Community HealthFirst Medicare Advantage Plan

Our $0 premium Medicare Advantage Plan provides you with important benefits beyond that of Original Medicare.  Please note this plan does not include any Prescription Drug (Part D) benefit. 

On this page you will find the following information for our Medicare Advantage Plan

• Plan Benefit Information
• Provider Directories
• Easy Enrollment Instructions and Forms
• Policies and Procedures for Member Privacy, Rights, Appeals and Grievances

To see specific plan benefits, cost shares and how it compares to your Original Medicare benefits, simply click the plan benefit information link for the county in which you live.

Medicare Advantage Plan (H5826 006) applies if you live in any of the following counties: Island, King, Kitsap, Pierce, Snohomish, Spokane, Thurston.

Benefit Highlights, an easy to understand overview of Plan Benefits and how they compare to original Medicare.

Summary of Benefits provides important details about the plan benefits, premiums, cost sharing and requirements for receiving care.

Evidence of Coverage (EOC) document is sent to members after they enroll and provides details about your Medicare Advantage Plan coverage.  See full description of the EOC below on this page.

Medicare Advantage Plan (H5826 007) applies if you live in any of the following counties:  Adams, Benton, Chelan, Cowlitz, Douglas, Ferry, Franklin, Grant, Grays Harbor, Lewis, Lincoln, Mason, Okanogan, Pend Oreille, Skagit, Stevens, Walla Walla, Whatcom & Yakima

Benefit Highlights, an easy to understand overview of Plan Benefits and how they compare to original Medicare.

Summary of Benefits provides important details about the plan benefits, premiums, cost sharing and requirements for receiving care.

Evidence of Coverage (EOC) document is sent to members after they enroll and provides details about your Medicare Advantage Plan coverage.  See full description of the EOC below on this page.

Evidence of Coverage - The Evidence of Coverage (EOC) document is sent to members after they enroll and provides details about your Medicare Advantage Plan coverage. This booklet is an important legal document. It will be helpful to you after you have enrolled in the plan. The Evidence of Coverage document provides you with the following information:

• The Plan’s service area
• The Plan’s benefits, including annual deductible amount of initial coverage limit, and cost sharing
• Major exclusions and limitations
• Exception process
• Grievance, coverage determinations, exception process, and appeals rights and procedures
• Disenrollment rights, responsibilities, and procedures

Patient Navigator Services - The Patients Navigator program is a service that is provided FREE to all Community HealthFirst members.  The Patient Navigator is your advocate and will guide you in exploring and understanding your new health benefits under the Community HealthFirst.  Patient Navigator services include:

• Answering your questions about your Community HealthFirst, Medicare or Medicaid benefits.
• Helping you schedule appointments with your Primary care Provider (PCP).
• Helping you schedule appointments with specialty care providers when needed.
• Helping you find and schedule appointments with dentists who accept Medicare reimbursement.
• Assisting you with non-emergency transportation arrangements.
• Assistance in using translation services when appropriate.
• Assistance in maintaining Social Security Administration and Medicaid Dual Eligibility paperwork.
• Connecting you with community and social service resources in your area.

For more information on the Patient Navigator program, please contact us Monday - Friday, 8 a.m. - 5 p.m. at 1-866-717-2479 (TTY/TTD for the hearing impaired call 1-866-816-2479).

Community HealthFirst and your Primary Care Provider (PCP) work as partners to be sure you get the right care, at the right time, at the right place.  Your PCP takes care of most of your health needs and writes you a referral when you need to see a specialist.  Ultimately, you and your PCP decide the best course of action for your health care. 

In the provider directories you will find the following information:

• Obtaining health care services
• Choosing a Primary Care Provider (PCP)
• Changing your PCP
• Specialist referrals
• Prior Authorizations
• Coverage for Urgent Care and Emergencies
• Billing from out of network providers
• Who to call if you have questions

To search for a specific Provider, simply click on the proper link below to open the Directory PDF, find the Directory listing for the county you live in, then check the network providers listed for your county.

Directory of Primary Care Providers and Hospitals 
Addendums to this directory

Directory of Specialist
Addendums to this directory

Enrolling in a Community HealthFirst Plan is easy as 1, 2, 3
Enrollment Check List, Instructions and Forms

We take your rights and concerns very seriously.  We want to ensure you receive the right care, at the right time, in the right place and that it is delivered with the respect and service you deserved.  When you do not agree with our benefit determinations or have issues with the treatment you receive, we want to know about it.   We consider them opportunities to improve care and service to our members.

Policies and Procedures for Member Privacy, Rights, Appeals and Grievance.