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AmeriHealth Caritas VIP Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AmeriHealth Caritas VIP Care (HMO D-SNP). 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 (HMO D-SNP) in 2026, please refer to our full plan details page.
AmeriHealth Caritas VIP Care (HMO D-SNP) is a HMO D-SNP plan offered by Independence Health Group, Inc. available for enrollment in 2025 to people living in State of Delaware. The overall rating for this plan is not yet available for 2026.
It's important to know that AmeriHealth Caritas VIP Care (HMO D-SNP) 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 (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. 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 (HMO D-SNP).
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 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $31.20. 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 a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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:
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Drug Coverage
The AmeriHealth Caritas VIP Care (HMO D-SNP) prescription drug plan has an annual drug deductible of $615. For standard pharmacy and standard mail order services, you will pay a 25% coinsurance for Tier 1 preferred generic, Tier 2 generic, Tier 3 preferred brand, and Tier 5 specialty drugs. Tier 4 non-preferred drugs require a slightly higher 26% coinsurance for standard pharmacy and standard mail order fills. Beneficiaries can save on Tier 6 select care drugs, which feature no copay for one, two, or three-month supplies through standard pharmacies and standard mail order. Understanding these coinsurance and copay structures can help you plan your healthcare budget and manage your prescription drug costs effectively under this plan.
Additional Benefits
The AmeriHealth Caritas VIP Care (HMO D-SNP) plan offers robust medical coverage with no copays for primary care, specialist visits, and outpatient services, though some outpatient care requires a 30% coinsurance. Inpatient hospital stays require copays for the initial days, such as $1,050 for days 1 to 2 of acute care, followed by no copay for days 3 through 90. Emergency room visits carry a $115 copay, while urgently needed services require a 30% coinsurance and no copay. This plan also includes valuable supplemental benefits with no copays or coinsurance, such as routine dental care up to a $3,600 annual limit, routine eye exams with a $430 eyewear allowance, and hearing aids up to $1,600 every three years. Additionally, members receive home health services at no cost, up to 28 one-way trips to plan-approved locations, and an $85 monthly allowance for over-the-counter items.
Inpatient Hospital See details
AmeriHealth Caritas VIP Care (HMO D-SNP) covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute care stays require a $1,050 copay for days 1 to 2 and no copay for days 3 to 90, while psychiatric stays require a $260 copay for days 1 to 8 and no copay for days 9 to 90. Additional inpatient days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
AmeriHealth Caritas VIP Care (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 30% coinsurance. Prior authorization is required for most of these outpatient services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization services are covered by AmeriHealth Caritas VIP Care (HMO D-SNP) with no copay and a 30% coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by AmeriHealth Caritas VIP Care (HMO D-SNP), with ground and air ambulance services requiring prior authorization and carrying a 30% coinsurance and no copay. Transportation services are partially covered, offering up to 28 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
AmeriHealth Caritas VIP Care (HMO D-SNP) covers emergency services with a $115.00 copay and no coinsurance, while urgently needed services require a 30% coinsurance and no copay. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum limit with no copay and no coinsurance.
Primary Care See details
AmeriHealth Caritas VIP Care (HMO D-SNP) covers primary care, specialist, and mental health services with no copays and coinsurance ranging from 0% to 30%. Therapy, podiatry, and psychiatric services also feature no copays and 30% coinsurance, while chiropractic care is partially covered, offering 12 routine visits per year but excluding other chiropractic services.
Preventive Services See details
Preventive services are partially covered by AmeriHealth Caritas VIP Care (HMO D-SNP) with no copay and no coinsurance for most services, while kidney disease education and diabetes training have no copay and a 30% coinsurance. Uncovered sub-services include annual physical exams, health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home modifications, and counseling.
Hearing Services See details
Hearing Services under the AmeriHealth Caritas VIP Care (HMO D-SNP) plan are covered with no copay and no coinsurance, which includes one routine hearing exam per year and unlimited fitting evaluations. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $1,600 maximum every three years, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by AmeriHealth Caritas VIP Care (HMO D-SNP) with no copay and no coinsurance, offering one routine eye exam per year and a $430 annual allowance for eyewear like contact lenses or eyeglasses. Other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by AmeriHealth Caritas VIP Care (HMO D-SNP) with no copay and no coinsurance for covered preventive and comprehensive treatments, up to a $3,600 annual limit on select services. Other diagnostic dental services, adjunctive general services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
AmeriHealth Caritas VIP Care (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have no coinsurance to 20% coinsurance, while Medicare Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
AmeriHealth Caritas VIP Care (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered under AmeriHealth Caritas VIP Care (HMO D-SNP) with no copay, though prior authorization is required. Durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts carry a 20% coinsurance, while diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by AmeriHealth Caritas VIP Care (HMO D-SNP) with no copays, though prior authorization is required. Under this plan, you will pay a 30% coinsurance for diagnostic procedures, lab services, diagnostic radiological services, and outpatient X-rays, and a 20% coinsurance for therapeutic radiological services.
Home Health Services See details
AmeriHealth Caritas VIP Care (HMO D-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
AmeriHealth Caritas VIP Care (HMO D-SNP) covers Cardiac Rehabilitation Services with no copay and prior authorization. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered in practice and require a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by AmeriHealth Caritas VIP Care (HMO D-SNP) with no coinsurance, though prior authorization is required. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage provided for additional days beyond the Medicare-covered limit.
Other Services See details
AmeriHealth Caritas VIP Care (HMO D-SNP) partially covers other services with no copay and no coinsurance, including up to 6 acupuncture treatments per year, chronic illness meal benefits with a referral, and an $85 monthly allowance for over-the-counter items. Other miscellaneous services and highly integrated SNP services are not covered under this benefit.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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