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Community Health Plan of WA Dual Complete (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Community Health Plan of WA Dual Complete (HMO D-SNP). 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 Dual Complete (HMO D-SNP) in 2025, please refer to our full plan details page.
Community Health Plan of WA Dual Complete (HMO D-SNP) is a HMO D-SNP 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 Dual Complete (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Community Health Plan of WA Dual Complete (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Community Health Plan of WA Dual Complete (HMO D-SNP).
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 Dual Complete (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $26.20. 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 a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
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 Dual Complete (HMO D-SNP)
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Drug Coverage
The Community Health Plan of WA Dual Complete (HMO D-SNP) plan has a $590 deductible for prescription drugs. After meeting the deductible, you will pay the costs for your prescriptions, but the exact amount will depend on the specific drug tier and pharmacy you use. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, your monthly premium for Part D will be $26.20.
Additional Benefits
The Community Health Plan of WA Dual Complete (HMO D-SNP) plan provides coverage for a wide range of services. Many services have a 20% coinsurance, including outpatient services, primary care, preventive services, hearing and vision services, and dental services. The plan also includes additional benefits, such as coverage for hearing aids up to $2,250 per year, over-the-counter items up to $100 per month, and transportation services. Emergency services and home health services are covered with no copay, while hospital and skilled nursing facility stays are covered with a copay that is defined by Medicare.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay that is defined by Medicare. Additional days for Inpatient Hospital-Acute and Psychiatric, and non-Medicare-covered stays, are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services with a 20% coinsurance, and Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services with a 20% coinsurance. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered with a 20% coinsurance, and requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a 20% coinsurance for both ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered for up to 20 one-way trips per year, using rideshare services, bus/subway, or medical transport, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Community Health Plan of WA Dual Complete (HMO D-SNP), with a 20% coinsurance for each service, and no copay. Worldwide Emergency Services has a maximum plan benefit coverage of $25,000.
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 under the Community Health Plan of WA Dual Complete (HMO D-SNP) plan. For Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits, there is a 20% coinsurance. For Occupational Therapy Services, the coinsurance is 20%. Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services have a coinsurance of 20%.
Preventive Services See details
The Community Health Plan of WA Dual Complete (HMO D-SNP) plan covers preventive services, including Medicare-covered preventive services with no copay and a doctor referral. Other covered services include alternative therapies, therapeutic massage, additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, kidney disease education services, and other preventive services with a 20% coinsurance. However, annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams with a coinsurance of up to 20%, and prescription hearing aids up to $2,250 per year. Fitting/evaluation for hearing aids is covered once per year. OTC hearing aids, and prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include coverage for eye exams with a 20% coinsurance. Eyewear is covered with a 20% coinsurance and a combined maximum benefit of $500 every year, covering contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with 20% coinsurance, and other dental services with a $5,000 maximum benefit per year. 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 covered, and all require prior authorization and a doctor referral.
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 coinsurance between 0-20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered with a doctor referral and a 20% coinsurance.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered by the Community Health Plan of WA Dual Complete (HMO D-SNP), but durable medical equipment for use outside the home is not covered. For durable medical equipment, there is a 20% coinsurance and no copay; for prosthetic devices, there is a 20% coinsurance and no copay; for medical supplies, there is a 20% coinsurance and no copay; for diabetic supplies and therapeutic shoes/inserts, there is a 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
The Community Health Plan of WA Dual Complete (HMO D-SNP) covers diagnostic and radiological services with no copay. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Lab Services has a coinsurance of at most 0%. Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by Community Health Plan of WA Dual Complete (HMO D-SNP) with no copay and no coinsurance. 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 any of the sub-services. Prior authorization and a doctor's referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered SNF and non-Medicare-covered stays are not covered. You will pay the Medicare-defined cost share for tier 1, and a doctor referral and prior authorization are required.
Other Services See details
The Community Health Plan of WA Dual Complete (HMO D-SNP) plan covers acupuncture with a limit of 25 treatments per year, and it also covers over-the-counter items up to $100 per month. The plan also covers a meal benefit, which 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.
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