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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 2025, 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 Statewide. The overall rating for this plan is not yet available for 2025.
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 $46.30. 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 $590.00 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 $9350.00 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) plan has a $590 deductible for prescription drugs. After meeting your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000. If you qualify for the low-income subsidy, you may have a reduced premium. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The AmeriHealth Caritas VIP Care (HMO D-SNP) plan offers a range of benefits, including coverage for inpatient hospital stays with a copay, outpatient services with 35% coinsurance, and emergency services with a copay. Primary care physician services may have 0-35% coinsurance, and routine chiropractic care has no copay. This plan also includes coverage for hearing and vision services, such as routine hearing exams and eye exams, and provides an allowance for eyewear and hearing aids. Dental services, home health services, and some durable medical equipment are also covered, but some services require prior authorization or have coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $355 copay for days 1-2, and no copay for days 3-90. For Inpatient Hospital Psychiatric, you will pay a $240 copay for days 1-8, and no copay for days 9-90.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Substance Abuse Services, all with a 35% coinsurance. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 35% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the AmeriHealth Caritas VIP Care (HMO D-SNP) plan. Ground and air ambulance services have a 35% coinsurance, and transportation services to a plan-approved health-related location are covered for up to 40 one-way trips per year via taxi, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services under the AmeriHealth Caritas VIP Care (HMO D-SNP) plan include a $110 copay for Emergency Services, a 35% coinsurance for Urgently Needed Services, and no copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation. Worldwide Emergency Services have a maximum plan benefit coverage of $50,000.
Primary Care See details
AmeriHealth Caritas VIP Care (HMO D-SNP) covers primary care physician services with a coinsurance of 0% to 35%, and routine chiropractic care with no copay and no coinsurance. This plan also covers occupational therapy services with 35% coinsurance, and physical therapy and speech-language pathology services with 35% coinsurance.
Preventive Services See details
The AmeriHealth Caritas VIP Care (HMO D-SNP) plan covers preventive services, but does not cover annual physical exams, health education, in-home safety assessments, 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, or support for caregivers. Additional benefits include Personal Emergency Response System (PERS), Additional Sessions of Smoking and Tobacco Cessation Counseling, a Fitness Benefit, Remote Access Technologies, Kidney Disease Education Services, and other preventive services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Diabetes Self-Management Training and Kidney Disease Education Services have a 35% coinsurance.
Hearing Services See details
Hearing services include coverage for hearing exams with no coinsurance, routine hearing exams once per year, and fitting/evaluation for hearing aids up to three times every three years. Prescription hearing aids (all types) are covered up to a maximum of $1500 every three years, however inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams with no coinsurance, and eyewear with a combined maximum of $400 per year for contact lenses and eyeglasses (lenses and frames). Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
AmeriHealth Caritas VIP Care (HMO D-SNP) covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services, but with limitations on the number of visits and periodicity. Orthodontic services are covered up to a maximum of $3,600 per year, while adjunctive general services and orthodontics are not covered. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery are covered with prior authorization.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the AmeriHealth Caritas VIP Care (HMO D-SNP) plan. You will pay a 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires prior authorization. Prosthetic Devices and Medical Supplies have a 20% coinsurance, while Diabetic Supplies have a 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by AmeriHealth Caritas VIP Care (HMO D-SNP). Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 35%, while Diagnostic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 35%, and Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the AmeriHealth Caritas VIP Care (HMO D-SNP) 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 not covered by the AmeriHealth Caritas VIP Care (HMO D-SNP) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has no copay, but is limited to 6 treatments per year. OTC items are covered up to $225.00 per month. The meal benefit requires a doctor's referral. Several other services are not covered.
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