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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 Northeast, Central and Western Pennsylvania. This plan received an overall rating of 4 out of 5 stars in 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 $32.70. 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) plan has an annual drug deductible of $615. For prescription drugs in Tiers 1 through 5, which include preferred generic, generic, preferred brand, non-preferred, and specialty drugs, you will pay a 25% coinsurance at standard pharmacies and through standard mail order. For Tier 6 Select Care Drugs, there is no copay for 1-month, 2-month, or 3-month supplies filled at standard pharmacies or standard mail order. This plan provides clear cost-sharing details to help you understand your out-of-pocket prescription drug costs.
Additional Benefits
The AmeriHealth Caritas VIP Care (HMO D-SNP) plan features no copay for primary care, home health, and outpatient services, although a 30% coinsurance applies to most outpatient care. Inpatient hospital stays require a $900 copay for days one and two, with no copay for days three through ninety, while emergency room visits carry a $115 copay. Skilled nursing facility care is covered with no copay for the first 20 days and a $218 daily copay for days 21 through 100. This plan also includes generous supplemental benefits with no copay and no coinsurance, such as up to $5,750 annually for preventive and restorative dental care. Members also benefit from no-copay vision and hearing coverage, which includes annual exams, up to $575 yearly for eyewear, and up to $2,000 every three years for prescription hearing aids. Additionally, the plan offers up to 36 free one-way trips annually and a monthly allowance of up to $256 for over-the-counter items with no copay.
Inpatient Hospital See details
Inpatient hospital services are partially covered by AmeriHealth Caritas VIP Care (HMO D-SNP) with no coinsurance, though prior authorization is required. For acute stays, there is a $900 copay for days 1-2 and no copay for days 3-90, while psychiatric stays require a $260 copay for days 1-8 and no copay for days 9-90; however, additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
AmeriHealth Caritas VIP Care (HMO D-SNP) outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, are covered with no copay and a 30% coinsurance. Prior authorization is required for these outpatient services.
Partial Hospitalization See details
AmeriHealth Caritas VIP Care (HMO D-SNP) covers partial hospitalization services with no copay and a 30% coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
AmeriHealth Caritas VIP Care (HMO D-SNP) covers ground and air ambulance services with a 30% coinsurance and no copay. Transportation services are partially covered under the plan, offering up to 36 one-way trips per year to plan-approved locations with no copay and no coinsurance, though 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 copay and no coinsurance, and urgently needed services with no copay and 30% coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance up to a maximum benefit limit of $50,000.
Primary Care See details
AmeriHealth Caritas VIP Care (HMO D-SNP) offers primary care and specialist services with no copay and 0% to 30% coinsurance, alongside therapy, psychiatric, and podiatry services which carry no copay and 30% coinsurance. Although some chiropractic services are covered, routine and other chiropractic services are not covered under this plan.
Preventive Services See details
Preventive Services are partially covered by AmeriHealth Caritas VIP Care (HMO D-SNP), offering no copay and no coinsurance for most care, though kidney disease education and diabetes self-management training require no copay and a 30% coinsurance. Covered benefits include glaucoma screenings, memory fitness, and smoking cessation counseling. Annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home safety modifications, and counseling are not covered.
Hearing Services See details
AmeriHealth Caritas VIP Care (HMO D-SNP) provides hearing services with no copay and no coinsurance, covering one routine hearing exam annually and up to $2,000 for prescription hearing aids every three years. However, this benefit is only partially covered, as OTC hearing aids, along with 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, no coinsurance, and no deductible for covered services, which include one routine eye exam and one pair of eyeglasses or contact lenses per year up to a $575 annual maximum. Other eye exam services, eyeglass lenses, 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 benefits, up to a maximum annual benefit of $5,750. While most preventive and restorative care is included, other diagnostic dental services, adjunctive general services, and orthodontics are not covered.
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. Associated Medicare Part B chemotherapy, radiation, and other drugs require no copay and carry from no coinsurance up to 20% coinsurance, while Medicare Part B insulin has a $35 copay and from no coinsurance up to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by AmeriHealth Caritas VIP Care (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by AmeriHealth Caritas VIP Care (HMO D-SNP) with no copays, though prior authorization is required for these services. Members pay a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, while diabetic supplies require between no coinsurance and 20% coinsurance.
Diagnostic and Radiological Services See details
AmeriHealth Caritas VIP Care (HMO D-SNP) covers diagnostic and radiological services with prior authorization and no copays. Members are responsible for 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, although prior authorization is required.
Cardiac Rehabilitation Services See details
AmeriHealth Caritas VIP Care (HMO D-SNP) covers some Cardiac Rehabilitation Services with no copay and prior authorization, though key sub-services are not covered in practice. Specifically, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy for symptomatic peripheral artery disease rehabilitation services are not covered and require a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by AmeriHealth Caritas VIP Care (HMO D-SNP) with no coinsurance and prior authorization required, as additional days beyond the Medicare-covered limit are not covered. Covered stays require no copay for days 1 to 20 and a $218 copay for days 21 to 100, with no prior three-day hospital stay required.
Other Services See details
AmeriHealth Caritas VIP Care (HMO D-SNP) partially covers other services, providing over-the-counter (OTC) items up to $256 monthly and a meal benefit for chronic illness with a referral, both featuring no copay and no coinsurance. Acupuncture is not covered under these benefits.
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