Eligibility - Community Health Plan of Washington - Medicare Advantage


To be eligible for Medicare, an individual must be a U.S. citizen or legal resident. Legal residents must have lived in the U.S. for at least 5 years before applying for Medicare. Most people are eligible to receive Medicare benefits if they meet one of the following requirements:

  • are at least 65 years old
  • are under 65 years old and living with a disability
  • are any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

Anyone who qualifies to receive Original Medicare is eligible to enroll in a Medicare Advantage plan. If you’re not sure whether you qualify, contact the Social Security Administration or talk to one of our Medicare experts at 1-800-944-1247 (TTY Relay: 7-1-1).

If you already know you qualify, enroll in one of our plans! A Medicare Advantage plan offers complete coverage under one card and many extra benefits at little to no extra cost per month.

Medicare Enrollment Periods

New to Medicare

Initial Enrollment Period (IEP)

For most people, this is when they enroll in Medicare after turning 65 or becoming eligible due to disability. If you do not sign up for Medicare when you first become eligible, you may be subject to a Part B late enrollment penalty once you do sign up for coverage.

  • If you are turning 65, you are able to enroll during the seven months surrounding your birthday. This includes your birthday month, plus the three months before and three months after your birthday.
  • If you become eligible for Medicare due to disability, you can enroll during the seven months surrounding your 25th month of getting disability benefits.

General Election Period (GEP)

If you did not sign up for Medicare during the Initial Enrollment Period, you can enroll during the GEPThis happens every year from January 1 to March 31. You may be charged a higher premium or late enrollment penalties if you wait until the GEP to enroll in Original Medicare.

After you enroll in Medicare Parts A and/or B, you may choose to apply for additional coverage. If you enroll in both Part A and Part B, you may choose to join a Medicare Advantage (Part C) or Medicare Prescription Drug (Part D) plan between April 1 and June 30 of the same year. You can also enroll in a Part D plan if you only enroll in Medicare Part B during the General Election Period.

Already in Medicare

Annual Enrollment Period (AEP)

If you already have a Medicare plan, every year you have the option to switch coverage with no restrictions. You can add or remove prescription drug coverage or join a different plan. You may only change coverage between October 15 and December 7.

Special Enrollment Period (SEP)

Certain life-changing circumstances could create the need to change coverage. For example, if you retire, no longer have coverage through an employer, move out of the service area, or qualify for state medical assistance.  If you qualify to change coverage, you can return to Original Medicare, add Medicare Prescription Drug (Part D) coverage, or join a Medicare Advantage plan.

If you have recently qualified for Medicare coverage by turning 65 or experience a circumstance that would allow you to enroll outside of the Annual Election Period, you can enroll in one of our CHPW Medicare Advantage plans.

Find Coverage in Your County

Some Advantage plans are only available in select areas. To see which plans are in your area, simply click the button below and locate your county on the map. It will show you which plans are available near you. On the service map, you can compare all plans available in your county at a glance.

MA Dual Plan (HMO SNP)

You qualify to join our MA Dual Plan (HMO SNP) if you reside in the geographic service area and:

  • are entitled to Medicaid
  • receive Medicare Part A benefits
  • receive Medicare Part B benefits (you or Medicaid must continue to pay your Medicare Part B premium)
  • qualify for “Extra Help” paying for your health care premiums

Have Questions?

We know that every person and every situation is different. We want you to be healthy. If you are not sure that you qualify for a Medicare Advantage plan, talk to one of our experts. They can you help find coverage that best fits your health care needs. Our experts are available at 1-800-944-1247 (TTY Relay: Dial 7-1-1) from 8:00 a.m. to 8:00 p.m., seven days a week. You can also request an expert to contact you using this online form.

Depending on your life situation, you may qualify for a different kind of health plan. CHPW also offers these health plans:

CHPW Apple Health
People with lower incomes may qualify for free or low-cost coverage through Apple Health (Medicaid). Visit wahealthplanfinder.org for eligibility requirements. Community Health Plan of Washington contracts with the state to provide Apple Health coverage.

See eligibility details ➜

CHNW Cascade Select

If you are not yet eligible for Medicare and your income level is above Apple Health standards you may qualify for Cascade Care. Cascade Care plans are affordable health plans offered on wahealthplanfinder.org. Cascade Care includes plans like CHNW Cascade Select.

See eligibility details ➜


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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