Local Care for a Low Premium
The Medicare Advantage Plan 4 covers medical, dental, vision, and prescription drugs for a low monthly premium.
You also get extra benefits that support your whole health—like acupuncture and massage treatments.
Where Is This Plan Offered?
Adams, Chelan, Douglas, Grant, Lewis, Okanogan, Skagit, Walla Walla, Whatcom, and Yakima counties.
Benefits at a Glance
Coverage Includes: Medical, Dental, Vision, Prescription Drugs, Fitness Program, and more.
| CHPW Medicare Advantage | Original Medicare | |
|---|---|---|
Premium |
$102* | Part B Premium |
Pharmacy |
5 Tiers (1/2/3/4/5)
Preferred: $0/$10/$42/50%/33% Use preferred pharmacy and preferred mail order for lowest copay |
Not Covered |
Vision |
$0 copay, limit one exam per year. Up to $150 every two years for prescription vision hardware. | Not Covered |
Dental |
$0 copay. Unlimited preventive visits + up to $500 per year for comprehensive services. | Not Covered |
Podiatry |
$0 copay. Up to 4 supplemental routine visits per year. | Not Covered |
Health and Wellbeing |
$0 copay. Up to 12 visits per year for acupuncture, naturopathy, and non-Medicare covered chiropractic. | Not Covered |
Fitness Program |
Fitness kit and gym membership | Not Covered |
*You must continue to pay your Medicare Part B premium.
Downloads documents
Summary of Benefits
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Download the Summary of Benefits – Plan 4 begins on page 26 |
Evidence of Coverage
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Evidence of Coverage (EOC) |
Covered Services & Cost
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Special Benefits |
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Prescription CoverageOur list of covered drugs (also called a formulary) provides information about costs, restrictions, and other important details related to a plan’s prescription medication coverage. |
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Providers and Care FacilitiesUse our Find a Doctor tool or browse our provider directories to find primary care providers, vision providers, specialists, care facilities, and pharmacies in our network. |
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Evidence of CoverageThe Evidence of Coverage (EOC) | Evidencia de cobertura (EOC) provides plan details and payment information for services, including copays, coinsurance, limitation, prior authorizations, and deductibles. |
Has Anything Changed for 2023?
Download the 2023 Annual Notice of Change (ANOC) to review any changes to the plan:
Annual Notice of Change 2023 | Aviso anual de cambios para 2023
Questions?
Call us at 1-800-944-1247 (TTY: 711). Our licensed Medicare experts will help you over the phone. We’re here for you 7 days a week, from 8 a.m. to 8 p.m.
