The Specials Needs (SNP) plan is for people with more than one health condition, complex medical needs, or disabilities. This plan is designed to provide extra support in accessing care and other resources. If you receive benefits for both Apple Health (Medicaid) and Medicare, then you qualify for extra benefits on this plan. Talk to an expert to learn more.
Click the button below to learn how to enroll in this plan.
2019 Plan Benefits at a Glance
Coverage in this Plan Includes:
Medical, Vision, Prescription drugs, Over-the-counter benefits, Hearing aid supplement, Transportation, and Gym membership.
|Community HealthFirst||Original Medicare|
|Pharmacy||Generic drugs at $0-$3.40
Other drugs at $0-$8.50*
|Vision||1 routine eye exam per year
Up to $130 per year for eyewear
|Dental||$0 copay and up to $1,800 per year for preventive services||Not Covered|
|Hearing Aids||1 hearing exam & 1 fitting/evaluation exam per year and $1,500 for hearing aids and supplies every 2 years||Not Covered|
|Transportation||24 one way rides to approved appointments||Not Covered|
|Over the Counter Allowance (OTC)||$50 to spend on non-prescription goods every 3 months||Not Covered|
The Summary of Benefits booklet gives you an idea of what services we cover and how much you pay. It does not list every service that we cover or list every limitation or exclusion. Click on the links below to download the summary of benefits in English or Spanish.
Offered in the Following Counties:
Adams, Benton, Chelan, Clark, Cowlitz, Douglas, Franklin, Grant, King, Kitsap, Lewis, Okanogan, Pierce, Skagit, Snohomish, Spokane, Thurston, Walla Walla, Whatcom, and Yakima.
Covered Services & Cost
The Evidence of Coverage lays out coverage and payment details for different services including copays, coinsurance, limitation, prior authorizations, and deductibles.
Browse the prescription drug formularies to check if your current medications are covered by the plan. Find information about restrictions and limitations to certain medications, and how much you will pay. Download a PDF or search for your medications by name in the online formulary.
Has Anything Changed in 2019?
That’s a great question. Any changes to the plan are detailed in the Annual Notice of Change (ANOC).
Silver & Fit Program
Stay fit at home or at the gym with the Silver & Fit Program. Meet new people, participate in challenges, and earn rewards while you get exercise to keep you active and healthy.
Plan 014 members have a $50 allowance to spend on over-the-counter products every 3 calendar months. OTC products include some durable medical equipment, health supplies, and other items. Order online or through the mail and get your products delivered to your home.
Rides to Medical Visits
We partner with American Logistics Company and Lyft to offer you 24 one-way trips per year to use for any medical appointments. Rides to accommodate wheelchairs and gurneys are available. Any ride over 60 miles needs approval. Call Customer Service for more information.
Schedule your ride: 1-833-209-6382 (TTY 7-1-1)
Hearing Aid Supplement
Hearings aids and related supplies for both ears are covered up to a combined amount of $1500 every two calendar years. Every year, one routine hearing exam and hearing aid fitting is included.
Our plan pays up to $1800 every year for most supplemental dental services.
Special Needs plan members are assigned a case manager who will give them individualized support and help coordinate their care. Case managers will work with providers to figure out what kind of care is best for you. They can help you make appointments and support you through treatments. Case managers are available by phone if you have any questions.
Providers and Care Facilities
Our directories let you know which primary care providers, vision providers, specialists, care facilities, and pharmacies are in our network.
Use our find a doctor tool or browse our provider directories to check who is in your area.