MA Plan 1 (HMO) - Community Health Plan of Washington - Medicare Advantage

MA Plan 1 (HMO)

The Medicare Advantage Plan 1 is our best value plan, offering prescription drug, vision, and dental coverage, plus the protection of an out-of-pocket maximum. All for a $0 monthly premium*.

  • $0 for two preventive dental visits per year
  • Vision coverage, including one free eye exam per year and up to $150 for eyewear every two years
  • A Health and Wellbeing benefit that includes up to 12 combined acupuncture, naturopathy, or chiropractor visits per year

If you are generally healthy, this plan may be for you. Available in most counties.


Plan Benefits at a Glance

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

Download the Summary of Benefits – Plan 1 begins on page 6 | Resumen de Beneficios (Spanish)

Where This Plan is Offered: Clallam, Clark, Cowlitz, Jefferson, King, Kitsap, Pierce, Snohomish, Spokane, Thurston, Walla Walla, Whatcom, and Yakima counties.

CHPW Medicare Advantage Original Medicare
Premium $0* Part B Premium
Pharmacy 5 Tiers (1/2/3/4/5)

Preferred: $0/$10/$42/50%/29%
Standard: $5/$15/$47/50%/29%

$230 deductible on Tier 5 specialty drugs only

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 eyewear. Not Covered
Dental $0 copay. $0 for up to two preventive visits per year (that aren’t covered by Original Medicare). Not Covered
Podiatry $0 copay. Up to 4 supplemental routine visits per year. Not Covered
Health & Wellbeing $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

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 2023?

Download the 2023 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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