Extra Benefits Beyond Original Medicare; No Qualifying Condition Needed
MAPD HMO
Champion AnWell
Medicare or Medicare and Medi-Cal
Enroll NowCalifornia
Orange County, California Medicare Advantage Plan
Champion Health Plan has a general Medicare Advantage plan for individuals who reside in Orange County, California who want strong coverage and extra benefits without needing a special condition to qualify. Available for individuals with Medicare only or Medicare and Medi-Cal.
California Counties Available
- Orange County
| Doctor & Care Cost | Champion AnWell |
|---|---|
| Monthly Premium |
In-Network: $0 |
| Annual Plan Deductible |
In-Network: No Deductible |
| Annual Maximum Out of Pocket (MOOP) |
In-Network: $499 |
| Primary Care Physician |
In-Network: $0 Copay |
| Specialists* |
In-Network: $0 Copay |
| Diagnostic Radiology, Labs* |
In-Network: $0 Copay |
| Annual Physical Exam |
In-Network: $0 Copay for one exam per year |
| Dialysis |
In-Network: 20% of the Cost |
| Urgent Care |
In-Network: $0 Copay |
| Emergency Care |
In-Network: $150 Copay |
| Worldwide Emergency Care |
In-Network: $0 Copay for up to $100,000 maximum Worldwide benefit limit reimbursable by the plan not to exceed 60% of local Medicare rates. Combined with Worldwide Urgently Needed Care. |
| Inpatient Hospital* |
In-Network: $0 Per Stay |
| Outpatient Hospital* |
In-Network: $100 Copay for outpatient hospital services |
| Plan Benefits | Champion AnWell |
|---|---|
| Healthy Foods / Over-the-Counter Items / Utilities Benefit |
In-Network: $270 Allowance every 3 months. $0 Copay for quarterly allowance to use for healthy foods and produce, over-the-counter items, and/or assistance with utilities. |
| Transportation |
In-Network: $0 Copay for 60 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 |
| Routine Eye Exam |
In-Network: $0 Copay for one exam and one refraction every year |
| Vision Eyewear (frames/lenses/contacts) |
In-Network: $350 Allowance every year |
| Routine Hearing Exam |
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 |
| Respite |
In-Network: $0 Copay for up to 12 four-hour sessions with Helper Bees |
| Personal Emergency Response System (PERS) |
In-Network: $0 Copay |
| Prescription Drug Costs | Champion AnWell |
|---|---|
| Tier 1 - Preferred Generics (Participating Retail Pharmacy) |
In-Network: $0 Copay |
| Tier 1 - Preferred Generics (Mail Order) |
In-Network: $0 Copay |
| Tier 2 - Non-Preferred Generics (Participating Retail Pharmacy) |
In-Network: $5 Copay |
| Tier 2 - Non-Preferred Generics (Mail Order) |
In-Network: $10 Copay |
| Tier 3 - Preferred Brand (Participating Retail Pharmacy) |
In-Network: $47 Copay |
| Tier 3 - Preferred Brand (Mail Order) |
In-Network: $94 Copay |
| Tier 4 - Non-Preferred Brands (Participating Retail Pharmacy) |
In-Network: $100 Copay |
| Tier 4 - Non-Preferred Brands (Mail Order) |
In-Network: $200 Copay |
| Tier 5 - Specialty Drugs (Participating Retail Pharmacy) |
In-Network: 33% of the Cost |
| Tier 5 - Specialty Drugs (Mail Order) |
In-Network: A 100-day supply is not available in Tier 5 |
| Tier 6 - Select Care (Participating Retail Pharmacy) |
In-Network: $0 Copay |
| Tier 6 - Select Care (Mail Order) |
In-Network: $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. |
