CCHP Senior Value Program (HMO) is a Medicare Advantage (Part C) Plan by CCHP (Chinese Community Health Plan).
This page features plan details for 2024 CCHP Senior Value Program (HMO) H0571 – 007 – 0 available in Counties: SF, SM.
IMPORTANT: This page has been updated with plan and premium data for 2024.
CCHP Senior Value Program (HMO) is offered in the following locations.
CCHP Senior Value Program (HMO) offers the following coverage and cost-sharing.
Insurer: | CCHP (Chinese Community Health Plan) |
Health Plan Deductible: | $0.00 |
MOOP: | $7,550 In-network |
Drugs Covered: | Yes |
Ready to sign up for CCHP Senior Value Program (HMO) ?
Part B | Part C | Part D | Part B Give Back | Total |
---|---|---|---|---|
$174.70 | $0.00 | $0.00 | $0.00 | $174.70 |
CCHP Senior Value Program (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
Drug Deductible: | $0.00 |
Initial Coverage Limit: | $5,030.00 |
Catastrophic Coverage Limit: | $8,000.00 |
Drug Benefit Type: | Enhanced Alternative |
Additional Gap Coverage: | |
Formulary Link: | Formulary Link |
The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.
The table below shows how the LIS impacts the Part D premium of this plan.
Part D | LIS Full |
---|---|
$0.00 | $ |
NOTE: The Inflation Reduction Act of 2022 has expanded full subsidy eligibility under the LIS program to individuals with incomes up to 150% of the Federal Poverty Level. People who qualify for Extra Help generally will pay no more than $4.50 for each generic drug and $11.20 for each brand-name drug.
After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00. Once you reach that amount, you will enter the next coverage phase.
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $0.00 copay | $5.00 copay | ||
2 (Generic) | $12.00 copay | $12.00 copay | ||
3 (Preferred Brand) | $47.00 copay | $47.00 copay | ||
4 (Non-Preferred Drug) | $100.00 copay | $100.00 copay | ||
5 (Specialty Tier) | 31% | 31% | 31% |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | ||||
2 (Generic) | ||||
3 (Preferred Brand) | ||||
4 (Non-Preferred Drug) | ||||
5 (Specialty Tier) |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $0.00 copay | $15.00 copay | $10.00 copay | |
2 (Generic) | $24.00 copay | $36.00 copay | $24.00 copay | |
3 (Preferred Brand) | $94.00 copay | $141.00 copay | $94.00 copay | |
4 (Non-Preferred Drug) | $200.00 copay | $300.00 copay | $200.00 copay | |
5 (Specialty Tier) |
After your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00, you will pay no more than the amounts below for any drug tier until you reach $8,000.00.
Tier | Cost |
---|---|
All other tiers (Generic) | 25% |
All other tiers (Brand-name) | 25% |
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $8,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.
CCHP Senior Value Program (HMO) also provides the following benefits.
$0 |
In-network | No |
$7,550 In-network |
Yes |
In-network | No |
$230-310 copay per visit (Authorization is required.) (Referral is required.) |
Primary | $0-5 copay per visit (Not applicable.) (Not applicable.) |
Specialist | $20 copay per visit (Authorization is required.) (Referral is required.) |
$0 copay (Authorization is required.) (Referral is required.) |
Emergency | $90 copay per visit (always covered) (Not applicable.) (Not applicable.) |
Urgent care | $45 copay per visit (always covered) (Not applicable.) (Not applicable.) |
Diagnostic tests and procedures | $0 copay (Authorization is required.) (Referral is required.) |
Lab services | $0 copay (Authorization is required.) (Referral is required.) |
Diagnostic radiology services (e.g., MRI) | $200 copay (Authorization is required.) (Referral is required.) |
Outpatient x-rays | $0 copay (Authorization is required.) (Referral is required.) |
Hearing exam | $20 copay (Authorization is not required.) (Referral is not required.) |
Fitting/evaluation | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Hearing aids | $600-2,075 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Oral exam | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Cleaning | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Fluoride treatment | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Dental x-ray(s) | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Non-routine services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Diagnostic services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Restorative services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Endodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Periodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Extractions | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Prosthodontics, other oral/maxillofacial surgery, other services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Routine eye exam | $35 copay (Limits may apply.) (Authorization is required.) (Referral is required.) |
Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Contact lenses | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Eyeglass frames | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Eyeglass lenses | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Upgrades | Not covered (Not applicable.) (Not applicable.) |
Occupational therapy visit | $20 copay (Authorization is required.) (Referral is required.) |
Physical therapy and speech and language therapy visit | $20 copay (Authorization is required.) (Referral is required.) |
$265 copay (Not applicable.) (Not applicable.) |
$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Foot exams and treatment | $20 copay (Authorization is required.) (Referral is required.) |
Routine foot care | Not covered (Not applicable.) (Not applicable.) |
Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
Diabetes supplies | $0 copay (Authorization is not required.) (Not applicable.) |
Covered (Authorization is not required.) (Referral is not required.) |
Chemotherapy | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
Other Part B drugs | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
Part B Insulin drugs | $35 copay (Authorization is required.) (Not applicable.) |
Tier 1 $150 per day for days 1 through 7 $0 per day for days 8 through 90 Tier 2 $315 per day for days 1 through 7 $0 per day for days 8 through 90 (Authorization is required.) (Referral is required.) |
Inpatient hospital – psychiatric | $250 per day for days 1 through 7 $0 per day for days 8 through 90 (Authorization is required.) (Referral is required.) |
Outpatient group therapy visit with a psychiatrist | $20 copay (Authorization is required.) (Referral is required.) |
Outpatient individual therapy visit with a psychiatrist | $20 copay (Authorization is required.) (Referral is required.) |
Outpatient group therapy visit | $20 copay (Authorization is required.) (Referral is required.) |
Outpatient individual therapy visit | $20 copay (Authorization is required.) (Referral is required.) |
$0 per day for days 1 through 20 $135 per day for days 21 through 100 (Authorization is required.) (Referral is required.) |
Monthly Premium | $18.00 |
Deductible | nan |
Preventive dental: | Monthly Premium: | $18.00 |
Preventive dental: | Deductible: | N/A |
Comprehensive dental: | Monthly Premium: | $18.00 |
Comprehensive dental: | Deductible: | N/A |
Ready to sign up for CCHP Senior Value Program (HMO) ?
SMID: MULTIPLAN_HCIHNDOGMED01_M
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