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

MA Dual Plan (HMO SNP)

The Medicare Advantage Dual (HMO SNP) plan offers added support for individuals who qualify for both Medicare Parts A and B and Apple Health (Medicaid) benefits.

  • Up to $4,500 on preventive and comprehensive dental care
  • Quarterly over-the-counter (OTC) benefit of up to $350
  • 75 one-way rides to and from provider and pharmacy visits

Note: Your monthly plan premium may be paid for as long as you qualify for 100% Low Income Subsidy (“Extra Help”). Your Medicare Part B premium must continue to be paid, although that too may be paid for through these subsidies. Contact us to learn more: 1-800-942-0247 (TTY Relay: 711), 8 a.m. to 8 p.m., seven days a week.

Plan Benefits at a Glance

Coverage Includes: Medical, Vision, Dental, Prescription Drugs, Over-the-Counter benefits, Hearing Aid Supplement, Transportation, Fitness Program, and more.

➔ Download the Summary of Benefits – Dual Plan begins on page 44 | Resumen de Beneficios (Spanish) | 福利摘要 (Chinese) | Краткий обзор льгот (Russian) | Tóm Tắt Quyền Lợi (Vietnamese)

Where This Plan is Offered: Adams, Benton, Chelan, Clallam, Clark, Cowlitz, Douglas, Franklin, Grant, Grays Harbor, Jefferson, King, Kitsap, Lewis, Mason, Okanogan, Pacific, Pierce, Skagit, Snohomish, Spokane, Stevens, Thurston, Walla Walla, Wahkiakum, Whatcom and Yakima counties.

CHPW Medicare Advantage Original Medicare
Premium $0* $0
Pharmacy Generic drugs: $0 to $3.95
Brand drugs: $0 to $9.85
Not Covered
Vision 1 routine eye exam per year + up to $400 every 2 years for prescription vision hardware Not Covered
Dental $0 copay. Up to $4,500 per year for
preventative and comprehensive services.
Not Covered
Hearing Aids $0 copay exam and fitting. Up to $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 75 one-way rides per year to provider offices, medical centers, and pharmacies Not Covered
Over the Counter Allowance (OTC) $350 to spend on health products every 3 months, up to $1,400 per year Not Covered
Fitness Program Fitness kit and gym membership Not Covered

*Your monthly plan premium of $40.40 is paid for as long as you qualify for 100% Low Income Subsidy (“Extra Help”). For more information on Extra Help, see Chapter 2, section 7, of your Evidence of Coverage. Your Medicare Part B premium must continue to be paid, although that too may be paid for through these subsidies.

Covered Services & Cost

Evidence of Coverage

The Evidence of Coverage (EOC) provides plan details and payment information for services, including copays, coinsurance, limitation, prior authorizations, and deductibles.

Prescription Coverage

Prescription drug formularies provide information about costs, restrictions, and other considerations related to the plan’s prescription medication coverage.

Special Benefits

Providers and Care Facilities

Use our Find a Doctor tool or browse our provider directories to find primary care providers, vision providers, specialists, care facilities, and pharmacies in our network.

Has Anything Changed for 2022?

Download the Annual Notice of Change (ANOC) to review any changes to the plan.



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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