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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 2026, 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 2026.
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 $10.50. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.20. You must continue to pay paying your reduced 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 $615.00 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 $9250.00 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:
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Drug Coverage
The Community Health Plan of WA Dual Complete (HMO D-SNP) features an annual prescription drug deductible of $615. Under this plan, standard pharmacy and standard mail order fills for Tier 1 preferred generic, Tier 2 generic, Tier 3 preferred brand, and Tier 5 specialty drugs require a 25% coinsurance. Tier 4 non-preferred drugs carry a higher coinsurance of 45% for a one-month supply. Beneficiaries can benefit from no copay on Tier 6 select care drugs for one-month, two-month, and three-month supplies through standard pharmacies and standard mail order. This coverage structure helps you understand your out-of-pocket costs for essential medications throughout the initial coverage phase.
Additional Benefits
The Community Health Plan of WA Dual Complete (HMO D-SNP) offers comprehensive medical coverage featuring no copays for most services, including primary care, outpatient care, and emergency services. Instead of copays, members generally pay a 20% coinsurance for outpatient visits, specialist care, diagnostic tests, and medical equipment. Inpatient hospital stays require Medicare-defined copays with no coinsurance, while skilled nursing facility care is subject to Medicare-defined coinsurance. This plan also provides valuable supplemental benefits with no copays and no coinsurance, including up to 40 one-way transportation trips, routine acupuncture, and fitness programs. Comprehensive dental services are covered up to a $2,250 annual limit, while vision hardware and prescription hearing aids feature annual allowances of $500 and $1,500 respectively. Most of these additional and specialized services require prior authorization or referrals to ensure coverage.
Inpatient Hospital See details
Community Health Plan of WA Dual Complete (HMO D-SNP) partially covers inpatient hospital services with no coinsurance and Medicare-defined copays, requiring prior authorization and referrals. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Community Health Plan of WA Dual Complete (HMO D-SNP) covers outpatient services with no copayments, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services. Prior authorization and referrals are required for most of these covered outpatient benefits.
Partial Hospitalization See details
Community Health Plan of WA Dual Complete (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization and a referral are required for these services.
Ambulance and Transportation Services See details
Community Health Plan of WA Dual Complete (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Additionally, transportation services are partially covered with no copay and no coinsurance for up to 40 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Community Health Plan of WA Dual Complete (HMO D-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay, up to a maximum of $115 and $40 per visit. Worldwide emergency, urgent, and transportation services are also covered with a 20% coinsurance and no copay, up to a maximum plan benefit of $25,000.
Primary Care See details
Community Health Plan of WA Dual Complete (HMO D-SNP) primary care, specialist, therapy, and mental health services are covered with no copay and a 20% coinsurance. Chiropractic benefits are partially covered, providing up to 25 routine visits per year with no copay and 20% coinsurance, though other chiropractic services are not covered.
Preventive Services See details
Community Health Plan of WA Dual Complete (HMO D-SNP) partially covers preventive services, offering alternative therapies, therapeutic massage, and fitness benefits with no copay and no coinsurance, while an annual physical exam and health education are not covered. Medicare-covered zero-dollar preventive services, kidney disease education, and specific screenings like glaucoma and diabetes self-management training have no copay but carry a 20% coinsurance.
Hearing Services See details
Community Health Plan of WA Dual Complete (HMO D-SNP) covers hearing exams with no copay and a 20% coinsurance for annual routine exams, which also require a referral. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $1,500 annual maximum, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Community Health Plan of WA Dual Complete (HMO D-SNP) offers partially covered vision services with no copays, though a 20% coinsurance applies to routine eye exams and contact lenses, and other eye exam services are not covered. Covered eyewear, which requires a referral, includes contact lenses, eyeglasses, and frames up to a combined maximum benefit of $500 every year.
Dental Services See details
Community Health Plan of WA Dual Complete (HMO D-SNP) covers Medicare dental services with no copay and 20% coinsurance. Other preventive and comprehensive dental services, including implants and orthodontics, are covered with no copay and no coinsurance up to a $2,250 annual maximum.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Community Health Plan of WA Dual Complete (HMO D-SNP) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and other Part B drugs, carry a coinsurance ranging from no coinsurance to 20%, while Medicare Part B insulin drugs require a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Community Health Plan of WA Dual Complete (HMO D-SNP) with no copay and a 20% coinsurance, though a referral is required to receive care.
Medical Equipment See details
Community Health Plan of WA Dual Complete (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and a 20% coinsurance. Prior authorization is required for durable medical equipment and prosthetic devices or medical supplies.
Diagnostic and Radiological Services See details
Community Health Plan of WA Dual Complete (HMO D-SNP) covers diagnostic and radiological services with no copayments, though prior authorization is required. There is no coinsurance for lab services, but a 20% coinsurance applies to diagnostic procedures, diagnostic and therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Community Health Plan of WA Dual Complete (HMO D-SNP) covers home health services with no copay and no coinsurance. Members will need to obtain a referral and prior authorization to access these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Community Health Plan of WA Dual Complete (HMO D-SNP) with no copay, though prior authorization and referrals are required. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and are subject to a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Community Health Plan of WA Dual Complete (HMO D-SNP) with no copay and Medicare-defined coinsurance, though prior authorization and referrals are required. A prior three-day inpatient hospital stay is required before admission, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Community Health Plan of WA Dual Complete (HMO D-SNP) partially covers other services, providing acupuncture for up to 25 treatments per year and meal benefits for chronic illnesses with a referral, both with no copay and no coinsurance. Over-the-counter (OTC) items and other additional services are not covered under this benefit.
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