Medicare Plan Lookup Official CMS data · Contract Year 2026
CMS 2026 data

2026 Medicare plan code

H6170-002

Medicare Plan

Champion Connect (HMO-POS C-SNP) · Champion Heath Plan · HMOPOS · Central & Southern California

Full CMS plan ID: H6170-002-000

H6170-002-000 is the full CMS identifier for the H6170-002 Medicare plan. Common searches include H6170 002 and H6170002.

Historical 2026 record. Benefits and service areas shown apply to that year.

2026

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2026 plan record

Champion Connect (HMO-POS C-SNP)

H6170-002-000 Central & Southern California HMOPOS Chronic or Disabling Condition

At-a-glance

Quick view

01

In-network

Inpatient hospital

inpatient copayment is selected but its amount is missing

02

Emergency transport

Ambulance

Ground · in-network$0–$125 copay
Air · in-network20% coinsurance

Ground ambulance: In-network: cost sharing varies by a CMS plan-defined group; Air ambulance: In-network: cost sharing varies by a CMS plan-defined group

03

Emergency services

Emergency room

$115 copay

Waived if admitted within 24 hours

04

Medical maximum

Maximum out-of-pocket

In-network$9,250
Combined in + out$9,250
05

Skilled care at home

Home health

In-network$0 copay
Out-of-networkNot separately reported
06

Monthly cost

Premium & giveback

Part C premium$0 / month
Consolidated C + D$0 / month

Plan details

All plan benefits

Medical care3 benefits

Primary care physician

Verify in plan documents
In-network$0 copay
Out-of-networkNot separately reported

Specialist

Verify in plan documents
In-network20% coinsurance
Out-of-networkNot separately reported

Preventive care

Verify in plan documents
In-network$0 copay
Out-of-networkNot separately reported
Diagnostics & imaging4 benefits

Diagnostic procedures & tests

Verify in plan documents
In-network20% coinsurance
Out-of-networkNot separately reported

Laboratory services

Verify in plan documents
In-network$0 copay
Out-of-networkNot separately reported

X-rays & standard imaging

Verify in plan documents
In-network20% coinsurance
Out-of-networkNot separately reported

MRI, CT & PET imaging

Verify in plan documents
In-network20% coinsurance
Out-of-networkNot separately reported
Urgent & hospital care6 benefits

Urgent care

In-networkCost share not reported
Out-of-networkNot separately reported

Emergency room

In-network$115 copay
Out-of-networkNot separately reported

Ground ambulance

Verify in plan documents
In-network$0–$125 copay
Out-of-networkNot separately reported

Air ambulance

Verify in plan documents
In-network20% coinsurance
Out-of-networkNot separately reported

Outpatient hospital

Verify in plan documents
In-network20% coinsurance
Out-of-networkNot separately reported

Outpatient surgery / ASC

Verify in plan documents
In-network$0 copay
Out-of-networkNot separately reported
Recovery & therapy5 benefits

Home health

Verify in plan documents
In-network$0 copay
Out-of-networkNot separately reported

Skilled nursing facility

In-networkCost share not reported
Out-of-networkNot separately reported

Cardiac & pulmonary rehabilitation

Verify in plan documents
In-network20% coinsurance
Out-of-networkNot separately reported

Occupational therapy

Verify in plan documents
In-network$0 copay
Out-of-networkNot separately reported

Physical & speech therapy

Verify in plan documents
In-network20% coinsurance
Out-of-networkNot separately reported
Behavioral health2 benefits

Mental health services

Verify in plan documents
In-network$0 copay
Out-of-networkNot separately reported

Substance use treatment

Verify in plan documents
In-network$0 copay
Out-of-networkNot separately reported
Specialty care2 benefits

Podiatry

Verify in plan documents
In-network20% coinsurance
Out-of-networkNot separately reported

Chiropractic

Verify in plan documents
In-network$0 copay
Out-of-networkNot separately reported
Supplemental benefits7 benefits

Dental

Verify in plan documents
In-networkCost share not reported
Out-of-networkNot separately reported

Vision

Verify in plan documents
In-network$0 copay
Out-of-networkNot separately reported

Hearing

Verify in plan documents
In-network$0 copay
Out-of-networkNot separately reported

Transportation

Verify in plan documents
In-networkVerify in plan documents
Out-of-networkNot separately reported

Fitness & wellness

In-networkCost share not reported
Out-of-networkNot separately reported

Over-the-counter allowance

Not reported in this CMS export

Not reported in this CMS export

Meals

Not reported in this CMS export

Not reported in this CMS export

Plan costs & rulesCoverage overview

Premium & Part B giveback

$0 Part C premium / month · Part B giveback not separately reported

Maximum out-of-pocket (MOOP)

In-network$9,250
Combined in + out$9,250

Medical deductibles

In-networkNot reported
Out-of-networkNot reported

Network & referrals

HMOPOS · Referrals: Required for some services · Out-of-network coverage: Not reported

Prescription drugs6 tiers

Part D deductible

Not reported

Drug tier 1

$0 retail copay · 30-day supply

Drug tier 2

$0 retail copay · 30-day supply

Drug tier 3

25% retail coinsurance · 30-day supply

Drug tier 4

25% retail coinsurance · 30-day supply

Drug tier 5

25% retail coinsurance · 30-day supply

Drug tier 6

$0 retail copay · 30-day supply

Using this plan

Understand H6170-002-000

Plain-language context built from this plan’s 2026 CMS record. It is a guide to the reported benefits, not a personalized cost estimate.

Plan at a glance

A quick read on this plan

Champion Connect (HMO-POS C-SNP) is a 2026 HMOPOS offered by Champion Heath Plan in Central & Southern California. Referrals are required for some services.

Common benefit costs

What you may pay

These are individual in-network benefit amounts. A real visit may involve more than one separately billed service.

Routine care

Primary care physician
$0 copay
Specialist
20% coinsurance
Laboratory services
$0 copay

Separate visits or services; costs are not added together.

Tests & outpatient care

Diagnostic procedures & tests
20% coinsurance
MRI, CT & PET imaging
20% coinsurance
Outpatient hospital
20% coinsurance

The service setting and billing details can change what you pay.

Emergency & hospital care

Emergency room
$115 copay

Actual costs depend on the care received and plan rules.

Helpful context

Terms worth knowing

Maximum out-of-pocket (MOOP)

This is the most you generally pay during the plan year for covered Part A and Part B medical services under the applicable network limit. Premiums and prescription drug costs generally do not count toward it.

Availability

Who can enroll

Service area
Central & Southern California (CA)
Plan type
HMOPOS
Special Needs Plan
Chronic or Disabling Condition
Contract / plan
H6170-002
Coverage year
2026

This is a Chronic or Disabling Condition; enrollment requires the plan's specific eligibility criteria as well as residence in its service area. Confirm eligibility and the exact service area with the plan before enrolling.

Supplemental coverage

Extra benefits reported

Availability is summarized here; allowances, frequency limits, networks, and prior-authorization rules may apply.

DentalCost share not reported
Vision$0 copay
Hearing$0 copay
Fitness & wellnessCost share not reported
TransportationVerify in plan documents

Plan-specific answers

Frequently asked questions

Where is H6170-002-000 available?

Champion Connect (HMO-POS C-SNP) is listed for Central & Southern California (CA). This is a Chronic or Disabling Condition; enrollment requires the plan's specific eligibility criteria as well as residence in its service area.

What is the in-network maximum out-of-pocket limit for H6170-002-000?

The 2026 CMS record lists an in-network medical maximum out-of-pocket limit of $9,250. Prescription drug spending generally does not count toward this medical limit.

What is the monthly plan premium for H6170-002-000?

The listed consolidated Part C and Part D premium is $0 per month. This does not replace the standard Medicare Part B premium.

What does an emergency room visit cost on H6170-002-000?

The plan record lists $115 copay, waived when an admission meets the plan's stated timing rule.

Does H6170-002-000 report extra benefits?

Yes. CMS reports dental, vision, hearing, fitness & wellness, transportation. See the detailed benefit rows and official plan documents for limits and conditions.

Source trail

Official CMS, Contract Year 2026

Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release; county identity is sourced from segment-level Landscape rows and stable codes are enriched from the aligned MA contract service-area release where matched. Quick-reference values should be confirmed in 2026 official plan documents.

PBP benefits ↗ Landscape data ↗ County service area ↗

Plan context

Where H6170-002-000 fits

Full CMS plan ID
H6170-002-000
Contract
H6170
Base plan code
H6170-002
Segment
000
Carrier
Champion Heath Plan
Plan type
HMOPOS
Service area
Central & Southern California (CA)

County/service-area foundation

CMS service-area entries

Named county entries are tied to this exact contract, plan, and segment in CMS Landscape data. County codes are enriched from the aligned CMS contract service-area release where a match exists.

  • Fresno, CA
  • Imperial, CA
  • Kern, CA
  • Los Angeles, CA
  • Los Angeles, CA
  • Madera, CA
  • Orange, CA
  • Riverside, CA
  • San Bernardino, CA
  • San Diego, CA

Same CMS contract

H6170-001-000 Champion Advantage (HMO-POS C-SNP) Central & Southern California · HMOPOS H6170-003-000 Champion Select (HMO-POS C-SNP) Central & Southern California · HMOPOS H6170-007-000 Champion Ally (HMO) Central & Southern California · HMO H6170-008-000 Champion Care (HMO C-SNP) Central & Southern California · HMO H6170-009-000 Champion Choice (HMO C-SNP) Central & Southern California · HMO H6170-010-000 Champion Plus (HMO C-SNP) Central & Southern California · HMO

About this code

What H6170-002-000 identifies

H6170-002-000 is a Contract Year 2026 Medicare plan segment code. Searches written as H6170-002, H6170 002, or the compact full CMS ID H6170002000 refer to this plan or its base plan code.

Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.