Summary of Benefits
You have options for your Medicare Advantage coverage. Think about your needs and what type of benefits will help you most. AmeriHealth Caritas VIP Care (HMO-SNP) offers all the benefits of regular Medicare, plus more.
AmeriHealth Caritas VIP Care provides:
- Coverage for inpatient hospital care, as well as skilled nursing facility and home health care coverage.
- Preventive services to help you stay healthy.
- A large network of doctors, hospitals, specialists, and pharmacies.
- Great service and personal attention.
Plus, you'll get extra benefits, including:
- Dental, vision, and hearing benefits not covered by original Medicare.
- Wellness education including smoking cessation and a nurse hotline.
- Transportation to your provider.
Questions? Call us toll-free at 1-800-858-1487 (TTY 711), 8 a.m. - 8 p.m., seven days a week.
Below is a brief summary of key benefits.
You may also view:
- A pre-enrollment checklist PDF.
- A complete Summary of Benefits PDF.
- An Over-the-Counter Benefit Product Catalog (OTC) PDF.
- Spanish Over-the-Counter Benefit Product Catalog (OTC) PDF.
- Review information about your over-the-counter benefits online by visiting www.amerihealthflexcard.com. You can also call 1-800-824-9713 (TTY 711), Monday – Friday from 8 a.m. to 8 p.m. EST.
- A complete Annual Notice of Changes — ANOC PDF.
- The ANOC tells you about all plan changes in the next year.
- Spanish ANOC PDF
- A complete Evidence of Coverage PDF.
- The EOC tells you how to get medical care and prescription drugs through our plan. The booklet explains what's covered, how much you'll pay for services, and all about your rights and responsibilities.
- Spanish EOC PDF
- You can also contact AmeriHealth Caritas VIP Care for more information.
Find a provider in our network for the benefits listed below.
|$0 monthly plan premium.
|Doctor office visits
|$0 copay for each Medicare-covered primary care provider (PCP) visit.
$0 copay for each Medicare-covered specialist visit.
No referral required.
|Preventive and comprehensive dental
Unlimited plan coverage limit for preventive dental benefits every year.
Unlimited plan coverage limit for comprehensive dental benefits every year.
*Prior authorization and service limits may apply for some comprehensive dental services.
Diagnostic hearing and balance evaluations performed by your PCP to determine if you need medical treatment are covered as outpatient care when furnished by a physician, audiologist, or other qualified provider.
You must receive your care from a network provider. We will only pay for covered hearing services if you go to an in-network hearing provider. In most cases, you will have to pay for care that you receive from an out-of-network provider.
Covered services include:
Our plan offers supplemental vision coverage including:
You must receive your care from a network provider. We will only pay for covered vision services if you go to an in-network vision provider. In most cases, you will have to pay for care that you receive from an out-of-network provider.
Unlimited trips to plan-approved locations every year (e.g., doctor's office, pharmacy, and hospital).
Prior authorization is required for trips that exceed 50 miles for a one‐way ride. Other prior authorization and scheduling rules apply.
|OTC Items VBID/Food & Produce/General Supports for Living
Up to $180 per month may be spent for over-the-counter (OTC) items included in the OTC catalog (PDF) and Spanish OTC catalog (PDF), online ordering portal and/or qualified items at participating retail settings via a restricted spend debit card. There is no limit on the total number of items or orders a member may purchase. Any unused balance will automatically expire at the end of each month or upon disenrollment from the plan.
Members who qualify based on socioeconomic (LIS) status may use $180 of the monthly allowance towards qualifying Food & Produce at participating retail locations and/or FarmBox mail-order, item limits may apply and/or qualifying rent and utility services. Any unused balance will automatically expire at the end of each month or upon disenrollment from the plan.
|Home health care
|$0 copay for Medicare-covered home health visits.
|Outpatient mental health care
$0 copay for each Medicare-covered individual therapy visit.
$0 copay for each Medicare-covered group therapy visit.
$0 copay for each Medicare-covered individual therapy visit with a psychiatrist.
$0 copay for each Medicare-covered group therapy visit with a psychiatrist.
|Important mesage about what you pay for vaccines
Our plan covers most Part D vaccines at no cost to you. Call Member Services for more information.