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:
- $0 copay for Medicare-covered dental and vision benefits.
- Coverage for inpatient hospital care, skilled nursing facilities, and home health care coverage.
- A large network of providers, hospitals, specialists, and pharmacies.
Plus, you'll get extra benefits, including:
- Preventive services to help you stay healthy.
- Wellness education including smoking cessation and a 24-hour Nurse Call Line.
- Great service and personal attention.
Questions? Call us toll free at 1-855-241-3648 (TTY/TDD 711), 8 a.m. - 8 p.m., 7 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) for members in Allegheny, Armstrong, Beaver, Bedford, Berks, Blair, Butler, Cambria, Dauphin, Fayette, Greene, Indiana, Lancaster, Lawrence, Lebanon, Lehigh, Northampton, Perry, Somerset, Washington, Westmoreland, Wyoming, and York counties.
- 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 AmeriHealth Caritas VIP Care Evidence of Coverage (PDF — June 18, 2019).
- 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.
- You can also contact AmeriHealth Caritas VIP Care for more information.
Find a provider in our network for the benefits listed below.
Or contact AmeriHealth Caritas VIP Care for more information.
Find a provider in our network for the benefits below.
|Premium||$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||
$0 copay for Medicare-covered dental benefits.
$0 copay for the following preventive dental benefits:
We offer additional supplemental comprehensive dental benefits.
We pay up to $1,000 every two years for supplemental comprehensive dental benefits. This benefit includes coverage for minor restorations (such as fillings), simple extractions, dentures, and denture repair.
|Hearing exams and aids||
$0 copay for Medicare-covered diagnostic hearing exams.
$0 copay for up to 1 routine hearing exam every year.
$0 copay for 1 fitting evaluation for a hearing aid every three years.
$0 copay for up to 1 hearing aid every three years.
$1,000 every 3 years for hearing aids for both ears combined.
$0 copay for Medicare-covered diagnosis and treatment for diseases and conditions of the eye, including an annual glaucoma screening for people at risk.
$0 copay for:
We pay up to $200 every two years for contact lenses and eyeglasses (frames and lenses).
$0 for up to 30 one-way trips to plan-approved locations every year. May consist of car, shuttle, or van service depending on appropriateness for situation.
Scheduling rules apply.
|Over-the-counter (OTC) items||You may spend up to $70 per quarter for items from our OTC catalog (PDF) (Spanish OTC catalog PDF). Money not spent in a quarter does not roll over into the next quarter.|
|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.
$0 copay for Medicare-covered partial hospitalization program services.