Champion Advantage (C-SNP) H6170 001 0 Plan Details
This page provides coverage and cost details for Champion Heath Plan’s H6170-001-0 Medicare SNP plan for 2025. Enrollment is subject to eligibility.
*This plan is new and has not yet been rated by CMS.
This private health insurance option offers all of the same basic benefits as Original Medicare, but out-of-pocket costs are different. It may include additional benefits that Medicare Part A and Part B do not cover.
Individuals must meet all Chronic or Disabling Condition SNP qualification requirements to join this C-SNP plan.
Champion Advantage Basic Plan Details
- Plan ID
- H6170-001-0
- Plan Type
- HMO-POS C-SNP
- Plan Year
- 2025
- Premium
- $0.00/mo
Plus your Medicare Part B premium. - Health Plan Deductible
- $0.00
- Out-of-Pocket Maximum
- 499.00 /yr (in-network)
- Part B Reduction
- $0.00/mo
- Drug Plan Benefit
- Enhanced
$0.00 deductible - Supplemental Benefits
- Vision, Hearing
- Availability
- See List
- Insured By
- Champion Heath Plan
| Summary of Benefits |
|---|
Health Plan Out-of-Pocket Costs
The following table is a summary of the most common out-of-pocket costs you will incur if you join this Champion Heath Plan plan:
Doctor's Office Visits
- Primary
- $0 Copay
- Specialist
- $0 Copay
Prior Authorization Required
Emergency, Urgent, and Inpatient Hospital Coverage
- Emergency room care
- $140 Copay
- Urgent care
- $0 Copay
- Ground ambulance
- $125 Copay
- Inpatient hospital care
- $0.00 per day for days 1 through 90
- Skilled Nursing Facility
- $0.00 per day for days 1 through 20
$214.00 per day for days 21 and beyond
Foot Care
- Foot Exams and Treatments (Medicare-covered)
- $0 Copay
Prior Authorization Required, Referral Required - Routine Foot Care
- Not Covered
Chiropractic Care
- Medicare-covered chiropractic
- $0 Copay
- Routine chiropractic
- $0 Copay
Mental Health Services
- Outpatient individual therapy
- $0 Copay
- Outpatient group therapy
- $0 Copay
- Inpatient psychiatric hospital care
- $100.00 per day for days 1 through 10
$0.00 per day for days 11 through 60
$329.00 per day for days 61 and beyond
Rehabilitation Services
- Physical therapy and speech and language therapy
- $0 Copay
Prior Authorization Required, Referral Required - Occupational therapy
- $0 Copay
Prior Authorization Required, Referral Required
Medical Equipment and Supplies
- Diabetes supplies
- $0 Copay
- Durable medical equipment
- 20% Coinsurance
Prior Authorization Required - Prosthetics
- 20% Coinsurance
Diagnostics, Lab Services, and Imaging
- Diagnostic radiology services
- $0 Copay
Prior Authorization Required - Lab services
- $0 Copay
Prior Authorization Required, Referral Required - Outpatient x-rays
- $0 Copay
Prior Authorization Required - Diagnostic tests and procedures
- $0 Copay
Prior Authorization Required, Referral Required
Medicare Part B Drugs
- Chemotherapy
- 20% Coinsurance
- Other Part B drugs (Medicare-covered)
- 20% Coinsurance
Dental Services
- Medicare Covered Preventive Dental
- Not Covered
- Oral exam
- $0
- Dental x-rays
- $0
- Cleaning
- $0
- Periodontics
- Not Covered
- Endodontics
- Not Covered
- Restorative Services
- Not Covered
- Maximum dental benefit
- $3,000.00 (Every year)
Hearing Aids and Services
- Fitting/evaluation
- Covered
Limits may apply - Hearing aids
- Not Covered
- Hearing exam
- Covered
Limits may apply
Vision Services
- Medicare-covered eye exam
- $0 Copay
- Routine eye exam
- $0 Copay
1 Every year - Eyewear benefits
- None
Prescription Drug Costs & Benefits
Champion Advantage includes enhanced benefit Medicare Part D. Enhanced benefits offer greater coverage than basic, typically providing lower cost-sharing, broader drug coverage, and additional benefits, such as covering drugs not included in the standard formulary. These plans usually have higher premiums due to the extra coverage and flexibility they provide, but they cover a larger percentage of overall drug costs.
As of 2023, approximately 75% of people on Medicare are enrolled in enhanced plans.
Prescription Drug Premium with Extra Help
Extra Help is a Social Security program that helps people with limited income and resources lower or cut Part D costs. The following table outlines premium assistance details with Extra Help.
| Low Income Premium Subsidy: | ${part_d_lips_amount} |
|---|---|
| Low Income Premium Subsidy CMS Pays: | $0.00 |
| Low Income Subsidy Premium: | $0.00 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Deductible
The Medicare Part D annual deductible with this plan is $0.00. You must pay this amount at the pharmacy before Champion Heath Plan begins paying its share.
Prescription Drug Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Champion Advantage has out-of-pocket costs you must pay when you pick up your prescriptions.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 | $0.00 |
| Generic | $3.00 | $0.00 |
| Preferred Brand | $47.00 | $0.00 |
| Non-Preferred Brand | $100.00 | $0.00 |
| Specialty Tier | 33.00% | 0.00% |
| Select Care Drugs | $0.00 | $0.00 |
| *The Part D deductible does not apply. | ||
CMS 5-Star Rating Marks
Each year CMS rates Medicare Special Needs Plans in nine broad categories based on a 5-star system. The table below shows the quality ratings for this Champion Heath Plan plan.
| CMS Measure | Star Rating |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | Plan too new to be measured |
| Managing Chronic (Long Term) Conditions | Plan too new to be measured |
| Member Experience with Health Plan | Plan too new to be measured |
| Complaints and Changes in Plans Performance | Plan too new to be measured |
| Health Plan Customer Service | Plan too new to be measured |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | Plan too new to be measured |
| Member Experience with the Drug Plan | Plan too new to be measured |
| Drug Safety and Accuracy of Drug Pricing | Plan too new to be measured |
How to Qualify to Enroll in
Champion Advantage
To be eligible to enroll in Champion Advantage , you must meet these requirements:
- You are eligible for Medicare;
- You live in San Diego County (the plan’s service area); and
- You have been diagnosed with one or more severe or disabling chronic conditions.
A disabling chronic condition (disease) is one that lasts one or more years and requires ongoing medical attention and/or limits activities of daily living. They include:
- Autoimmune disorders
- End-stage renal disease
- Cancer
- Cardiovascular disorders
- Hematologic disorders
- HIV/AIDS
- Chronic heart failure
- Chronic lung disorders
- Neurologic disorders
- Dementia
- Diabetes
- End-stage liver disease
- Neurologic disorders
- Stroke
- Mental health conditions
Plan Availability
Champion Advantage (H6170-001-0) is available in the following locations (click to open):
Additional C-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
- H6170-003-0: Champion Select ()
- H6170-001-0: Champion Advantage ()
- H6170-002-0: Champion Connect ()
Contact Us About Champion Heath Plan
| Website: | Champion Heath Plan Plan Page (opens in new tab) |
|---|---|
| Providers: | Champion Heath Plan Providers Page (opens in new tab) |
| Formulary: | Champion Heath Plan Formulary Page (opens in new tab) |
| Pharmacy: | Champion Heath Plan Pharmacy Page (opens in new tab) |
| New Member Health Plan Help: | (800)885-8000 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (800)885-8000 |
| New Member Part D TTY Users: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Health Plan Compatibility
Medicare Advantage Special Need Plans are not compatible with most other forms of health insurance. If you have Medicare Part A and/or Medicare Part B and join a SNP plan, you will be disenrolled from Original Medicare. You cannot simultaneously enroll in an SNP plan and Medicare Supplement Insurance.
With a D-SNP, members retain their existing Medicaid plan and benefits. Veterans who have VA Health Benefits may also be able to receive care at their local VA hospital.
Citations & References
- Champion Heath Plan, http://www.championhmo.com, Last Accessed October 13, 2024
- Medicaid.gov, "Medicaid & CHIP in California", Last Accessed October 1, 2024
- CMS.gov, Landscape Source Files, Last Accessed October 2, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 2, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 5, 2024
Research Note: This content is based on independent analysis of CMS data by David Bynon, Medicare analyst and founder of MedicareWire.
For details on how this plan was analyzed and constructed using CMS data, see our Medicare Plan Research Methodology.
Disclaimer: MedicareWire does not endorse or rank Medicare plans. Plan information is provided for educational and research purposes only and may not reflect the most current data available from CMS or the plan provider.
Plans Offered
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