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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 Northeast, Central and Western Pennsylvania. This plan received an overall rating of 3.5 out of 5 stars in 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 $48.40. 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. If you qualify for the low-income subsidy (LIS), your monthly premium for Part D will be $48.40. During the initial coverage phase, after you meet your deductible, you will pay the costs for your drugs. Once your total drug costs reach $2000, you enter the next coverage phase. In the catastrophic coverage phase, you will pay nothing for covered drugs after your yearly out-of-pocket drug costs reach $2000.
Additional Benefits
The AmeriHealth Caritas VIP Care (HMO D-SNP) plan offers a variety of benefits, including inpatient hospital stays with copays, and outpatient services with 35% coinsurance. Emergency Services have a $110 copay, and worldwide emergency services have no copay. The plan also covers hearing and vision services, including routine exams and eyewear. Additional benefits include dental services, home infusion, dialysis, and medical equipment with varying coinsurance. Home health services have no copay. The plan provides coverage for over-the-counter items up to $320 per month, and meal benefits with a doctor's referral.
Inpatient Hospital See details
Inpatient Hospital benefits with AmeriHealth Caritas VIP Care (HMO D-SNP) cover Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, though additional days, non-Medicare-covered stays, and upgrades are not covered. For Inpatient Hospital-Acute, you will pay a $305 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 are covered by the AmeriHealth Caritas VIP Care (HMO D-SNP) plan, including outpatient hospital services, observation services, ambulatory surgical center 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 by the AmeriHealth Caritas VIP Care (HMO D-SNP) plan, but requires prior authorization. You will pay 35% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under 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.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the AmeriHealth Caritas VIP Care (HMO D-SNP) plan. Emergency Services have a $110 copay with no coinsurance, while Urgently Needed Services have a 35% coinsurance with no copay. Worldwide Emergency Services has a $0 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Primary Care Physician Services, Physician Specialist Services, and Additional Telehealth Benefits have a coinsurance of 0% to 35%, while Chiropractic Services, Occupational Therapy Services, Physical Therapy and Speech-Language Pathology Services, Individual and Group Sessions for Mental Health Specialty Services, Routine Foot Care, Other Health Care Professional, Individual and Group Sessions for Psychiatric Services, and Opioid Treatment Program Services have a 35% coinsurance. Routine Chiropractic Care is 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, and support for caregivers of enrollees are not covered. Additional sessions of smoking and tobacco cessation counseling are covered. The plan also covers a fitness benefit and remote access technologies. Kidney disease education services and diabetes self-management training have a 35% coinsurance. Other preventive services, including barium enemas, are covered.
Hearing Services See details
Hearing Services include routine hearing exams with no coinsurance, and fitting/evaluation for hearing aids, with a maximum of 3 visits every three years. Prescription hearing aids are covered up to $2000 every three years, and prescription hearing aids (all types) are covered for 2 visits every three years, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams with no coinsurance. Eyewear, including contact lenses and eyeglasses (lenses and frames), are covered, with a combined maximum plan benefit of $575 per year, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The AmeriHealth Caritas VIP Care (HMO D-SNP) plan covers a variety of dental services, including oral exams, dental x-rays, and other diagnostic and preventative services, with some limitations on the number of visits and periodicity. Orthodontic services are covered with a maximum benefit of $6,000 per year, while adjunctive general services and orthodontics are not covered.
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 for these services.
Dialysis Services See details
Dialysis Services are covered by the AmeriHealth Caritas VIP Care (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered by the AmeriHealth Caritas VIP Care (HMO D-SNP) plan. Durable Medical Equipment (DME) has a 20% coinsurance with no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetics and Medical Supplies have no copay and a 20% coinsurance, and Diabetic Supplies have between 0% and 20% coinsurance with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay. 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 by the AmeriHealth Caritas VIP Care (HMO D-SNP) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The AmeriHealth Caritas VIP Care (HMO D-SNP) plan does not cover acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services. Over-the-counter items are covered up to $320 per month, including nicotine replacement therapy and Naloxone. Meal benefits are covered with a doctor's referral.
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