Champion Home (HMO C-SNP)
Available to residents of Kern County, CA for 2027. Contract H6170, plan 016, segment 0.
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- Plan health benefits
- Benefits in plain text
- Rx cost-sharing for all pharmacies and tiers
- Other plans in Kern County
- Plan website
- Browse the Champion Home (HMO C-SNP) formulary
2027 drug-by-drug coverage is not published by CMS yet. The drug lookup covers 2026, whose formulary is live.
New for 2027. This plan has no 2026 predecessor in the CMS crosswalk. Every CA plan’s 2026–2027 changes →
Plan details
| Monthly premium (Part C + D) | $0.00 |
|---|---|
| — medical (Part C) part | $0.00 |
| — drug (Part D) part | $0.00? |
| Monthly premium with full Extra Help (LIS) | $0.00? |
| Part B premium reduction (giveback) | None |
| In-network out-of-pocket maximum | $9,850.00? |
| Drug deductible | $700.00Tier 1, 2 and 6 exempt |
| Drug out-of-pocket threshold | $2,400.00 |
| Plan type | HMO C-SNP? |
| Special needs plan | Chronic-condition SNP |
| Qualifying condition | CardiovascularDisorders,ChronicHeartFailure,DiabetesMellitus |
| Contract / plan | H6170-016-0 |
| Offered by | Champion Heath Plan |
| Parent organization | Champion Health Plans-USA, LLC. |
| Formulary tiers | 6 |
| Formulary exception tier | 4? |
| Pharmacy search | www.championhmo.com |
| Member services | (800)885-8000TTY 711 |
CMS star ratings
- Overall
- —
- Health plan (Part C)
- —
- Drug plan (Part D)
- —
Published per contract — every plan under contract H6170 shares this rating.
Plan health benefits
| Service | In-network |
|---|---|
| Doctor visits | |
| Primary care doctor | $0 copay |
| Specialist | 20% coinsurance(authorization required) |
| Other health care professional | 20% coinsurance(authorization and referral required) |
| Additional telehealth services | $0 copay |
| Preventive care | |
| Medicare-covered preventive services | $0 copay |
| Annual physical exam | $0 copay(authorization required) |
| Kidney disease education | $0 copay(authorization and referral required) |
| Glaucoma screening | $0 copay |
| Diabetes self-management training | $0 copay |
| Diagnostic tests, labs and imaging | |
| Diagnostic tests and procedures | 20% coinsurance(authorization and referral required) |
| Lab services | $0 copay(authorization and referral required) |
| Diagnostic radiology (e.g. MRI, CT) | 20% coinsurance |
| Therapeutic radiology | 20% coinsurance |
| Outpatient x-rays | $0 copay |
| Emergency and urgent care | |
| Emergency room | $115 copay |
| Urgent care | $0 copay |
| Worldwide emergency coverage | Not covered |
| Worldwide urgent care | Not covered |
| Worldwide emergency transportation | Not covered |
| Hospital care | |
| Inpatient hospital stay | Original Medicare cost-sharing(authorization and referral required) |
| Outpatient hospital services | 20% coinsurance(authorization and referral required) |
| Outpatient observation | 20% coinsurance(authorization and referral required) |
| Ambulatory surgical center | 20% coinsurance(authorization and referral required) |
| Outpatient blood services | $0 copay |
| Skilled nursing and home health | |
| Skilled nursing facility | $0 per day for days 1–20; $221 per day for days 21–100(authorization and referral required) |
| Home health care | $0 copay(authorization and referral required) |
| Kidney dialysis | 20% coinsurance |
| Rehabilitation | |
| Occupational therapy | $0 copay(authorization and referral required) |
| Physical therapy and speech-language therapy | $0 copay(authorization and referral required) |
| Cardiac rehabilitation | 20% coinsurance(authorization and referral required) |
| Pulmonary rehabilitation | 20% coinsurance(authorization and referral required) |
| Mental health and substance use | |
| Inpatient psychiatric hospital stay | Original Medicare cost-sharing(authorization and referral required) |
| Outpatient mental health, individual session | $0 copay(authorization and referral required) |
| Outpatient mental health, group session | $0 copay(authorization and referral required) |
| Psychiatrist, individual session | $0 copay(authorization and referral required) |
| Psychiatrist, group session | $0 copay(authorization and referral required) |
| Partial hospitalization | $0 copay(authorization and referral required) |
| Intensive outpatient program | $0 copay |
| Outpatient substance use, individual session | $0 copay(authorization and referral required) |
| Outpatient substance use, group session | $0 copay(authorization and referral required) |
| Opioid treatment program | 20% coinsurance(authorization and referral required) |
| Ambulance and transportation | |
| Ground ambulance | $0–$125 copay; 0%–20% coinsurance(authorization required) |
| Air ambulance | 20% coinsurance(authorization required) |
| Transportation to plan-approved locations | $0 copay(limits apply) |
| Medical equipment and supplies | |
| Durable medical equipment (e.g. wheelchairs, oxygen) | 20% coinsurance(authorization required) |
| Prosthetics (e.g. braces, artificial limbs) | 20% coinsurance(authorization required) |
| Medical supplies | 20% coinsurance(authorization required) |
| Diabetes supplies | $0 copay |
| Diabetic therapeutic shoes or inserts | $0 copay |
| Chiropractic, acupuncture and foot care | |
| Chiropractic (Medicare-covered) | $0 copay |
| Routine chiropractic care | Not covered |
| Acupuncture | Not covered |
| Foot exams and treatment (Medicare-covered) | 20% coinsurance(authorization and referral required) |
| Routine foot care | Not covered |
| Dental? | |
| Medicare-covered dental services | $0 copay |
| Preventive dental plan limit | $3,000 plan limit every year |
| Oral exams | $0 copay(limits apply) |
| Cleanings | $0 copay(limits apply) |
| Fluoride treatment | $0 copay(limits apply) |
| Dental x-rays | $0 copay(limits apply) |
| Other diagnostic dental services | $0 copay(limits apply) |
| Other preventive dental services | $0 copay |
| Endodontics (root canals) | 20% coinsurance(authorization and referral required, limits apply) |
| Periodontics (gum disease) | 20% coinsurance(authorization and referral required) |
| Dentures and other removable prosthodontics | 40% coinsurance(authorization and referral required) |
| Maxillofacial prosthetics | Not covered |
| Implants | Not covered |
| Bridges and other fixed prosthodontics | 40% coinsurance |
| Oral and maxillofacial surgery | 20% coinsurance(authorization and referral required, limits apply) |
| Orthodontics | Not covered |
| Adjunctive general services | Not covered |
| Vision? | |
| Eye exam (Medicare-covered) | $0 copay |
| Routine eye exam | $0 copay(limits apply) |
| Eyewear after cataract surgery (Medicare-covered) | $0 copay(limits apply) |
| Eyewear plan limit | $350 plan limit every year |
| Contact lenses | Not covered |
| Eyeglasses (frames and lenses) | $0 copay(limits apply) |
| Eyeglass lenses | Not covered |
| Eyeglass frames | Not covered |
| Eyewear upgrades | $0 copay(limits apply) |
| Hearing? | |
| Hearing exam (Medicare-covered) | $0 copay |
| Routine hearing exam | $0 copay(limits apply) |
| Hearing aid fitting and evaluation | $0 copay |
| Hearing aids (all types) | $149 copay(limits apply) |
| Hearing aids, inner ear | Not covered |
| Hearing aids, outer ear | Not covered |
| Hearing aids, over the ear | Not covered |
| Medicare Part B drugs | |
| Part B insulin | $0–$35 copay(authorization required) |
| Chemotherapy and radiation drugs | 0%–20% coinsurance(authorization required) |
| Other Part B drugs | 0%–20% coinsurance(authorization required) |
| Other extra benefits? | |
| Over-the-counter (OTC) allowance | Not covered |
| Meals after a hospital stay or for a chronic condition | Not covered |
| Fitness benefit | Not covered |
| Health education | $0 copay |
| Nutritional / dietary benefit | Not covered |
| Extra smoking and tobacco cessation counseling | Not covered |
| Enhanced disease management | Not covered |
| Telemonitoring | Not covered |
| Remote access technologies (web/phone, nurse line) | $0 copay |
| Home and bathroom safety devices | Not covered |
| Counseling services | Not covered |
| In-home safety assessment | Not covered |
| Personal emergency response system (PERS) | $0 copay |
| Medical nutrition therapy | Not covered |
| Post-discharge in-home medication reconciliation | Not covered |
| Re-admission prevention | Not covered |
| Wigs for hair loss from chemotherapy | Not covered |
| Weight management programs | Not covered |
| Alternative therapies | Not covered |
| Therapeutic massage | Not covered |
| Adult day health services | Not covered |
| Home-based palliative care | Not covered |
| In-home support services | Not covered |
| Support for caregivers | Not covered |
In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2027). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed. Contact the plan for the full Evidence of Coverage.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 · Preferred Generic | $0.00 |
| Tier 2 · Generic | $0.00 |
| Tier 3 · Preferred Brand | 25% |
| Tier 4 · Non-Preferred Brand | 25% |
| Tier 5 · Specialty Tier | 25% |
| Tier 6 · Select Care Drugs | $0.00 |
Rx cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | n/a | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | n/a | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | 25% | 25% | n/a | 25% | 25% | 25% |
| Tier 4: Non-Preferred Brand | 25% | 25% | n/a | 25% | 25% | 25% |
| Tier 5: Specialty Tier | 25% | 25% | n/a | n/a | n/a | n/a |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | n/a | $0.00 | $0.00 | $0.00 |
These are the initial coverage phase amounts, as the plan filed them in its benefit package. The deductible and post-threshold phases are not stated per tier in that filing, so they are not shown here rather than being inferred; the plan's annual out-of-pocket threshold is $2,400.00.
Star rating measures
| Measure | 2027 | 2026 |
|---|---|---|
| Managing Chronic (Long Term) Conditions | ||
| Special Needs Plan (SNP) Care Management · C07 | 1 out of 5 stars for Special Needs Plan (SNP) Care Management | 1 out of 5 stars for Special Needs Plan (SNP) Care Management |
| Care for Older Adults – Medication Review · C08 | 1 out of 5 stars for Care for Older Adults – Medication Review | no data |
| Care for Older Adults - Functional Status Assessment · C09 | 2 out of 5 stars for Care for Older Adults - Functional Status Assessment | new measure |
| Health Plan Customer Service | ||
| Plan Makes Timely Decisions about Appeals · C30 | 1 out of 5 stars for Plan Makes Timely Decisions about Appeals | not enough data |
| Reviewing Appeals Decisions · C31 | 1 out of 5 stars for Reviewing Appeals Decisions | not enough data |
| Call Center – Foreign Language Interpreter and TTY Availability · C32 | 2 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability | 3 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability |
| DD1: Drug Plan Customer Service | ||
| Call Center – Foreign Language Interpreter and TTY Availability · D01 | 3 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability | 3 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability |
| DD4: Drug Safety and Accuracy of Drug Pricing | ||
| MPF Price Accuracy · D07 | 5 out of 5 stars for MPF Price Accuracy | 5 out of 5 stars for MPF Price Accuracy |
Measures are paired between the two years by name, not by the C/D number: CMS reuses those numbers, and in 2027 nineteen of them refer to a different measure than they did in 2026. A measure introduced for 2027 has no 2026 score to show. Published per contract — every plan under H6170 shares it.
Also available in 9 other CA counties
Benefits in plain text
Champion Home (HMO C-SNP) (H6170-016-0) is a 2027 HMO C-SNP Medicare Advantage plan offered by Champion Heath Plan, available to residents of Kern County, CA.
The monthly premium is $0.00.
With full Extra Help (the Low-Income Subsidy), the total monthly premium is $0.00.
Its in-network out-of-pocket maximum is $9,850.00.
The drug deductible is $700.00. Tier 1, 2 and 6 exempt.
It is a special needs plan (Chronic-condition SNP).
At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1 (Preferred Generic): $0.00; tier 2 (Generic): $0.00; tier 3 (Preferred Brand): 25%; tier 4 (Non-Preferred Brand): 25%; tier 5 (Specialty Tier): 25%; tier 6 (Select Care Drugs): $0.00.
Email a copy of the plan benefit details
Plan facts come from the CMS plan Landscape file and the CMS plan benefit package (PBP) files.