You can do more when your whole health is covered.
Get all the care you need at no extra cost through our Medicare Advantage (HMO D-SNP) plan.
Medicare Advantage Dual Select (HMO D-SNP) offers support to those who qualify for both Medicare and partially qualify for Apple Health (Medicaid).
Where is this plan offered??
Adams, Benton, Chelan, Clallam, Clark, Cowlitz, Douglas, Franklin, Grant, Grays Harbor, Jefferson, King, Kitsap, Kittitas, Lewis, Mason, Okanogan, Pacific, Pend Oreille, Pierce, Skagit, Snohomish, Spokane, Stevens, Thurston, Wahkiakum, Walla Walla, Whatcom, and Yakima counties.
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Call 1-800-944-1247 (TTY: 711) Enroll Now
7 days a week, 8 a.m. to 8 p.m.
Benefits at a Glance
Coverage Includes: Vision, Dental, Prescription Drugs, Hearing Aid, Transportation, and more.
| CHPW Medicare Advantage | Original Medicare | |
|---|---|---|
Premium |
$0-$6.30* | $0 |
Pharmacy |
Coinsurance Max Copay Tier 1: 25% $5.80 Tier 2: 25% $5.80 Tier 3: 25% $14.40 Tier 4: 50% $14.40 Tier 5: 25% $14.40 Tier 6: $0 $0 |
Not Covered |
Vision |
1 routine eye exam plus up to $250 every year for glasses or contacts. Choose from a wide network of Vision Service Plan (VSP) Choice Network providers. | Not Covered |
Dental |
$500 a year for preventive and comprehensive services. Choose from a large network of dentists.** | Not Covered |
Hearing Aids |
$1,000 every year; $0 copay for exam & fitting. Limit one per ear per year. | Not Covered |
Podiatry |
$0 copay. Up to 4 visits per year for non-Medicare covered foot care from a Medicare-approved foot care provider. | Not Covered |
Transportation |
40 one-way trips (40-mile limit) to health-related appointments each calendar year. | Not Covered |
*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.
**You must use a dentist who is part of Delta Dental of Washington’s dental network. To find the most current listing of Delta Dental PPO Plus Premier network dentists, visit DeltaDentalWA.com.
Support with a personal touch
Did you know all CHPW Medicare Advantage members are eligible for personalized Care Management services? A dedicated care team works with you and your Primary Care Provider and clinic to help make sure your needs are met. Learn more.
Download documents
Summary of Benefits
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Evidence of Coverage
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Covered Services & Cost
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Special Benefits |
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Prescription CoverageOur list of covered drugs (also called a formulary) provides information about costs, restrictions, and other important details related to a plan’s prescription medication coverage. |
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Providers and Care FacilitiesUse 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. |
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Evidence of CoverageThe Evidence of Coverage (EOC) provides plan details and payment information for services, including copays, coinsurance, limitation, prior authorizations, and deductibles. |
Has Anything Changed for 2027?
Download the Annual Notice of Change (ANOC) to review any changes to the plan.
- Annual Notice of Change (ANOC) – English
- Annual Notice of Change (ANOC) – Large Font
- Aviso Anual de Cambios (ANOC) – Spanish
Questions?
Call us at 1-800-944-1247 (TTY: 711). A CHPW Medicare Representative will help you over the phone. We’re here for you 7 days a week, from 8 a.m. to 8 p.m.
