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 1-855-241-3648 (TTY 711), 8 a.m. - 8 p.m., seven days a week.

Below is a brief summary of key benefits.

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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

Unlimited amount each year for preventive dental services.

$0 copay for the following preventive dental benefits:

  • Up to one oral exam every six months.
  • Up to one cleaning every six months.
  • Up to one fluoride treatment every six months.
  • Up to four dental x-ray visits every year

The combined total comprehensive dental benefits cannot exceed $3,000 every year. The comprehensive dental benefits include the following services up to a $3,000 combined limit every year:

  • minor restorations (fillings)
  • simple extractions
  • dentures, 1 every 5 years. Prior authorization is required.
  • denture repair and reline
  • surgical extractions
  • Oral surgery
  • Periodontics
  • Endodontics
  • Crowns, 1 every 5 years, per tooth. No more than 4 per calendar year, with no more than 2 crowns per arch.
  • Mini-implants (lower arch only) and implant supported denture (lower arch only).

*Prior authorization is required for dentures, periodontics, endodontics, crowns, mini implants, and implant supported dentures. Fixed bridges and all other dental implants, except for mini-implants, are not covered.


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 1 routine hearing exam every year
  • $0 for up to 3 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 3 years

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 1 routine vision exam every year.
  • In addition to the cataract surgery benefit, the plan will cover up to $350 every year towards eyeglasses or contact lenses.

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 per year for health care services to plan-approved locations (e.g. doctor's office, pharmacy, and hospital). May consist of a car, shuttle, or van service depending on appropriateness for the situation and the member's needs. Rides must be scheduled at least one business day in advance except in special circumstances. Transportation is authorized for plan-approved locations only (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.
Over-the-counter (OTC) pharmacy and Special Supplemental Benefits for the Chronically Ill (SSBCI)/Food and Produce

Up to $310 per quarter may be spent for over-the-counter (OTC) items included in the OTC catalog (PDF), online ordering portal and/or qualified items at participating retail settings via a restricted spend debit card. Spanish OTC catalog (PDF)  Members may purchase up to six products per category per quarter. There is no limit on the total number of items a member may purchase. OTC catalog and online ordering portal orders are limited to three orders per quarter. Additional limits may apply to some items.

Members with qualifying SSBCI chronic conditions may also use up to $100 of the $310 quarterly allowance towards qualifying food & produce at participating retail locations and/or FarmBox mail-order. Item limits may apply. Any unused balance will automatically expire at the end of each quarter or upon disenrollment from the plan.

Refer to the Evidence of Coverage (EOC) (PDF) for more information on the qualifying SSBCI chronic conditions. The benefits mentioned are a part of special supplemental program for the chronically ill. Not all members qualify.

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 message about what you pay for vaccines

Our plan covers most Part D vaccines at no cost to you. Call Member Services for more information

Important message about what you pay for insulin

You won't pay more than $35 for a one- month supply of each insulin product covered by our plan, no matter what cost sharing tier it is on. In most cases you will not pay more than $10.35 for a one-month supply of each insulin product.