Champion Ally (HMO)
Available to residents of San Bernardino County, CA for 2026. Contract H6170, plan 007, segment 0.
Plan details
| Monthly drug premium | $0.00 |
|---|---|
| Drug deductible | $0.00 |
| Plan type | Medicare Advantage |
| Contract / plan | H6170-007-0 |
| Offered by | Champion Heath Plan |
| Parent organization | Champion Health Plans-USA, LLC. |
| Formulary drugs | 3,250 |
CMS star ratings
- Overall
- —
- Health plan (Part C)
- —
- Drug plan (Part D)
- —
Published per contract — every plan under contract H6170 shares this rating.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 | $0.00 |
| Tier 2 | $3.00 |
| Tier 3 | $47.00 |
| Tier 4 | $100.00 |
| Tier 5 | 33% |
| Tier 6 | $0.00 |
Also available in 9 other CA counties
Plan facts come from the CMS quarterly prescription drug plan public use files.