 Select (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 Select (HMO-POS C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $16.10. 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 Select (HMO-POS C-SNP) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay 25% coinsurance for most drugs, but no copay for specialty tier drugs when using a standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. If you qualify for the low-income subsidy, the plan's premium will be $16.10.
Additional Benefits
The Champion Select (HMO-POS C-SNP) plan offers comprehensive coverage with a focus on essential healthcare services. The plan includes no copay for inpatient hospital-acute, outpatient observation, ambulatory surgical center, primary care, preventive services, hearing exams, vision exams, and home health services. Emergency services have a $140 copay, while ambulance services and prescription hearing aids have varying copays. This plan provides coverage for a wide range of services including dental, home infusion, dialysis, medical equipment, and diagnostic services. Additional benefits include coverage for over-the-counter items with a maximum benefit, and transportation to health-related locations. Some services like outpatient blood services, routine chiropractic care, and specific therapies are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization and a doctor's referral. For Inpatient Hospital-Acute, there is no copay. For Inpatient Hospital Psychiatric, the copay is $100 for days 1-10, no copay for days 11-60, and $329 for days 61-90. Additional days and non-Medicare-covered stays for both are not covered.
Outpatient Services See details
Outpatient Services are covered, with a $100 copay for Outpatient Hospital Services, and no copay for Observation Services. Ambulatory Surgical Center (ASC) Services have no copay, and Individual and Group Sessions for Outpatient Substance Abuse have no copay. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Champion Select (HMO-POS C-SNP) plan, with no copay required. Prior authorization and a doctor referral are required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a copay between $0 and $125, while air ambulance services have a coinsurance of 0% to 20%. Transportation to plan-approved health-related locations is covered for up to 100 one-way trips per year, with a variety of transportation modes available, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered. Emergency Services have a $140 copay and no coinsurance, and Urgently Needed Services have no copay and no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $10,000.
Primary Care See details
The Champion Select (HMO-POS C-SNP) plan covers primary care physician services, chiropractic services, physician specialist services, mental health specialty services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services with no copay. Occupational Therapy Services are covered with a copay, and routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered zero dollar preventive services, and an annual physical exam with no copay. The plan also covers additional preventive services, kidney disease education services, and other preventive services, with no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. In-home safety assessment, medical nutrition therapy, post discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefit, home-based palliative care, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, and counseling services are not covered.
Hearing Services See details
The Champion Select (HMO-POS C-SNP) plan covers hearing exams and fitting/evaluation for hearing aids with no copay, and routine hearing exams with a limit of one per year. Prescription hearing aids are partially covered, with a $149 copay for all types of prescription hearing aids (excluding inner ear, outer ear, and over the ear). OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams and eyewear have no copay. Eyewear includes eyeglasses (lenses and frames) and upgrades, while contact lenses, eyeglass lenses, and eyeglass frames are not covered.
Dental Services See details
Dental services are covered, with a maximum benefit of $3,000 per year. Oral exams are covered up to two visits, and dental X-rays, prophylaxis (cleaning), fluoride treatment, and other preventive dental services are each covered for a limited number of visits per year. Restorative services are covered with 20% to 40% coinsurance, while endodontics and oral and maxillofacial surgery have 20% coinsurance, and periodontics, prosthodontics, removable, and maxillofacial prosthetics have 40% 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, and Medicare Part B Chemotherapy/Radiation Drugs 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 Select (HMO-POS C-SNP) plan. There is no copay or coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered by the Champion Select (HMO-POS C-SNP) plan. Durable Medical Equipment (DME) has no copay and a coinsurance between 0% and 20%; however, Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a coinsurance between 0% and 20%, while Medical Supplies have a coinsurance between 0% and 20%. Diabetic Equipment has no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with no copay, lab services with no copay, and diagnostic and therapeutic radiological services and outpatient X-ray services with no copay. All services require prior authorization and a doctor's referral.
Home Health Services See details
Home Health Services are covered by the Champion Select (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 covered, but the specific services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. A doctor referral and prior authorization are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The Champion Select (HMO-POS C-SNP) plan covers Over-the-Counter (OTC) Items with a maximum benefit coverage amount of $400.00 every three months, but does not cover Acupuncture, Meal Benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, or Self-Directed Personal Assistance Services.
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