The MA Dual (HMO 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. Talk to an expert to learn more or read our eligibility page.
Click the button below to learn how to enroll in this plan.
2021 Plan Benefits at a Glance
Coverage in This Plan Includes:
Medical, Vision, Prescription Drugs, Over-the-Counter benefits, Hearing Aid Supplement, Transportation, and Fitness Program.
| CHPW Medicare Advantage | Original Medicare | |
|---|---|---|
| Premium | $0* | $0 |
| Pharmacy | Generic drugs at $0-$3.70 Other drugs at $0-$9.20 (amount varies depending on level of subsidy. Level 4 subsidy (rare) has an $85 deductible and 15% copay.) |
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 $3,000 supplemental benefit limit per year | Not Covered |
| Hearing Aids | 1 hearing exam & 1 fitting/evaluation exam per year and $1,700 for hearing aids and supplies every year | 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 | Fitness kit and gym membership | Not Covered |
*The premium of $36 is paid for by Medicaid or because you qualify for Extra Help. Your Medicare Part B premium must continue to be paid, although that too may be paid for through these subsidies.
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, Stevens, 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.
Has Anything Changed for 2021?
That’s a great question. Any changes to the plan are detailed in the Annual Notice of Change (ANOC).
➔ Download the 2021 Annual Notice of Change (English)
➔ Download the 2021 Annual Notice of Change (Spanish)
➔ Download the 2021 Annual Notice of Change (Russian)
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 Products
Dual plan 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.
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.
➔ Learn more about transportation for medical appointments
Hearing Aid Supplement
Hearings aids and related supplies for both ears are covered up to a combined amount of $1,700 every year. Every year, one routine hearing exam and hearing aid fitting is included.
Dental Services
Our plan covers up to $3,000 every year for most supplemental dental services. There is no limit to preventive services, such as cleanings, oral exams, and fluoride treatments. There is no restrictive dental network. You can visit any dentist you like and they will send CHPW the bill.
Fitness Program
Stay fit at home or at the gym. Make sure to exercise to keep you active and healthy.
Case Management
Dual plan members are assigned a case manager who will offer individualized support and help coordinating your 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.
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.
