Pharmacy Plan (HMO) 009 | - CHPW Medicare Advantage

Pharmacy Plan (HMO) 009

For members who need enhanced prescription coverage. If you regularly take more than 2 prescription medications or have certain conditions with higher cost drug treatment, this plan is for you.

Click the button below to learn how to enroll in this plan.

2020 Plan Benefits at a Glance

Coverage in This Plan Includes:

Medical, Dental, Vision, Prescription Drugs, Fitness Program, and more.

CHPW Medicare Advantage Original Medicare
Premium $94* Part B Premium
Pharmacy 5 Tiers (1/2/3/4/5)

Preferred: $0/$10/$42/50%/33%
Standard: $5/$15/$47/50%/33%

Use preferred pharmacy 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, no limit for preventive dental services. Up to $500 supplemental benefit limit per year. Not Covered
Podiatry $0 copay (up to 4 supplemental routine visits per year) Not Covered
Alternative Medicine $0 copay (up to 12 visits per year) for acupuncture, naturopathy, and non-Medicare chiropractic Not Covered
Fitness Program Free basic gym membership or Fitbit device, personal coaching Not Covered

*You must continue to pay your Medicare Part B premium.

The Summary of Benefits booklet gives you an idea of what services we cover and how much you pay. It does not list every service that we cover or list every limitation or exclusion.

➔ Summary of Benefits |Resumen de Beneficios

Offered in the Following Counties:

Adams, Chelan, Douglas, Grant, Lewis, Okanogan, Skagit, Walla Walla, Whatcom, and Yakima.

Covered Services & Cost

The Evidence of Coverage lays out coverage and payment details for different services including copays, coinsurance, limitation, prior authorizations, and deductibles.

➔ Download the Evidence of Coverage
➔ Descargue la Evidencia de Cobertura

Prescription Coverage

Check the formulary that corresponds to your plan on our Prescription Coverage page for coverage, copays, and limitations. You can download a PDF or you can search for your medications by name in the online formulary.

➔ Check prescription coverage

Has Anything Changed for 2020?

That’s a great question. Any changes to the plan are detailed in the Annual Notice of Change (ANOC).

➔ Download the 2020 Annual Notice of Change
➔ Descargue el aviso Anual de Cambios de 2020

Special Benefits

Fitness Program

Free basic gym membership or Fitbit device, personal coaching

➔ Explore our Fitness benefit


Dental Coverage

Keeping your teeth and gums healthy is an important part of your whole health care plan. Dental coverage is included on select plans for yearly cleanings, x-rays, fluoride treatments, and other limited services.



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