MA Plan 3 (HMO) - Community Health Plan of Washington - Medicare Advantage

MA Plan 3 (HMO)

For members who need enhanced prescription coverage. If you regularly take two or more prescription medications or have certain conditions with higher-cost drug treatment, this plan is for you.

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

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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 $68* Part B Premium
Pharmacy 5 Tiers (1/2/3/4/5)

Preferred: $0/$10/$42/50%/33%
Standard: $5/$15/$47/50%/33%

Use preferred pharmacy for lowest copay

Not Covered
Vision $0 copay, limit one exam per year. Up to $150 every two years for prescription vision hardware. Not Covered
Dental  $0 copay, no limit for preventive dental services. Up to $500 supplemental benefit limit 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

Offered in the Following Counties:

Clark, Cowlitz, King, Kitsap, Pierce, Snohomish, Spokane, and Thurston.

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
➔ Descargue la Evidencia de Cobertura

Prescription Coverage

Check the formulary that corresponds to your plan on our Prescription Coverage page for coverage, copays, and limitations. You can download a PDF or you can search for your medications by name in the online formulary.

➔ Check prescription coverage

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.

➔ Explore our Fitness benefit

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

DID YOU KNOW...?

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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