The Medicare Advantage Dual (HMO D-SNP) plan offers added support for individuals who qualify for both Medicare Parts A and B and Apple Health (Medicaid) benefits.
- Up to $5,000 on preventive and comprehensive dental care
- Monthly over-the-counter (OTC) and grocery benefit of up to $175
- Up to $500 per year to spend on eyewear
- 60 hours per year of free personalized support and companionship with Family on Demand
- $0 copay for up to 25 combined sessions of acupuncture, naturopathy, routine chiropractic, massage therapy, and more!
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.
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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 | Resumen de Beneficios (Spanish)
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 Brand drugs: $0 |
Not Covered |
| Vision | 1 routine eye exam per year + up to $500 every year for prescription vision hardware | Not Covered |
| Dental | $0 copay. Up to $5,000 per year for preventative and comprehensive services. |
Not Covered |
| Hearing Aids | $0 copay exam and fitting. Up to $2,250 for hearing aids and supplies every year. | Not Covered |
| Podiatry | $0 copay. Up to 4 supplemental routine visits per year. | Not Covered |
| Health and Wellbeing | $0 copay. Up to 25 visits combined per year for acupuncture, naturopathy, massage therapy, and non-Medicare covered chiropractic, as well as various CHPW-recommended Wellbeing programs | Not Covered |
| Family on Demand | 60 hours per year of free personalized support and companionship | Not Covered |
| Transportation | 75 one-way rides per year to provider offices, medical centers, and pharmacies | Not Covered |
| Over the Counter Allowance (OTC) | $125 to spend on health products each month | Not Covered |
| Grocery | $50 to spend on groceries each month, up to $600 per year | Not Covered |
| Fitness Program | Fitness kit and gym membership | Not Covered |
*Your monthly plan premium of $41 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
- Family on Demand
- Post-Discharge Meals
- Over-the-Counter Products & Grocery
- Rides to Medical Visits
- Hearing Aids and Exam Coverage
- Dental Services
- Fitness Program
- Individualized case management
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 2023?
Download the Annual Notice of Change (ANOC) to review any changes to the plan.
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.
