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If you are generally healthy but want to have the protection of an out-of-pocket maximum, plus prescription drug, vision, and dental coverage, this plan may be for you. Our best value plan, MA Plan 1 is now available in most counties.
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, Fitness Program, and more.
| CHPW Medicare Advantage | Original Medicare | |
|---|---|---|
| Premium | $0* | Part B Premium |
| Pharmacy | 5 Tiers (1/2/3/4/5)
Preferred: $0/$10/$42/50%/29% $230 deductible on Tier 5 specialty drugs only Use preferred pharmacy for lowest copay |
Not Covered |
| Vision | $0 copay, limit one exam per year. Up to $150 every two years for prescription eyewear. | Not Covered |
| Dental | $0 copay, limit one preventive visit per 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 |
| Fitness Program | Fitness kit and gym membership | 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:
Clark, Cowlitz, King, Kitsap, Pierce, 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 on certain medications, as well as 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
Special Benefits
Fitness Program
Stay fit at home or at the gym. Make sure to exercise to keep you active and healthy.
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.
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.
