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† Benefits shows are in network and administered by VSP and allows a number of options to receive frames and basic lenses within this benefit amount.
* 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 the State or another plan for Medicaid benefits, CHPW 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 CHPW Medicare Advantage plan payment as payment-in-full or bill the correct Medicaid source.
** Your monthly plan premium of $33.80 is paid for by Washington State Medicaid or another third party because you qualify for “Extra Help” on the QMB program.