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

MA Plan 3 (HMO)

The Medicare Advantage Plan 3 offers enhanced supplemental benefits and lower copays for several services.

  • New $0 copay for primary care visits
  • For 2022, the Plan 3 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


Plan Benefits at a Glance

Coverage Includes: Medical, Vision, Prescription Drugs, Fitness Program, and more.

➔ Download the Summary of Benefits – Plan 3 begins on page 34 | 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 $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 and preferred mail order 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. Up to $850 per year for
preventative and comprehensive services.
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) | Evidencia de cobertura (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 2022 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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