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:

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

$1,000 plan coverage limit for preventive dental benefits every year.

$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 two dental X-rays 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.

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 1 routine hearing exam every year
  • $0 for up to 3 fittings for a hearing aid every three years
  • $0 for 48 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 Medicare-covered diagnosis and treatment for diseases and conditions of the eye.
  • $0 copay for up to 1 routine vision exam every year.
  • 1 pair of Medicare-covered eyeglasses or contact lenses after cataract surgery.
  • In addition to the cataract surgery benefit, the plan will cover up to $350 every year towards eyeglasses or contact lenses.

The eyewear allowance only applies to the following limited eyewear benefits: Fashion / Designer / Premier frames collections; Clear plastic single-vision, lined bifocal, trifocal or lenticular lenses (any size or Rx); Tinting of Plastic Lenses; and Scratch-Resistant Coating. Or in lieu of eyeglasses, the $350 allowance may be applied to a limited selection of visually required contact lenses. Additional charges may apply for eyewear benefits that are not listed here.

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

$0 for up to 100 one-way trips to plan-approved locations every year. May consist of car, shuttle, or van service depending on appropriateness for situation.

Authorization and scheduling rules apply.

Over-the-counter (OTC) items

You may spend up to $365 per quarter for (OTC) items from our OTC catalog (PDF). Money not spent in a quarter does not roll over into the next quarter.

Spanish OTC catalog (PDF).

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.

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