Special Needs Plan (HMO) 014 - Community Health Plan of Washington - Medicare Advantage

Special Needs Plan (HMO) 014

The Specials Needs (SNP) plan is for people with more than one health condition, complex medical needs, or disabilities. This plan is designed to provide extra support in accessing care and other resources.  If you receive benefits for both Apple Health (Medicaid) and Medicare, then you qualify for extra benefits on this plan. Talk to an expert to learn more.

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 drugs, Over-the-counter benefits, Hearing aid supplement, Transportation, and Gym membership.

CHPW Medicare Advantage Original Medicare
Premium $0 $0
Pharmacy Generic drugs at $0-$3.40
Other drugs at $0-$8.50*
Not Covered
Vision 1 routine eye exam per year
Up to $130 per year for eyewear
Not Covered
Dental Up to $1,800 supplemental benefit limit per year Not Covered
Hearing Aids 1 hearing exam & 1 fitting/evaluation exam per year and $1,500 for hearing aids and supplies every 2 years Not Covered
Transportation 24 one way rides to approved appointments Not Covered
Over the Counter Allowance (OTC) $50 to spend on non-prescription goods every 3 months Not Covered

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. Click on the links below to download the summary of benefits in English or Spanish.

➔ Summary of Benefits | Resumen de Beneficios

Offered in the Following Counties:

Adams, Benton, Chelan, Clark, Cowlitz, Douglas, Franklin, Grant, King, Kitsap, Lewis, Okanogan, 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.

➔ Download the 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 the 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

Over-the-Counter Products

Plan 014 members have a $50 allowance to spend on over-the-counter products every 3 calendar months. OTC products include some durable medical equipment, health supplies, and other items. Order online or through the mail and get your products delivered to your home.

➔ Browse Catalog | ➔ Catálogo de Productos

Rides to Medical Visits

We partner with American Logistics Company and Lyft to offer you 24 one-way trips per year to use for any medical appointments. Rides to accommodate wheelchairs and gurneys are available. Any ride over 60 miles needs approval. Call Customer Service for more information.

Schedule your ride: 1-833-209-6382 (TTY 7-1-1)

Hearing Aid Supplement

Hearings aids and related supplies for both ears are covered up to a combined amount of $1500 every two calendar years. Every year, one routine hearing exam and hearing aid fitting is included.

Dental Services

Our plan pays up to $1800 every year for most supplemental dental services.

Case Management

Special Needs plan members are assigned a case manager who will give them individualized support and help coordinate their care. Case managers will work with providers to figure out what kind of care is best for you. They can help you make appointments and support you through treatments. Case managers are available by phone if you have any questions.

➔ Learn more about our case management program.

Providers and Care Facilities

Our directories let you know which primary care providers, vision providers, specialists, care facilities, and pharmacies are in our network.
Use our find a doctor tool or browse our provider directories to check who is in your area.


Keep an Eye on Your Health

Woman getting an eye examRegular eye exams are important, even if you have good vision. Doctors can detect a variety of health issues just by examining your eye. Catching problems like tumors, diabetes or high blood pressure can help you get treatment before more serious symptoms show up.

Eye exams are covered in-network for CHPW Medicare Advantage members. Vision coverage is included in all plans.



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