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Community Health Plan of WA MA Freedom Plan (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Community Health Plan of WA MA Freedom Plan (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Community Health Plan of WA MA Freedom Plan (HMO) in 2025, please refer to our full plan details page.
Community Health Plan of WA MA Freedom Plan (HMO) is a HMO plan offered by Community Health Plan of Washington available for enrollment in 2025 to people living in Western Washington and Spokane Counties. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Community Health Plan of WA MA Freedom Plan (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Community Health Plan of WA MA Freedom Plan (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Community Health Plan of WA MA Freedom Plan (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9350.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
Sign up for Community Health Plan of WA MA Freedom Plan (HMO)
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Drug Coverage
Prescription drugs are not covered by Community Health Plan of WA MA Freedom Plan (HMO).
Additional Benefits
The Community Health Plan of WA MA Freedom Plan (HMO) offers a range of benefits, including coverage for inpatient hospital stays, outpatient services, and emergency services. This plan includes copays for services like inpatient hospital stays, outpatient services, and ambulance services, while some services have coinsurance requirements. Additional benefits include coverage for primary care, preventive services, hearing and vision services, dental services, home infusion, dialysis, medical equipment, diagnostic and radiological services, home health services, and skilled nursing facility (SNF) stays. The plan also covers acupuncture and has no copay for home health services.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric services, are covered by the Community Health Plan of WA MA Freedom Plan (HMO). For Inpatient Hospital-Acute, you'll pay a $500 copay for days 1-4, and no copay for days 5-90, and for Inpatient Hospital Psychiatric, you'll pay a $175 copay for days 1-10, and no copay for days 11-90. Additional days for Inpatient Hospital-Acute have no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services, observation services, and ASC services each have a $250 copay. Individual and group outpatient substance abuse sessions have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered under the Community Health Plan of WA MA Freedom Plan (HMO), but requires prior authorization and a doctor referral. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services, each with a $300 copay and no coinsurance; however, transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including urgently needed services, are covered by Community Health Plan of WA MA Freedom Plan (HMO), with a $100 copay and no coinsurance for emergency services. Worldwide emergency services are also covered, with a 20% coinsurance for worldwide emergency coverage, urgent coverage, and emergency transportation.
Primary Care See details
Primary Care coverage includes Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic Services have a $15 copay, Routine Chiropractic Care is limited to 12 visits per year, and Occupational Therapy Services, Individual and Group Sessions for Mental Health Specialty Services, and Individual and Group Sessions for Psychiatric Services have a $30 copay. Physician Specialist Services have a $40 copay, Physical Therapy and Speech-Language Pathology Services have a $30 copay, and Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $40.
Preventive Services See details
Preventive Services are covered, including Medicare-covered preventive services with no copay and additional preventive services. Annual physical exams, health education, in-home safety assessments, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered. Alternative Therapies, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefits, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are also covered.
Hearing Services See details
Hearing services are partially covered by the Community Health Plan of WA MA Freedom Plan (HMO), including hearing exams with a $20 copay, but routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids are not covered. OTC hearing aids are also not covered.
Vision Services See details
Vision services include eye exams with a $40 copay, and eyewear with 20% coinsurance. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no coinsurance.
Dental Services See details
The Community Health Plan of WA MA Freedom Plan (HMO) covers dental services, with a 20% coinsurance for Medicare Dental Services. Other Dental Services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics, are all covered. Orthodontic Services have a maximum plan benefit of $500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Community Health Plan of WA MA Freedom Plan (HMO) with a doctor referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance and no copay, Prosthetic Devices with 20% coinsurance and no copay, and Medical Supplies with 20% coinsurance and no copay. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, and all radiological services. Diagnostic procedures/tests and diagnostic radiological services have a coinsurance of at most 20%, while lab services have no coinsurance. Therapeutic radiological services also have a coinsurance of at most 20%. Outpatient X-Ray Services have a $15 copay.
Home Health Services See details
Home Health Services are covered by the Community Health Plan of WA MA Freedom Plan (HMO) with no copay and no coinsurance, but require authorization and a referral. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Community Health Plan of WA MA Freedom Plan (HMO). Prior authorization and a doctor referral are required for the services, but the plan does not cover any of the listed services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Community Health Plan of WA MA Freedom Plan (HMO), but require prior authorization and a doctor's referral. There is no copay for days 1-20, but there is a $200 copay for days 21-100; there is no coinsurance. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Community Health Plan of WA MA Freedom Plan (HMO) covers acupuncture with a limit of 12 treatments per year, but does not cover over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, EPSDT Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services. A doctor referral is required for the meal benefit.
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