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Champion Plus (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Champion Plus (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 Plus (HMO C-SNP) in 2026, please refer to our full plan details page.
Champion Plus (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 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 Plus (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 Plus (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 Plus (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 Plus (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $13.80. 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 Plus (HMO C-SNP) Medicare plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 (Preferred Generic), Tier 2 (Generic), and Tier 6 (Select Care Drugs) prescriptions filled at a standard pharmacy or through standard mail order. This coverage structure ensures highly affordable access to your essential daily medications. For brand-name and specialty medications, you will pay a 25% coinsurance instead of a flat copay. This 25% coinsurance applies to Tier 3 (Preferred Brand) and Tier 4 (Non-Preferred Brand) drugs for both 1-month and 3-month supplies, as well as Tier 5 (Specialty Tier) drugs for a 1-month supply at standard pharmacies.
Additional Benefits
The Champion Plus (HMO C-SNP) plan provides comprehensive medical coverage with many essential services available with no copay, including primary care visits, telehealth, and preventive care. For hospital stays, inpatient care has no copay or coinsurance but is subject to a Medicare-defined deductible, while outpatient hospital services and dialysis require a 20% coinsurance with no copay. Emergency room visits carry a $115 copay, which is waived if you are admitted within 24 hours, and urgent care is covered with no copay. This plan also features supplemental benefits to help manage your health, such as dental coverage with no copay for preventive services up to a $3,000 annual limit, alongside no-copay vision exams and a $500 yearly allowance for eyewear. Prescription hearing aids are available for a $149 copay, and the plan covers up to 36 one-way transportation trips per year to plan-approved locations with no copay and no coinsurance. Additionally, durable medical equipment and specialist visits are covered with no copay and up to a 20% coinsurance.
Inpatient Hospital See details
Champion Plus (HMO C-SNP) partially covers inpatient acute and psychiatric hospital services with no copay and no coinsurance, subject to a Medicare-defined deductible, with prior authorization and referrals required. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Champion Plus (HMO C-SNP) covers outpatient hospital, observation, and ambulatory surgical center services with no copay and a 20% coinsurance. Outpatient substance abuse and blood services are also fully covered under this plan with no copay and no coinsurance.
Partial Hospitalization See details
Champion Plus (HMO C-SNP) covers partial hospitalization services with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Champion Plus (HMO C-SNP) covers ambulance services, with ground transport requiring a copay ranging from no copay to $125 and coinsurance from no coinsurance to 20%, while air transport requires a 20% coinsurance and a copay. Transportation services are partially covered with no copay and no coinsurance for up to 36 one-way trips per year to plan-approved locations, but trips to any health-related location are not covered.
Emergency Services See details
Champion Plus (HMO C-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with no copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $10,000 maximum with no copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Primary care benefits under Champion Plus (HMO C-SNP) feature no copay and no coinsurance for primary care doctor visits, occupational therapy, telehealth, mental health, and psychiatric services. Specialist visits, physical therapy, and opioid treatment require a 20% coinsurance with no copay, while podiatry and routine chiropractic services are not covered.
Preventive Services See details
Champion Plus (HMO C-SNP) partially covers preventive services, offering covered benefits like annual physical exams, kidney disease education, and glaucoma screenings with no copay and no coinsurance. Several sub-services are not covered under this benefit, including in-home safety assessments, medical nutrition therapy, weight management programs, and therapeutic massage.
Hearing Services See details
Hearing services are covered by Champion Plus (HMO C-SNP), offering routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with a $149 copay and no coinsurance for up to two aids every three years, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Champion Plus (HMO C-SNP) with no copay, no coinsurance, and no deductible for covered services. This benefit includes one routine eye exam per year and eyeglasses (lenses and frames) up to a $500 annual limit, while contact lenses, individual lenses or frames, and other eye exam services are not covered.
Dental Services See details
Dental services are partially covered by Champion Plus (HMO C-SNP), featuring a $3,000 annual maximum with no copay and no coinsurance for preventive care. Covered comprehensive services require no copay and 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 Plus (HMO C-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs require a 0% to 20% coinsurance, while Part B insulin is covered with a $0 to $35 copay and no coinsurance.
Dialysis Services See details
Champion Plus (HMO C-SNP) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Champion Plus (HMO C-SNP) covers medical equipment, offering durable medical equipment and prosthetics with no copay and a 0% to 20% coinsurance. Diabetic supplies, equipment, and therapeutic shoes or inserts are also covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Champion Plus (HMO C-SNP) partially covers diagnostic and radiological services with no copay and a 20% coinsurance for covered diagnostic procedures, diagnostic radiology, and therapeutic radiology. Outpatient lab services and outpatient X-ray services are not covered, and covered diagnostic services require a referral and prior authorization.
Home Health Services See details
Champion Plus (HMO C-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization and a referral are required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered in practice under Champion Plus (HMO C-SNP) because all sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered and require 20% coinsurance despite having no copay.
Skilled Nursing Facility (SNF) See details
Champion Plus (HMO C-SNP) covers skilled nursing facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 copay for days 21 through 100 per stay. Prior authorization and referrals are required, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Champion Plus (HMO C-SNP) covers some services under its other services benefit, but acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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