This list is provided for general information only and does not include all benefits. Limitations, copayments, and restrictions may apply. For more information about CHPW Dual Plans, view the 2027 CHPW Dual Plans Summary of Benefits, available in : English and Spanish
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✗ Special Supplemental Benefits for the Chronically Ill (SSBCI) are available to eligible enrollees. You may qualify for these benefits if you have been diagnosed with a chronic condition such as Diabetes, Cardiovascular Disease, Congestive Heart Failure (CHF), Mental Health Conditions, Cancer, or other qualifying conditions listed in your Evidence of Coverage. You must also meet all other eligibility criteria. To find out if you are eligible, please contact Community Health Plan of Washington’s Care Management team at 1-866-418-7005 (TTY: 711), Monday through Friday, 8 a.m. to 5 p.m.
† Supplemental benefits shown are in-network and administered by VSP. There are a number of options to receive frames and basic lenses within this benefit amount.
‡ This is the 2026 amount and may change for 2027.
⅄ 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.
# Exact amount depends on level of Extra Help.
* All cost-sharing on this plan, including premiums, medical, and prescription drug costs, is based upon your level of Medicaid eligibility. If you are enrolled with Apple Health (Medicaid) or another plan for Medicaid benefits, Community Health Plan of Washington Medicare Advantage will help you resolve any billing issues. Your doctor cannot bill you for cost-sharing covered under your Medicaid benefits. Your doctor must accept Community Health Plan of Washington Medicare Advantage plan payment as payment-in-full or bill the correct Medicaid source. Part B deductible reflects the amount that would apply without full Medicaid cost-sharing assistance.
** Your monthly plan premium of $6.30 is paid for as long as you qualify for 100% Low Income Subsidy (“Extra Help”). For more information on Extra Help, see Chapter 1, section 4, of your Evidence of Coverage. You must continue to pay your Medicare Part B premium (unless your Part B premium is paid for you by Apple Health (Medicaid) or another third party).
