Champion Advantage (HMO-POS C-SNP) Costs & Coverage, Clark County, Nevada
Champion Advantage (HMO-POS C-SNP) Costs & Coverage, Clark County, Nevada
Uncover the tailored benefits and costs of Champion Advantage (HMO-POS C-SNP), a 2025 Medicare Special Needs Plan crafted to support your specific healthcare requirements. Dive into this detail page to see how this Champion Health Plan SNP can support your specific health conditions or financial circumstances.
Available in Clark County, NV, to qualified beneficiaries, Champion Advantage 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.
- Doctor Visits
- Foot Care
- Chiropractic
- Urgent & Emergency
- Mental Health
- Rehab Services
- Equipment & Supplies
- Diag, Lab, Imaging
- Part B Drugs
- Dental
- Hearing Aids
- Vision
- Prescriptions
| Plan ID H6474-001-0 Overview | |
|---|---|
| Health Plan ID: | H6474-001-0 |
| Medicare Advantage Plan Type: | HMO-POS C-SNP |
| Plan Year: | 2025 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | 499.00 |
| Part B Give Back: | $0.00/mo |
| Part D Drug Plan Benefit: | Enhanced, $0.00 deductible |
| Supplemental Benefits: | Vision, Hearing |
| Availability: | Clark County, NV |
| Insured By: | Champion Health Plan |
| We're Here to Help You Enroll |
|---|
Health Plan Cost Sharing & Benefits
Champion Advantage is an HMO-POS (Point-of-Service) plan. While HMO-POS {plan_type_2} plans share many features with traditional Health Maintenance Organization (HMO) plans, they offer greater flexibility by allowing members to access healthcare providers outside the network for certain services. Typically, a referral from your physician is required to go out of network. Additionally, there are separate deductibles for in-network and out-of-network services.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | $0 Copay |
| Specialist: | $0 Copay Prior Authorization Required |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| 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 |
This section covers Medicare-approved foot care services, including exams and routine foot care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Foot Exams and Treatments (Medicare-covered): | $0 Copay Prior Authorization Required, Referral Required |
| Routine Foot Care: | Not Covered |
Understand the coverage for Medicare-approved chiropractic services and routine chiropractic care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Medicare-covered chiropractic: | $0 Copay |
| Routine chiropractic: | $0 Copay |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| 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 |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | $0 Copay Prior Authorization Required, Referral Required |
| Occupational therapy: | $0 Copay Prior Authorization Required, Referral Required |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | $0 Copay |
| Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
| Prosthetics: | 20% Coinsurance |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| 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 |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | 20% Coinsurance |
| Other Part B drugs (Medicare-covered): | 20% Coinsurance |
This section details the dental services covered under your plan including, Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| 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 |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Fitting/evaluation | $0 Copay |
| Hearing aids | Covered Limits may apply |
| Hearing exam | $0 Copay |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Medicare-covered eye exam (in-network) | $0 Copay |
| Routine eye exam (in-network) | $0 Copay 1 Every year |
| Eyewear benefits | Eyeglasses: Yes Contact Lenses: No Eyeglass Lenses: No Eyeglass Frames: No Eyewear Upgrades: No |
Maximum eyewear benefit: | $335.00 Every year |
Prescription Drug Plan Costs & Benefits
Prescription Drug Plan Premium
The following table outlines the prescription drug plan premium details of this plan.
| Basic Part D Premium: | $0.00 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $0.00 |
| Low Income Premium Subsidy: | $21.30 |
| Low Income Premium Subsidy CMS Pays: | $0.00 |
| Low Income Subsidy Premium: | $0.00 |
For more information about the Low Income Subsidy, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $0.00. This is the amount you must pay at the pharmacy before Champion Health Plan begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Champion Advantage has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
| 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 | |
| *Deductible does not apply. | |||
CMS Rating Marks
Each year, Medicare Advantage {plan_type_2}s are rated by the Centers for Medicare & Medicaid Services (CMS) across nine categories using a 5-star system. These star ratings are designed to help you assess the quality of care and service offered by this Champion Health 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 |
Eligibility Criteria for Enrolling in Champion Advantage
To enroll in Champion Advantage , you must meet the following criteria:
- You are eligible for Medicare;
- You reside within the plan’s service area; and
- You have been diagnosed with one or more severe or disabling chronic conditions.
This plan is for individuals requiring dialysis (any mode of dialysis).
Medicare Special Needs Plan Enrollment Periods
After confirming your eligibility for Champion Advantage , it’s essential to understand when you can enroll or make changes to your Medicare plan. The following enrollment periods are important to understand and mark on your calendar
- Initial Enrollment Period (IEP): The first time you can enroll in Medicare, typically around your 65th birthday.
- Annual Enrollment Period (AEP): Occurs yearly and allows you to make changes to your Medicare coverage.
- Special Enrollment Periods (SEPs): Special circumstances, such as moving or losing other coverage, may qualify you to enroll outside of the usual periods.
For more details on enrollment periods, you can learn more here and make sure you’re well-informed about your Medicare choices.
Contact Champion Health Plan
| Website: | Champion Health Plan Plan Page |
|---|---|
| Providers: | Champion Health Plan Providers Page |
| Formulary: | Champion Health Plan Formulary Page |
| Pharmacy: | Champion Health Plan Pharmacy Page |
| 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.
Plans Offered through Medicare.org
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.