The Medicare Advantage Plan 4 offers enhanced supplemental benefits and lower copays for several services.
- New $0 copay for primary care visits
- For 2022, the Plan 4 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, Dental, Vision, Prescription Drugs, Fitness Program, and more.
Where This Plan is Offered: Adams, Chelan, Douglas, Grant, Lewis, Okanogan, Skagit, Walla Walla, Whatcom, and Yakima counties.
|CHPW Medicare Advantage||Original Medicare|
|Premium||$94*||Part B Premium|
|Pharmacy||5 Tiers (1/2/3/4/5)
Use preferred pharmacy and preferred mail order for lowest copay
|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.
|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 drug formularies provide information about costs, restrictions, and other considerations related to the plan’s prescription medication coverage.