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

Special Needs Plan (HMO) 014

The Special Needs (SNP) plan is designed to provide extra support in accessing care and other resources.

To be eligible for this plan, you must qualify for Medicare Parts A and B and Medicaid benefits as a Qualified Medicare Beneficiary (QMB). Talk to an expert to learn more or read our eligibility page.

Click the button below to learn how to enroll in this plan.


2020 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-$3.60
Other drugs at $0-$8.95*
Not Covered
Vision 1 routine eye exam per year, up to $400 every 2 years for prescription vision hardware Not Covered
Dental $0 copay, no limit to preventive services and up to $2,500 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
Podiatry $0 copay (up to 4 supplemental routine visits per year) Not Covered
Alternative Medicine $0 copay (up to 12 visits per year) for acupuncture, naturopathy, and non-Medicare covered Chiropractic Not Covered
Transportation 50 one way rides per year to plan approved appointments Not Covered
Over the Counter Allowance (OTC) $250 to spend on health products every 3 months, up to $1,000 per year Not Covered
Fitness Program Free basic gym membership or Fitbit device, personal coaching 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 for 2020?

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

➔ Download the 2020 Annual Notice of Change

Special Benefits

Post Discharge Meals

After an inpatient hospital or skilled nursing facility stay, members can receive 2 meals per day delivered to their door for 14 days.

➔ Learn more about Meals Benefits

Over-the-Counter (OTC) Products

Plan 014 members have a $250 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.

➔ More About OTC Catalog

Rides to Medical Visits

We partner with RoundTrip to provide 50 one-way trips per year to help you with any covered medical benefit. Rides to accommodate wheelchairs and gurneys are available. Please call Customer Service to schedule your ride or for more information.”

 ➔ Download transportation pdf document 

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 covers up to $2,500 every year for most supplemental dental services. There is no limit to preventive services, such as cleanings, oral exams, and fluoride treatments.

Fitness 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 our Fitness benefit

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.


Dental Coverage

Keeping your teeth and gums healthy is an important part of your whole health care plan. Dental coverage is included on all plans for yearly cleanings, x-rays, and fluoride treatments. Select plans have additional coverage for other basic and major dental services.



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