A non-government entity
Community Health Plan of WA MA Plan 2 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Community Health Plan of WA MA Plan 2 (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 Plan 2 (HMO) in 2025, please refer to our full plan details page.
Community Health Plan of WA MA Plan 2 (HMO) is a HMO plan offered by Community Health Plan of Washington available for enrollment in 2025 to people living in Eastern and Western Washington State. 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 Plan 2 (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Community Health Plan of WA MA Plan 2 (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 Plan 2 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $23.10. 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.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
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 Plan 2 (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Community Health Plan of WA MA Plan 2 (HMO) has an enhanced alternative drug benefit. This plan has no deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance for your prescriptions, depending on the drug tier and pharmacy type. For example, preferred generic drugs have a $10 copay at a preferred pharmacy. After your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Community Health Plan of WA MA Plan 2 (HMO) offers a range of benefits including inpatient hospital care with copays, outpatient services with copays and coinsurance, and emergency services with copays. The plan also covers primary care, preventive services, vision, and dental, with varying cost-sharing structures like copays and coinsurance depending on the service. This plan includes coverage for hearing, home health, and skilled nursing facilities with specific cost-sharing and authorization requirements, as well as additional services such as acupuncture and an over-the-counter items benefit.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including both acute and psychiatric care. For Inpatient Hospital-Acute, you pay a $500 copay for days 1-4, and no copay for days 5-90; for Inpatient Hospital Psychiatric, you pay a $350 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services, observation services, and ambulatory surgical center services have a copay of $365.00. Outpatient substance abuse services have a 20% coinsurance for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Community Health Plan of WA MA Plan 2 (HMO), with a 20% coinsurance. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $350 copay for both ground and air ambulance services. Transportation Services to plan-approved health-related locations are covered for up to 20 one-way trips every year, using rideshare services, bus/subway, or medical transport, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including urgently needed services and worldwide emergency services, are covered. Emergency services have a $100 copay, while urgently needed services have a $40 copay; worldwide emergency services have a 20% coinsurance.
Primary Care See details
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 are covered. Chiropractic Services have a $15 copay, while Occupational Therapy Services have a $35 copay. Physician Specialist Services have a $50 copay, and Physical Therapy and Speech-Language Pathology Services have a $45 copay. Mental Health Specialty Services have a $40 copay for both individual and group sessions, and Individual and Group Sessions for Psychiatric Services have 20% coinsurance. Additional Telehealth Benefits have a 0-20% coinsurance and a $0-$50 copay, and Opioid Treatment Program Services have 20% coinsurance.
Preventive Services See details
The Community Health Plan of WA MA Plan 2 (HMO) covers preventive services, including Medicare-covered preventive services with no copay, and additional preventive services, though annual physical exams, health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy (MNT), post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, 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. This plan also covers alternative therapies (25 visits), therapeutic massage (25 sessions), additional sessions of smoking and tobacco cessation counseling (8 visits), fitness benefits, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing Services are partially covered by Community Health Plan of WA MA Plan 2 (HMO), with hearing exams requiring prior authorization and a doctor referral and a coinsurance of at most 20%, but routine hearing exams and fitting/evaluation for hearing aids are not covered. Prescription hearing aids and OTC hearing aids are also not covered.
Vision Services See details
Vision services are covered, with a 20% coinsurance for eye exams and contact lenses. Routine eye exams, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with 20% coinsurance, and other dental services with Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, and Other Preventive Dental Services. Orthodontic Services are covered up to a maximum of $500 per year, and additional benefits include Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0-20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered with a doctor's referral. You will pay 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and no copay, Prosthetics/Medical Supplies with a 20% coinsurance and no copay, and Diabetic Equipment with 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 Diagnostic Procedures/Tests with a coinsurance of at most 20%, Lab Services with no coinsurance, Diagnostic Radiological Services with a coinsurance of at most 20%, Therapeutic Radiological Services with a coinsurance of at most 20%, and Outpatient X-Ray Services with a $15 copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the Community Health Plan of WA MA Plan 2 (HMO) with no copay and no coinsurance, but authorization and a referral are required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization and a doctor's referral. You will have no copay for days 1-20, and a $200 copay for days 21-100.
Other Services See details
The Community Health Plan of WA MA Plan 2 (HMO) plan covers acupuncture, with a limit of 25 treatments per year. This plan also provides an Over-the-Counter (OTC) Items benefit, but it does not cover nicotine replacement therapy or naloxone. The plan includes a meal benefit that requires a doctor's referral. However, Early and Periodic Screening, Diagnostic, and Treatment (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 are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved