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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 2026, 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 2026.
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 $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 Select (HMO D-SNP) features an annual prescription drug deductible of $615. Under this plan, cost sharing for most prescription drugs is based on a coinsurance percentage when using standard pharmacies or standard mail order services. For Tier 1 preferred generics, Tier 2 generics, Tier 3 preferred brands, and Tier 5 specialty drugs, members generally pay a 25% coinsurance for a one-month supply. Tier 4 non-preferred drugs require a higher 50% coinsurance for a one-month supply at standard pharmacies and standard mail order. Conversely, Tier 6 select care drugs are covered with no copay for one-month, two-month, and three-month supplies through both standard pharmacies and standard mail order. This plan provides structured drug coverage to help members manage their prescription medication costs throughout the year.
Additional Benefits
The Community Health Plan of WA Dual Select (HMO D-SNP) offers comprehensive medical coverage, featuring no copay and a standard 20% coinsurance for most outpatient, emergency, primary care, and specialist services. Major services like inpatient hospital stays, home health care, and home infusion are covered with no copay and no coinsurance, though prior authorization is typically required. For extra wellness benefits, the plan provides comprehensive dental care with no copay or coinsurance up to $1,250 annually, alongside allowances of $500 for eyewear and $1,500 for hearing aids. Members also benefit from up to 40 one-way transportation trips per year and up to 25 acupuncture sessions with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Community Health Plan of WA Dual Select (HMO D-SNP) with no copay and no coinsurance, although referrals and prior authorization are required. This benefit does not cover additional days, upgrades, or non-Medicare-covered stays.
Outpatient Services See details
Community Health Plan of WA Dual Select (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization and referrals are required for most of these covered services.
Partial Hospitalization See details
Community Health Plan of WA Dual Select (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Community Health Plan of WA Dual Select (HMO D-SNP) covers ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered, providing up to 40 one-way trips per year to plan-approved locations with no copay or coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
Community Health Plan of WA Dual Select (HMO D-SNP) covers emergency and urgent care services with a 20% coinsurance and no copay, up to a maximum of $115 per emergency visit and $40 per urgent care visit. Worldwide emergency, urgent, and transportation services are also covered with a 20% coinsurance and no copay, up to a maximum plan benefit limit of $25,000.
Primary Care See details
Community Health Plan of WA Dual Select (HMO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and 20% coinsurance. Chiropractic care is partially covered, offering up to 25 routine visits per year with no copay and 20% coinsurance, while other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Community Health Plan of WA Dual Select (HMO D-SNP), offering select benefits like fitness and alternative therapies with no copay and no coinsurance, while kidney education and other screenings carry a 20% coinsurance and no copay. Uncovered services under this plan include annual physical exams, health education, in-home safety assessments, personal emergency response systems, and medical nutrition therapy.
Hearing Services See details
Hearing services are partially covered by Community Health Plan of WA Dual Select (HMO D-SNP), providing routine hearing exams with no copay and a 20% coinsurance, and prescription hearing aids with no copay or coinsurance up to a $1,500 annual limit. OTC hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are partially covered by Community Health Plan of WA Dual Select (HMO D-SNP), offering eye exams and eyewear with no copay, though a 20% coinsurance applies to routine eye exams and contact lenses. This benefit includes one routine eye exam annually and a $500 yearly maximum for eyewear with a required referral, while other eye exam services are not covered.
Dental Services See details
Dental services are covered by Community Health Plan of WA Dual Select (HMO D-SNP) with no copay and no coinsurance, up to a maximum benefit of $1,250 every year. This comprehensive coverage includes preventive care, restorative services, endodontics, periodontics, implants, and orthodontics with no copays or coinsurance.
Home Infusion bundled Services See details
Community Health Plan of WA Dual Select (HMO D-SNP) covers Home Infusion bundled Services with no copay and no coinsurance, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Community Health Plan of WA Dual Select (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance. A referral is required to receive this care.
Medical Equipment See details
Community Health Plan of WA Dual Select (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for durable medical equipment, prosthetics, and medical supplies.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Community Health Plan of WA Dual Select (HMO D-SNP) with no copay and a 20% coinsurance, subject to prior authorization. This benefit is partially covered as lab services are not covered, though diagnostic procedures, radiological services, and outpatient X-rays are covered.
Home Health Services See details
Home health services are covered by Community Health Plan of WA Dual Select (HMO D-SNP) with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no copay under the Community Health Plan of WA Dual Select (HMO D-SNP), but in practice, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Community Health Plan of WA Dual Select (HMO D-SNP) with no copay, though Medicare-defined coinsurance applies and prior authorization and referrals are required. Admission requires a prior three-day inpatient hospital stay, and the plan does not cover additional days beyond the standard Medicare-covered limit.
Other Services See details
Community Health Plan of WA Dual Select (HMO D-SNP) partially covers other services, offering acupuncture and meal benefits with no copay and no coinsurance. Acupuncture is limited to 25 treatments per year, meal benefits for chronic illness require a referral, and over-the-counter (OTC) items are not covered.
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