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AmeriHealth Caritas VIP Care Plus (Medicare-Medicaid Plan)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AmeriHealth Caritas VIP Care Plus (Medicare-Medicaid Plan). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on AmeriHealth Caritas VIP Care Plus (Medicare-Medicaid Plan) in 2025, please refer to our full plan details page.
AmeriHealth Caritas VIP Care Plus (Medicare-Medicaid Plan) is a Medicare-Medicaid Plan plan offered by Independence Health Group, Inc. available for enrollment in 2025 to people living in Wayne and Macomb Counties. The overall rating for this plan is not yet available for 2025.
It's important to know that AmeriHealth Caritas VIP Care Plus (Medicare-Medicaid Plan) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
AmeriHealth Caritas VIP Care Plus (Medicare-Medicaid Plan)is a Medicare-Medicaide (MMP) plan. This means you can only enroll in this plan if you meet specific criteria for both medicare and medicaid. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about AmeriHealth Caritas VIP Care Plus (Medicare-Medicaid Plan).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For AmeriHealth Caritas VIP Care Plus (Medicare-Medicaid Plan), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
We don't have information on the Maximum Out-Of-Pocket cost for this plan. You can call our licensed insurance specialists by clicking "Call to Enroll" below for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
Sign up for AmeriHealth Caritas VIP Care Plus (Medicare-Medicaid Plan)
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Drug Coverage
The AmeriHealth Caritas VIP Care Plus (Medicare-Medicaid Plan) has an enhanced alternative drug benefit. The plan has a $0 deductible for prescription drugs. Once you meet the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000, after which you enter the next coverage phase. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The AmeriHealth Caritas VIP Care Plus plan provides coverage for a variety of services with no copay, including ambulance services, emergency services, primary care, home health, dialysis, medical equipment, and diagnostic services. The plan also covers outpatient services, partial hospitalization, hearing services, vision services, and dental services, but may require prior authorization. Some benefits have limitations, such as the $75 quarterly maximum for over-the-counter items, and the plan does not cover some services like some preventive and vision services, as well as personal care services.
Inpatient Hospital See details
The AmeriHealth Caritas VIP Care Plus plan covers Inpatient Hospital-Acute, including additional days for inpatient hospital-acute, with prior authorization required. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered. Inpatient Hospital Psychiatric benefits are covered, but additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient blood services. Outpatient substance abuse services are covered, with the exception of individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by this plan. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered, with no copay or coinsurance for all ambulance services, but ground and air ambulance services are not covered. Transportation services to any health-related location are covered, and there is no copay or coinsurance.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the AmeriHealth Caritas VIP Care Plus plan, with no copay and no coinsurance. However, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Opioid Treatment Program Services are covered with no copay and no coinsurance. Chiropractic Services only covers some services, and does not cover routine chiropractic care. Mental Health Specialty Services and Psychiatric Services are partially covered, and do not cover individual or group sessions. Podiatry Services are not covered.
Preventive Services See details
Preventive Services are covered, but annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, and home and bathroom safety devices and modifications, and counseling services are not covered. Fitness benefits, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit are covered.
Hearing Services See details
Hearing Services are covered, including Hearing Exams and Prescription Hearing Aids (all types) with prior authorization and a doctor's referral, but Routine Hearing Exams, Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear, and OTC Hearing Aids are not covered. Fitting/Evaluation for Hearing Aid benefits are covered for 2 visits every year.
Vision Services See details
Vision Services include routine eye exams once every two years, as well as coverage for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, each available once per year; however, upgrades are not covered. Prior authorization is required for eyewear.
Dental Services See details
AmeriHealth Caritas VIP Care Plus (Medicare-Medicaid Plan) covers various dental services, including oral exams, dental x-rays, other diagnostic services, cleanings, fluoride treatments, and other preventive services. Restorative services, orthodontics, and some other dental services are covered, but require prior authorization.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the AmeriHealth Caritas VIP Care Plus plan, including Medicare Part B Insulin Drugs. Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered with no copay and no coinsurance.
Medical Equipment See details
Medical equipment is covered under this plan, including Durable Medical Equipment and Prosthetics/Medical Supplies, both with no copay or coinsurance. However, Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but the plan does not cover Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, or Outpatient X-Ray Services. There is no copay for any covered services.
Home Health Services See details
Home Health Services are covered by the AmeriHealth Caritas VIP Care Plus plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the AmeriHealth Caritas VIP Care Plus plan, with prior authorization required. Additional days beyond Medicare-covered SNF stays are covered, and there is no copay or coinsurance for these services. Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items, which has a maximum benefit coverage of $75 every three months, and additional services which include Nursing Home Services and Private Duty Nursing Services. Acupuncture, Meal Benefit, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Case Management, Tobacco Cessation Counseling for Pregnant Women, Respiratory Care Services, Family Planning Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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