Champion Connect (HMO-POS C-SNP) Medicare Special Need Plan H6170-002 • 2027
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $9850.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $700.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 232 beneficiaries
Introduction
CMS Plan ID H6170-002 identifies Champion Connect, a Medicare Advantage Chronic Condition Special Needs Plan (C-SNP) offered by Champion Heath Plan. Its provider network is a Health Maintenance Organization with a Point of Service (HMO-POS), and Medicare Part D prescription drug coverage is included. For 2027, the plan has a $0.00 monthly premium, $0.00 medical deductible, and $9850.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $700.00.
Enrollment across the plan's service areas totals 232 beneficiaries, according to CMS. Enrollment is limited to beneficiaries who live within the plan's service area: See List.
Eligibility
Champion Connect is a Chronic Condition Special Needs Plan (C-SNP) designed for people with qualifying health conditions.
- Special Needs Plan Type
- Chronic Condition Special Needs Plan (C-SNP)
- Medicare Requirement
- Must have Medicare Part A and Part B
- Special Needs Requirement
- This plan is for individuals with chronic kidney disease.
- Service Area Requirement
- Must live in the plan's service area
- Prescription Drug Coverage
- Medicare Part D prescription drug coverage is included.
Plan Benefits
Champion Connect has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H6170-002.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Specialist | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
In-network: 20% coinsurance Out-of-network: 20% coinsurance |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay |
| Telehealth benefit | In-network: $0 copay | In-network: $0 copay |
| Routine chiropractic | In-network: $0 copay | Not covered |
| Fitness benefits | Coming soon | In-network: $0 copay |
| Health education | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Counseling services | Not covered | Not covered |
| Over-the-counter drug benefits | Not covered | Not covered |
| Health transportation (non-emergency) | Coming soon | In-network: $0 copay Out-of-network: $0 copay |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
In-network: 20% coinsurance Out-of-network: 20% coinsurance |
| Lab services | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Outpatient x-rays | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Diagnostic tests and procedures | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
In-network: 20% coinsurance Out-of-network: 20% coinsurance |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $115 copay | $115 copay |
| Worldwide emergency care | Coming soon | $0 copay |
| Urgent care | $0 copay | $0 copay |
| Inpatient hospital care | In-network: Tier 1 $0 per day for days 1-60 $434 per day for days 61-90 $868 per day for days 91-150 |
In-network: Tier 1 $0 per day for days 1-60 $419 per day for days 61-90 $838 per day for days 91-150 |
| Skilled Nursing Facility | In-network: Tier 1 $0 per day for days 1-20 $221 per day for days 21-100 |
In-network: Tier 1 $0 per day for days 1-20 $218 per day for days 21-100 |
| Ground ambulance | In-network: $0-$125 copay, 0%-20% coinsurance Out-of-network: $0 copay, 20% coinsurance |
In-network: $0-$125 copay Out-of-network: $0-$125 copay |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Outpatient group therapy | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Inpatient psychiatric hospital care | In-network: Tier 1 $0 per day for days 1-60 $434 per day for days 61-90 $868 per day for days 91-150 |
In-network: Tier 1 $0 per day for days 1-60 $419 per day for days 61-90 $838 per day for days 91-150 |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: 20% coinsurance Out-of-network: 20% coinsurance |
| Occupational therapy | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Durable medical equipment | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 0%-20% coinsurance |
| Prosthetics | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 0%-20% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance Out-of-network: 0%-20% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered) | In-network: 0%-20% coinsurance Out-of-network: 0%-20% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 0%-20% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay | In-network: $0 copay |
| Dental x-rays | In-network: $0 copay | In-network: $0 copay |
| Cleaning | In-network: $0 copay | In-network: $0 copay |
| Periodontics | In-network: 20% coinsurance | In-network: 20% coinsurance |
| Endodontics | In-network: 20% coinsurance | In-network: 20% coinsurance |
| Restorative services | In-network: 20%-40% coinsurance | In-network: 20%-40% coinsurance |
| Implant services | Not covered | Not covered |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | In-network: 20% coinsurance | In-network: 20% coinsurance |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Contact lenses | Not covered | Not covered |
| Eyeglass frames only | Not covered | Not covered |
| Eyeglass lenses only | Not covered | Not covered |
| Eyeglasses (frames & lenses) | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Upgrades | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Fitting/evaluation | In-network: $0 copay | In-network: $0 copay Out-of-network: $0 copay |
| Prescription hearing aids | In-network: $149 copay | In-network: $149 copay |
| OTC hearing aids | Not covered | Not covered |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Not covered |
| Home-based palliative care | Not covered | Not covered |
| Personal emergency response system | Coming soon | In-network: $0 copay |
| Weight management programs | Not covered | Not covered |
| Wigs for chemotherapy-related hair loss | Coming soon | Not covered |
| Alternative therapies | Not covered | Not covered |
| Massage therapy | Not covered | Not covered |
| Home/bathroom safety devices | In-network: $0 copay | In-network: $0 copay |
Certain preventive services are covered 100% by Champion Connect as a Part B benefit.
Prescription Drug Coverage
Champion Connect includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | ($8.60) |
| Supplemental Part D Premium: | $8.60 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $7.28 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $700.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Champion Heath Plan starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Champion Connect may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | $0.00 copay |
| Generic | $0.00 copay | $0.00 copay |
| Preferred Brand | 25% coinsurance | 25% coinsurance |
| Non-Preferred Brand | 25% coinsurance | 25% coinsurance |
| Specialty Tier | 25% coinsurance | 25% coinsurance |
| Select Care Drugs | $0.00 copay | $0.00 copay |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H6170)
Medicare assigns star ratings to plans based on quality and performance across multiple measures, including customer service, member experience, and health outcomes. Ratings are updated annually by the Centers for Medicare & Medicaid Services (CMS) and are shown on a 1 to 5 star scale, with 5 stars representing the highest quality.
| CMS Measure | Star Rating |
|---|---|
| 2027 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 |
Contact Information for Champion Heath Plan
- Website
- Champion Heath Plan Plan Page
- Providers
- Champion Heath Plan Providers Page
- Formulary
- Champion Heath Plan Formulary Page
- Pharmacy
- Champion Heath 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
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Plan Availability
Champion Connect (H6170-002-0) is available in the following locations (click to open):
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Champion Heath Plan (official source) | http://www.championhmo.com | October 4, 2026 |
| CMS.gov | Chronic Condition Special Needs Plans (C-SNPs) | April 28, 2026 |
| Medicare.gov | Understanding Medicare Advantage Plans | April 28, 2026 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | April 28, 2026 |
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