2022 MA No Rx Plan (HMO) - Community Health Plan of Washington - Medicare Advantage

2022 MA No Rx Plan (HMO)

The Medicaid Advantage No Rx Plan offers enhanced Medicare coverage for those who don’t need prescription benefits.

  • $0 monthly premium*
  • $0 copay for primary care visits
  • For 2022, the No Rx Plan dental benefit has increased to $850
  • You can use this dental benefit with any dentist who will bill CHPW
  • You also get the protection of an out-of-pocket maximum

If you don’t need prescription drug coverage but want coverage for dental and vision, this plan may be for you. A great choice for individuals who have creditable prescription drug coverage through Veterans Affairs (VA).

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2022 Plan Benefits at a Glance

Coverage Includes: Medical, Dental, Vision, Fitness Program, and more.
Please note: this plan does not offer prescription drug coverage.

➔ Download the Summary of Benefits – No Rx Plan begins on page 6 | Resumen de Beneficios (Spanish) | 福利摘要 (Chinese) | Краткий обзор льгот (Russian) | Tóm Tắt Quyền Lợi (Vietnamese)

Where This Plan is Offered: Clark, Cowlitz, King, Kitsap, Pierce, Snohomish, Spokane, and Thurston counties.

CHPW Medicare Advantage Original Medicare
Premium $0* Part B Premium
Vision $0 copay, limit one exam per year. Up to $150 every two years for prescription vision hardware. Not Covered
Pharmacy Not Covered Not Covered
Dental $0 copay. Up to $850 combined preventive and comprehensive 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.

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

This plan does not offer prescription drug 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, and care facilities in our network.

Has Anything Changed for 2022?

Download the 2022 Annual Notice of Change (ANOC) to review any changes to the plan.

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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