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.

Below is a brief summary of key benefits.

You may also view:

  • A pre-enrollment checklist PDF.
  • complete Summary of Benefits PDF.
  • An Over-the-Counter Benefit Product Catalog (OTC) PDF.
  • 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.

    Premium $0 monthly plan premium.
    Doctor office visits $0 copay for each Medicare-covered primary care provider (PCP) visit.
    Specialist visits

    $0 copay for each Medicare-covered specialist visit.

    No referral required.

    Preventive and comprehensive dental

    Preventive:

    • Oral exams – one every six months: $0 copay.
    • Cleaning – one every six months: $0 copay.
    • Fluoride treatment – one every six months: $0 copay.
    • Dental X‐rays – four every year: $0 copay.

    Unlimited plan coverage limit for preventive dental benefits every year.

    Comprehensive:

    • Minor restorations (fillings).
    • Simple and Surgical extractions.
    • Dentures, Denture repair, and reline.
    • Oral surgery.
    • Periodontics/endodontics.
    • Crowns.
    • Mini‐implants.

    Unlimited plan coverage limit for comprehensive dental benefits every year.

    *Prior authorization and service limits may apply for some comprehensive dental services.

    Hearing

    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.

    • $0 for up to one routine hearing exam every year
    • $0 for up to three fittings for a hearing aid every three years
    • $0 for 80 batteries per aid for non-rechargeable models every three years
    • $1,500 allowance for hearing aids every year

    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.

    Vision services

    Covered services include:

    • Outpatient physician services for the diagnosis and treatment of diseases and injuries of the eye, including treatment for age-related macular degeneration. Original Medicare doesn't cover routine eye exams (eye refractions) for eyeglasses/contacts.
    • For people who are at high risk of glaucoma, we will cover one glaucoma screening each year. People at high risk of glaucoma include: people with a family history of glaucoma, people with diabetes, African-Americans who are age 50 and older, and Hispanic Americans who are 65 or older.
    • For people with diabetes, screening for diabetic retinopathy is covered once per year.
    • One pair of eyeglasses or contact lenses after each cataract surgery that includes insertion of an intraocular lens. (If you have two separate cataract operations, you cannot reserve the benefit after the first surgery and purchase two eyeglasses after the second surgery.)

    Our plan offers supplemental vision coverage including:

    • $0 copay for up to one routine vision exam every year.
    • In addition to the cataract surgery benefit, the plan will cover up to $150 towards 1 set of Eyeglasses (lenses and frames) or one pair of Contact Lenses every 2 years.  

    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.

    Transportation

    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.

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