Extra Plan (HMO) 010 - Community Health Plan of Washington - Medicare Advantage

Extra Plan (HMO) 010

Get the most coverage for our lowest premium cost. This plan offers full coverage including prescription drugs, and extra benefits. If you regularly take one or more prescription medications or have certain conditions with higher cost drug treatment, this plan may be for you. Extra coverage on the extra plan. Click the button below to learn how to enroll in this plan.


2019 Plan Benefits at a Glance

Coverage in this Plan Includes:

Medical, vision, prescription drug, gym membership and more.

CHPW Medicare Advantage Original Medicare
Premium $26* Part B Premium
Pharmacy Tier 5 Preferred Pharmacy, 33% coinsurance Not Covered
Vision $0 copay, limit one exam per year. Up to $100 every two years for prescription eye wear Not Covered
Podiatry $0 copay (up to 4 supplemental routine visits per year) Not Covered
Fitness Program Free basic gym membership or up to 2 Home Fitness kits per year Not Covered

*You must continue to pay your Medicare Part B premium.

The Summary of Benefits booklet gives you an idea of what services we cover and how much you pay. It does not list every service that we cover or list every limitation or exclusion.

➔ Summary of Benefits | Resumen de Beneficios

Offered in the Following Counties:

Chelan, Clark, Cowlitz, Douglas, Grant, King, Kitsap, Pierce, Skagit, Snohomish, Spokane, Thurston, Walla Walla, Whatcom, and Yakima.

Covered Services & Cost

The Evidence of Coverage lays out coverage and payment details for different services including copays, coinsurance, limitation, prior authorizations, and deductibles.

➔ Click to download Evidence of Coverage

Prescription Coverage

Browse the prescription drug formularies to check if your current medications are covered by the plan. Find information about restrictions and limitations to certain medications, and how much you will pay.  Download a PDF or search for your medications by name in the online formulary.

➔ Check prescription coverage

Has Anything Changed in 2019?

That’s a great question. Any changes to the plan are detailed in the Annual Notice of Change (ANOC).

➔ Download Annual Notice of Change for 2019

Special Benefits

Silver & Fit Program

Stay fit at home or at the gym with the Silver & Fit Program. Meet new people, participate in challenges, and earn rewards while you get exercise to keep you active and healthy.

➔ Explore Silver & Fit


Dental Coverage

Keeping your teeth and gums healthy is an important part of your whole health care plan. Dental coverage is included on select plans for yearly cleanings, x-rays, fluoride treatments, and other limited services.



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Email: Sales@chpw.org