Heart and Diabetes Care
C-SNP HMO
Champion Compass
Medicare Only
Enroll NowCalifornia
Chronic Special Needs Plans for Diabetes and Heart Disease
Champion Health Plan offers Champion Compass, Champion Home, and Champion Secure. These plans bring together specialized clinical support, medication coverage, and care coordination, designed around the unique needs of members living in Assisted Living communities or Long Term Care facilities who are managing heart disease or diabetes. Our care teams work directly with your cardiologist, endocrinologist, and primary care doctor to coordinate blood sugar management, heart health monitoring, medications, and the full range of preventive services Champion members count on. If you’re living with chronic heart failure, chronic systolic heart failure, chronic diastolic heart failure, chronic combined systolic and diastolic heart failure, other documented chronic heart failure (acute heart failure without an underlying chronic diagnosis may not qualify), or Cardiovascular disorders (CMS limits this category to Cardiac arrhythmias, Coronary artery disease, peripheral vascular disease, chronic venous thromboembolic disorder), these plans are designed around your care needs.
Heart and Diabetes Care plus Medi-Cal Support
C-SNP HMO
Champion Home
Medicare + Medi-Cal
Enroll NowHeart and Diabetes Care plus Medi-Cal Support
C-SNP HMO
Champion Secure
Medicare + Medi-Cal
Enroll NowCalifornia Counties Available
- Imperial County
- Fresno County
- Kern County
- Los Angeles County
- Madera County
- Orange County
- Riverside County
- San Bernardino County
- San Diego County
| Doctor & Care Cost | Champion Compass | Champion Home | Champion Secure |
|---|---|---|---|
| Monthly Premium |
In-Network: $0 |
In-Network: $0 Your Cost with Medicare & Medi-Cal: $0 (with Extra Help) |
In-Network: $0 Your Cost with Medicare & Medi-Cal: $0 (with Extra Help) |
| Annual Plan Deductible |
In-Network: No Deductible |
In-Network: No Plan Deductible Your Cost with Medicare & Medi-Cal: No Plan Deductible |
In-Network: No Plan Deductible Your Cost with Medicare & Medi-Cal: No Plan Deductible |
| Annual Maximum Out of Pocket (MOOP) |
In-Network: $999 |
In-Network: $9,850 Your Cost with Medicare & Medi-Cal: $0† |
In-Network: $9,850 Your Cost with Medicare & Medi-Cal: $0† |
| Primary Care Physician |
In-Network: $0 Copay |
In-Network: $0 Copay Your Cost with Medicare & Medi-Cal: $0 Copay |
In-Network: 20% of the Cost Your Cost with Medicare & Medi-Cal: $0 Copay† |
| Specialists* |
In-Network: $0 Copay |
In-Network: 20% of the Cost Your Cost with Medicare & Medi-Cal: $0 Copay† |
In-Network: 20% of the Cost Your Cost with Medicare & Medi-Cal: $0 Copay† |
| Diagnostic Radiology, Labs* |
In-Network: $0 Copay |
In-Network: $0 Copay for lab services and X-Rays Your Cost with Medicare & Medi-Cal: $0 Copay for lab services and X-rays |
In-Network: $0 Copay for lab services and X-rays Your Cost with Medicare & Medi-Cal: $0 Copay for lab services and X-rays |
| Annual Physical Exam |
In-Network: $0 Copay for one exam per year |
In-Network: $0 Copay for one exam per year |
|
| Dialysis |
In-Network: 20% of the Cost |
In-Network: 20% of the Cost Your Cost with Medicare & Medi-Cal: $0 Copay† |
In-Network: 20% of the Cost Your Cost with Medicare & Medi-Cal: $0 Copay† |
| Urgent Care |
In-Network: $0 Copay |
In-Network: $0 Copay Your Cost with Medicare & Medi-Cal: $0 Copay |
In-Network: $0 Copay Your Cost with Medicare & Medi-Cal: $0 Copay |
| Emergency Care |
In-Network: $150 Copay |
In-Network: $115 Copay Your Cost with Medicare & Medi-Cal: $0 Copay† |
In-Network: $115 Copay Your Cost with Medicare & Medi-Cal: $0 Copay† |
| Inpatient Hospital* |
In-Network: $0 Per Stay |
In-Network: $1,736 Deductible per benefit period Your Cost with Medicare & Medi-Cal: $0† |
In-Network: $1,736 Deductible per benefit period Your Cost with Medicare & Medi-Cal: $0† |
| Outpatient Hospital* |
In-Network: $100 Copay for outpatient hospital services |
In-Network: 20% of the Cost for outpatient hospital services, surgery in an Ambulatory Surgery Center, and outpatient hospital observation Your Cost with Medicare & Medi-Cal: $0† |
In-Network: 20% of the Cost for outpatient hospital services, surgery in an Ambulatory Surgery Center, and outpatient hospital observation Your Cost with Medicare & Medi-Cal: $0† |
| Plan Benefits | Champion Compass | Champion Home | Champion Secure |
|---|---|---|---|
| Healthy Foods / Over-the-Counter Items / Utilities Benefit |
In-Network: $250 Allowance every 3 months. Eligible members pay $0 Copay for monthly allowance to use for purchasing an electric toothbrush and/or incontinence supplies, receiving a post discharge in-home medication reconciliation and support for caregivers. Support for caregivers is limited to twelve (12) 4-hour sessions per year with Helper Bees to support member’s caregiver. Any unused amounts from a monthly allowance not used within 90 days does not roll over to the next period. |
In-Network: $468 Allowance every 3 months. $0 Copay for monthly allowance to use for purchase of an electric toothbrush and/ or incontinence supplies, receiving a post discharge in-home medication reconciliation and support for caregivers. Support for caregivers is limited to twelve (12) 4-hour sessions per year with Helper Bees to support member’s caregiver. Any unused amounts from a monthly allowance not used within 90 days does not roll over to the next period.^ |
|
| Transportation |
In-Network: $0 Copay for 40 one-way trips to plan-approved health-related locations, up to 25 miles per trip |
In-Network: $0 Copay for 48 one-way trips to plan-approved health-related locations, up to 25 miles per trip |
In-Network: $0 Copay for 48 one-way trips to plan-approved health-related locations, up to 25 miles per trip |
| Dental Services* |
In-Network: $0 Copay for Preventive Dental Services and Medicare-covered dental services |
In-Network: $0 Copay for Preventive Dental Services and Medicare-covered dental services |
In-Network: $0 Copay for Preventive Dental Services and Medicare-covered dental services Your Cost with Medicare & Medi-Cal: $0 Copay† |
| Routine Eye Exam |
In-Network: $0 Copay for one exam and one refraction every year |
In-Network: $0 Copay for one exam and one refraction every year |
In-Network: $0 Copay for one exam and one refraction every year |
| Vision Eyewear (frames/lenses/contacts) |
In-Network: $350 Allowance every year |
In-Network: $350 Allowance every year |
In-Network: $350 Allowance every year |
| Routine Hearing Exam |
In-Network: $0 Copay for one exam and one fitting/evaluation every year |
In-Network: $0 Copay for one exam and one fitting/evaluation every year |
In-Network: $0 Copay for one exam and one fitting/evaluation every year |
| Hearing Aid |
In-Network: $149 Copay per TruHearing Advanced hearing aid (all models), up to 2 aids every 3 years |
In-Network: $149 Copay per TruHearing Advanced hearing aid (all models), up to 2 aids every 3 years |
In-Network: $149 Copay per TruHearing Advanced hearing aid (all models), up to 2 aids every 3 years |
| Personal Emergency Response System (PERS) |
In-Network: $0 Copay |
In-Network: $0 Copay |
| Prescription Drug Costs | Champion Compass | Champion Home | Champion Secure |
|---|---|---|---|
| Tier 1 - Preferred Generics (Participating Retail Pharmacy) |
In-Network: $0 Copay |
In-Network: $0 Copay Your Cost with Medicare & Medi-Cal: $0 Copay |
In-Network: $0 Copay Your Cost with Medicare & Medi-Cal: $0 Copay |
| Tier 1 - Preferred Generics (Mail Order) |
In-Network: $0 Copay |
In-Network: $0 Copay Your Cost with Medicare & Medi-Cal: $0 Copay |
In-Network: $0 Copay Your Cost with Medicare & Medi-Cal: $0 Copay |
| Tier 2 - Non-Preferred Generics (Participating Retail Pharmacy) |
In-Network: $5 Copay |
In-Network: $0 Copay Your Cost with Medicare & Medi-Cal: $0 Copay |
In-Network: $0 Copay Your Cost with Medicare & Medi-Cal: $0 Copay |
| Tier 2 - Non-Preferred Generics (Mail Order) |
In-Network: $10 Copay |
In-Network: $0 Copay Your Cost with Medicare & Medi-Cal: $0 Copay |
In-Network: $0 Copay Your Cost with Medicare & Medi-Cal: $0 Copay |
| Tier 3 - Preferred Brand (Participating Retail Pharmacy) |
In-Network: $47 Copay |
In-Network: 25% of the Cost Your Cost with Medicare & Medi-Cal: Generics: $0 or $1.65 or $5.80 Copay |
In-Network: 25% of the Cost Your Cost with Medicare & Medi-Cal: Generics: $0 or $1.65 or $5.80 Copay |
| Tier 3 - Preferred Brand (Mail Order) |
In-Network: $94 Copay |
In-Network: 25% of the Cost Your Cost with Medicare & Medi-Cal: Generics: $0 or $1.65 or $5.80 Copay |
In-Network: 25% of the Cost Your Cost with Medicare & Medi-Cal: Generics: $0 or $1.65 or $5.80 Copay |
| Tier 4 - Non-Preferred Brands (Participating Retail Pharmacy) |
In-Network: $100 Copay |
In-Network: 25% of the Cost Your Cost with Medicare & Medi-Cal: Generics: $0 or $1.65 or $5.80 Copay |
In-Network: 25% of the Cost Your Cost with Medicare & Medi-Cal: Generics: $0 or $1.65 or $5.80 Copay |
| Tier 4 - Non-Preferred Brands (Mail Order) |
In-Network: $200 Copay |
In-Network: 25% of the Cost Your Cost with Medicare & Medi-Cal: Generics: $0 or $1.65 or $5.80 Copay |
In-Network: 25% of the Cost Your Cost with Medicare & Medi-Cal: Generics: $0 or $1.65 or $5.80 Copay |
| Tier 5 - Specialty Drugs (Participating Retail Pharmacy) |
In-Network: 33% of the Cost |
In-Network: 25% of the Cost Your Cost with Medicare & Medi-Cal: Generics: $0 or $1.65 or $5.80 Copay |
In-Network: 25% of the Cost Your Cost with Medicare & Medi-Cal: Generics: $0 or $1.65 or $5.80 Copay |
| Tier 5 - Specialty Drugs (Mail Order) |
In-Network: A 100-day supply is not available in Tier 5 |
In-Network: A 100-day supply is not available in Tier 5 Your Cost with Medicare & Medi-Cal: Generics: $0 or $1.65 or $5.80 Copay |
In-Network: A 100-day supply is not available in Tier 5 Your Cost with Medicare & Medi-Cal: Generics: $0 or $1.65 or $5.80 Copay |
| Tier 6 - Select Care (Participating Retail Pharmacy) |
In-Network: $0 Copay |
In-Network: $0 Copay Your Cost with Medicare & Medi-Cal: $0 Copay |
In-Network: $0 Copay Your Cost with Medicare & Medi-Cal: $0 Copay |
| Tier 6 - Select Care (Mail Order) |
In-Network: $0 Copay |
In-Network: $0 Copay Your Cost with Medicare & Medi-Cal: $0 Copay |
In-Network: $0 Copay Your Cost with Medicare & Medi-Cal: $0 Copay |
| Insulin |
In-Network: At retail pharmacy locations, you won’t pay more than $35 for a one-month supply or $105 for a three-month supply of each insulin product covered by our plan on Tiers 2, 3 and 4. You will not pay more than $35 for a one-month supply of insulin on Tier 5. For mail order, you won’t pay more than $70 for a three month supply of each insulin product covered by our plan on Tiers 2, 3 and 4. Long term supplies of insulins in Tier 5 are not available through retail or mail order. |
In-Network: You won’t pay more than $35 for a one-month supply or $105 for a three-month supply of each insulin product covered by our plan on Tiers 3 and 4 and no more than $35 for a one-month supply of insulin on Tier 5, even if you haven’t paid your deductible. Your Cost with Medicare & Medi-Cal: Generics: $0 or $1.65 or $5.80 Copay |
In-Network: You won’t pay more than $35 for a one-month supply or $105 for a three-month supply of each insulin product covered by our plan on Tiers 3 and 4 and no more than $35 for a one-month supply of insulin on Tier 5, even if you haven’t paid your deductible. Your Cost with Medicare & Medi-Cal: Generics: $0 or $1.65 or $5.80 Copay |
| Plan Resources | Champion Compass | Champion Home | Champion Secure |
|---|---|---|---|
| Summary of Benefits | Download | Download | Download |
| Over-the-Counter Catalog | Download | Download | Download |
| Healthy Foods Catalog | Download | Download | Download |
| Dental Fee Schedule | Download | Download | Download |
| Clinical Criteria | Download | Download | Download |
| Verification of Chronic Condition Form | Download | Download | Download |
| Health Risk Assessment Form | Download | Download | Download |
| Enrollment Form | Download | Download | Download |
