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AmeriHealth Caritas VIP Care Choice (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AmeriHealth Caritas VIP Care Choice (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 Choice (HMO D-SNP) in 2026, please refer to our full plan details page.
AmeriHealth Caritas VIP Care Choice (HMO D-SNP) is a HMO D-SNP plan offered by Independence Health Group, Inc. available for enrollment in 2026 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 Choice (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 Choice (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 Choice (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 Choice (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 $7550.00 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 Choice (HMO D-SNP) prescription drug plan has an annual drug deductible of $615. Under this plan, Tiers 1 through 5—which include preferred generic, generic, preferred brand, non-preferred, and specialty drugs—require a 25% coinsurance for one-month, two-month, and three-month supplies at standard pharmacies. Standard mail order options for these tiers also require a 25% coinsurance for two-month and three-month supplies. For Tier 6 select care drugs, there is no copay for one-month, two-month, or three-month supplies filled at a standard pharmacy. Additionally, you will pay no copay for two-month and three-month fills of Tier 6 medications ordered through standard mail order. This plan offers a straightforward cost structure for beneficiaries managing their routine medication expenses.
Additional Benefits
The AmeriHealth Caritas VIP Care Choice (HMO D-SNP) plan offers comprehensive medical coverage with no copay or coinsurance for primary care visits and home health services. For outpatient hospital services, specialist visits, and diagnostic tests, members generally pay no copay and a 20% coinsurance. Inpatient hospital stays require prior authorization and feature set copays, such as $1,500 per acute admission, but carry no coinsurance. This plan also includes valuable supplemental benefits, such as preventive and comprehensive dental care up to a $2,000 annual limit with no copay or coinsurance. Additionally, members can access routine vision and hearing services, up to 24 free one-way trips to approved health locations, and a $45 monthly allowance for over-the-counter items. Emergency and urgent care are also covered with flat copays and no coinsurance.
Inpatient Hospital See details
AmeriHealth Caritas VIP Care Choice (HMO D-SNP) partially covers inpatient hospital services with no coinsurance, requiring prior authorization for all stays. Acute stays require a $1,500 copay per admission, while psychiatric stays require a $350 copay for days 1 through 5 and no copay for days 6 through 90; additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
AmeriHealth Caritas VIP Care Choice (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services, with no copay and a 20% coinsurance. Prior authorization is required for most of these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
AmeriHealth Caritas VIP Care Choice (HMO D-SNP) covers partial hospitalization services, which require prior authorization. Depending on the service, you will pay either a $70 copay with no coinsurance or no copay with a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the AmeriHealth Caritas VIP Care Choice (HMO D-SNP) plan, which features a 20% coinsurance and no copay for ground and air ambulance services. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved health-related locations, though transportation to any health-related location is not covered.
Emergency Services See details
AmeriHealth Caritas VIP Care Choice (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance, up to a $50,000 maximum benefit limit.
Primary Care See details
AmeriHealth Caritas VIP Care Choice (HMO D-SNP) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical and occupational therapies, podiatry, and opioid treatment are covered with no copay and a 20% coinsurance. Although some chiropractic, mental health, and psychiatric services are covered, routine and other chiropractic care, as well as individual and group sessions for mental health and psychiatric services, are not covered.
Preventive Services See details
Preventive Services are partially covered by AmeriHealth Caritas VIP Care Choice (HMO D-SNP) with no copay and no coinsurance for covered benefits like kidney disease education, glaucoma screenings, and memory fitness. However, an annual physical exam and various additional services, such as health education, weight management, and personal emergency response systems, are not covered.
Hearing Services See details
AmeriHealth Caritas VIP Care Choice (HMO D-SNP) covers hearing services, including one routine hearing exam annually with no copay and a 20% coinsurance, alongside unlimited fitting evaluations. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,200 limit every three years, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
AmeriHealth Caritas VIP Care Choice (HMO D-SNP) covers one routine eye exam per year with no copay, 20% coinsurance, and no deductible, while other eye exams are not covered. Eyewear is also covered up to $200 annually with no copay or deductible, allowing for either one pair of eyeglasses with no coinsurance or one pair of contact lenses with 20% coinsurance, though upgrades and separate lenses or frames are not covered.
Dental Services See details
Dental services are partially covered by AmeriHealth Caritas VIP Care Choice (HMO D-SNP), with Medicare-covered dental requiring no copay and a 20% coinsurance, and other preventive and comprehensive services available with no copay and no coinsurance up to a $2,000 annual limit. Other diagnostic dental services, adjunctive general services, and orthodontics are not covered.
Home Infusion bundled Services See details
AmeriHealth Caritas VIP Care Choice (HMO D-SNP) covers Home Infusion bundled Services with no copay, although prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, insulin, and other drugs, have no coinsurance to 20% coinsurance, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered by AmeriHealth Caritas VIP Care Choice (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
AmeriHealth Caritas VIP Care Choice (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and prior authorization required. Beneficiaries will pay a 20% coinsurance for most equipment, therapeutic shoes, and medical supplies, while diabetic supplies carry a coinsurance ranging from 0% to 20%.
Diagnostic and Radiological Services See details
AmeriHealth Caritas VIP Care Choice (HMO D-SNP) covers diagnostic and radiological services with prior authorization, requiring a 20% coinsurance and no copay for lab services and diagnostic procedures. Covered radiological services, including X-rays and therapeutic radiology, carry a 20% coinsurance and a copay of up to $250 for diagnostic radiological services.
Home Health Services See details
Home Health Services are covered under the AmeriHealth Caritas VIP Care Choice (HMO D-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
AmeriHealth Caritas VIP Care Choice (HMO D-SNP) does not cover cardiac rehabilitation services in practice, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. For any eligible Medicare-covered sessions, there is no copay but a 20% coinsurance is required, and prior authorization is necessary.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by AmeriHealth Caritas VIP Care Choice (HMO D-SNP) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Other Services are partially covered by AmeriHealth Caritas VIP Care Choice (HMO D-SNP), as acupuncture is not covered. Covered benefits include a chronic illness meal benefit (referral required) and over-the-counter items up to $45 monthly, both of which are available with no copay and no coinsurance.
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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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