When You Get More, You Can Do More
Get extra services at no extra cost through our D-SNP plan.
Medicare Advantage Dual Complete (HMO D-SNP) offers more support to those who qualify for both Medicare and Apple Health (Medicaid).
Where Is This Plan Offered?
Adams, Benton, Chelan, Clallam, Clark, Cowlitz, Douglas, Franklin, Grant, Grays Harbor, Jefferson, King, Kitsap, Kittitas, Lewis, Mason, Okanogan, Pacific, Pend Oreille, Pierce, Skagit, Snohomish, Spokane, Stevens, Thurston, Walla Walla, Wahkiakum, Whatcom, and Yakima counties.
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Call 1-800-944-1247 (TTY: 711) Enroll Now
7 days a week, 8 a.m. to 8 p.m.
Extra Benefits at a Glance
Coverage Includes: Vision, Dental, Prescription Drugs, Over-the-Counter and Grocery Benefits, Hearing Aid, Transportation, Fitness Program, and more.
| CHPW Medicare Advantage | Original Medicare | |
|---|---|---|
Premium |
$0* | $0 |
Pharmacy |
Generic drugs: $0 Brand drugs: $0 |
Not Covered |
Vision |
1 routine eye exam plus up to $500 every year for glasses or contacts. Choose from a wide network of vision providers. | Not Covered |
Dental |
$5,000 a year for preventive and comprehensive services. Choose from a large network of dentists.** | Not Covered |
Hearing Aids |
$2,250 every year; $0 copay for exam & fitting. Limit one per ear per year. | Not Covered |
Podiatry |
$0 copay. Up to 4 visits per year for non-Medicare covered foot care from a Medicare-approved foot care provider. | Not Covered |
Health and Wellbeing |
Combined total of 25 visits a year for acupuncture, naturopathy, chiropractic, and massage. |
Not Covered |
Family on Demand |
60 hours per year of free personalized support and companionship. | Not Covered |
Transportation |
40 one-way trips (50-mile limit) to health-related appointments each calendar year. | Not Covered |
Over-the-Counter (OTC) & Grocery |
$100 every month to spend on covered grocery and OTC items. | Not Covered |
Fitness Program |
Fitness kit, gym membership | Not Covered |
*Your monthly plan premium may be paid for as long as you qualify for 100% Low Income Subsidy (“Extra Help”). Your Medicare Part B premium must continue to be paid, although that too may be paid for through these subsidies. Contact us to learn more: 1-800-942-0247 (TTY Relay: 711), 8 a.m. to 8 p.m., seven days a week.
**You must use a dentist who is part of Delta Dental of Washington’s dental network. To find the most current listing of Delta Dental PPO Plus Premier network dentists, visit DeltaDentalWA.com.
Download documents
Summary of Benefits
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Summary of Benefits |
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) provides plan details and payment information for services, including copays, coinsurance, limitation, prior authorizations, and deductibles. |
Has Anything Changed for 2024?
Download the Annual Notice of Change (ANOC) to review any changes to the plan.
Annual Notice of Change (ANOC) – English
Aviso Anual de Cambios (ANOC) – Spanish
Don’t Qualify for Dual Complete?
You might qualify for a similar plan, Dual Select (HMO D-SNP) or CHPW MA Plan 2 (HMO).
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.
