The Special Needs (SNP) plan is designed to provide extra support in accessing care and other resources.
To be eligible for this plan, you must qualify for Medicare Parts A and B and Medicaid benefits as a Qualified Medicare Beneficiary (QMB). Talk to an expert to learn more or read our eligibility page.
Click the button below to learn how to enroll in this plan.
2020 Plan Benefits at a Glance
Coverage in This Plan Includes:
Medical, Vision, Prescription Drugs, Over-The-Counter benefits, Hearing Aid Supplement, Transportation, and Gym Membership.
| CHPW Medicare Advantage | Original Medicare | |
|---|---|---|
| Premium | $0 | $0 |
| Pharmacy | Generic drugs at $0-$3.60 Other drugs at $0-$8.95* |
Not Covered |
| Vision | 1 routine eye exam per year, up to $400 every 2 years for prescription vision hardware | Not Covered |
| Dental | $0 copay, no limit to preventive services and up to $2,500 supplemental benefit limit per year | Not Covered |
| Hearing Aids | 1 hearing exam & 1 fitting/evaluation exam per year and $1,500 for hearing aids and supplies every 2 years | 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 covered Chiropractic | Not Covered |
| Transportation | 50 one way rides per year to plan approved appointments | Not Covered |
| Over the Counter Allowance (OTC) | $250 to spend on health products every 3 months, up to $1,000 per year | Not Covered |
| Fitness Program | Free basic gym membership or Fitbit device, personal coaching | Not Covered |
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. Click on the links below to download the summary of benefits in English or Spanish.
➔ Summary of Benefits | Resumen de Beneficios
Offered in the Following Counties:
Adams, Benton, Chelan, Clark, Cowlitz, Douglas, Franklin, Grant, King, Kitsap, Lewis, Okanogan, Pierce, Skagit, Snohomish, Spokane, Thurston, 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
Prescription Coverage
Browse the prescription drug formularies to check if your current medications are covered by the plan. Find information about restrictions and limitations to certain medications, and how much you will pay. Download a PDF or search for your medications by name in the online formulary.
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
Special Benefits
Post Discharge Meals
After an inpatient hospital or skilled nursing facility stay, members can receive 2 meals per day delivered to their door for 14 days.
➔ Learn more about Meals Benefits
Over-the-Counter Products
Plan 014 members have a $250 allowance to spend on over-the-counter products every 3 calendar months. OTC products include some durable medical equipment, health supplies, and other items. Order online or through the mail and get your products delivered to your home.
Rides to Medical Visits
We partner with RoundTrip to provide 50 one-way trips per year to help you with any covered medical benefit. Rides to accommodate wheelchairs and gurneys are available. Please call Customer Service to schedule your ride or for more information.”
➔ Download transportation pdf document
Hearing Aid Supplement
Hearings aids and related supplies for both ears are covered up to a combined amount of $1500 every two calendar years. Every year, one routine hearing exam and hearing aid fitting is included.
Dental Services
Our plan covers up to $2,500 every year for most supplemental dental services. There is no limit to preventive services, such as cleanings, oral exams, and fluoride treatments.
Fitness Program
Stay fit at home or at the gym with the Silver & Fit Program. Meet new people, participate in challenges, and earn rewards while you get exercise to keep you active and healthy.
Case Management
Special Needs plan members are assigned a case manager who will give them individualized support and help coordinate their care. Case managers will work with providers to figure out what kind of care is best for you. They can help you make appointments and support you through treatments. Case managers are available by phone if you have any questions.
➔ Learn more about our case management program.
Providers and Care Facilities
Our directories let you know which primary care providers, vision providers, specialists, care facilities, and pharmacies are in our network.
Use our Find a Doctor tool or browse our provider directories to check who is in your area.
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.
