The Medicare Advantage Plan 4 offers enhanced supplemental benefits.
- Dental care with unlimited preventive visits, up to $500 a year towards comprehensive services
- Vision coverage, including one free eye exam per year and up to $150 for eyewear every two years
- $0 copay for a combined 12 acupuncture, naturopathy, or chiropractor visits per year
Plan Benefits at a Glance
Coverage Includes: Medical, Dental, Vision, Prescription Drugs, Fitness Program, and more.
Download the Summary of Benefits – Plan 4 begins on page 26 | Resumen de Beneficios (Spanish)
Where This Plan is Offered: Adams, Chelan, Douglas, Grant, Lewis, Okanogan, Skagit, Walla Walla, Whatcom, and Yakima counties.
| CHPW Medicare Advantage | Original Medicare | |
|---|---|---|
| Premium | $102* | Part B Premium |
| Pharmacy | 5 Tiers (1/2/3/4/5)
Preferred: $0/$10/$42/50%/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. Unlimited preventive visits + up to $500 per year for comprehensive services. | Not Covered |
| Podiatry | $0 copay. Up to 4 supplemental routine visits per year. | Not Covered |
| Health and 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) | 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 2023?
Download the 2023 Annual Notice of Change (ANOC) to review any changes to the plan:
Annual Notice of Change 2023 | Aviso anual de cambios para 2023
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.
