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Community Health Plan of WA Dual Select (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 Select (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 Select (HMO D-SNP) in 2025, please refer to our full plan details page.
Community Health Plan of WA Dual Select (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 Select (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 Select (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 Select (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 Select (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:
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Drug Coverage
The Community Health Plan of WA Dual Select (HMO D-SNP) plan has a deductible of $590. After you meet your deductible, you will pay the costs of your drugs based on the tier and pharmacy you use, until your total drug costs reach $2000. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs. If you qualify for the low-income subsidy (LIS), your Part D premium will be $26.20. The plan's formulary provides specific details on the drugs covered.
Additional Benefits
The Community Health Plan of WA Dual Select (HMO D-SNP) offers a wide array of benefits. This plan provides coverage for a range of services including primary care, outpatient services, and emergency services, often with a 20% coinsurance. It also includes benefits for hearing, vision, and dental services, as well as coverage for home health services with no copay, and transportation services. This plan also includes coverage for ambulance services with a 20% coinsurance, and offers additional benefits such as acupuncture, over-the-counter items, and meal benefits, and preventive services. The plan also offers coverage for hearing aids, and a combined maximum benefit for eyewear. However, it's important to note that some services, like certain cardiac rehabilitation services, and additional hours of care are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization and a doctor referral. The plan charges the Medicare-defined cost share for tier 1, but additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient substance abuse services. Outpatient hospital and observation services have a 20% coinsurance, and outpatient substance abuse services have a coinsurance between 20% and 20%. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, 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, with no copay for ambulance services, but a 20% coinsurance applies to both ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered for up to 32 one-way trips per year, 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. Emergency and Urgently Needed Services have a 20% coinsurance with no copay, and Worldwide Emergency Services have a 20% coinsurance for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, with a maximum benefit 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. Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have a 20% coinsurance, while Occupational Therapy Services, Individual and Group Sessions for Mental Health Specialty Services, Routine Foot Care, Other Health Care Professional, Individual and Group Sessions for Psychiatric Services, and Opioid Treatment Program Services have a 20% coinsurance.
Preventive Services See details
Preventive Services include coverage for Medicare-covered zero dollar services, with no copay, and a referral is required. Additional preventive services are partially covered, but do not include Health Education, In-Home Safety Assessment, 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, and Enhanced Disease Management. Alternative Therapies and Therapeutic Massage are covered for 25 sessions per year, and the plan also covers Additional Sessions of Smoking and Tobacco Cessation Counseling for 8 visits, Fitness Benefit, Remote Access Technologies, Kidney Disease Education Services with 20% coinsurance, and Other Preventive Services including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit with 20% coinsurance.
Hearing Services See details
Hearing services include coverage for hearing exams, with a coinsurance of at most 20% and routine hearing exams covered once per year. This plan also covers fitting/evaluation for hearing aids once per year and prescription hearing aids up to a plan maximum of $2250 per year, but does not cover inner ear, outer ear, or over the ear prescription hearing aids, or OTC hearing aids.
Vision Services See details
Vision services include coverage for eye exams and eyewear. Eye exams have a 20% coinsurance, while eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, also has a 20% coinsurance. The plan offers a combined maximum benefit of $500 per year for eyewear.
Dental Services See details
Dental services, including oral exams, dental x-rays, and other diagnostic services, are covered with a maximum benefit of $750 per year. Additionally, services like prophylaxis (cleaning), fluoride treatment, restorative services, and orthodontics are covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by Community Health Plan of WA Dual Select (HMO D-SNP) with a doctor referral. The coinsurance is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Diabetic Supplies have a 20% coinsurance. Medical Supplies have a 20% coinsurance. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Community Health Plan of WA Dual Select (HMO D-SNP), with no copay for all diagnostic and radiological services. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Lab Services has no coinsurance. Therapeutic Radiological Services and Outpatient X-Ray Services also have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Community Health Plan of WA Dual Select (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 not covered by the Community Health Plan of WA Dual Select (HMO D-SNP). Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Community Health Plan of WA Dual Select (HMO D-SNP), but additional days beyond Medicare-covered, and non-Medicare-covered stays are not covered. You will pay the Medicare-defined cost share for tier 1, and prior authorization and a doctor referral are required.
Other Services See details
The Community Health Plan of WA Dual Select (HMO D-SNP) plan covers acupuncture with a limit of 25 treatments per year, but does not specify any cost. Over-the-counter items are covered, but there is no maximum plan benefit coverage amount. Meal benefits are covered with a doctor 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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