First Choice VIP Care (HMO D-SNP)

Inpatient Hospital See details

Inpatient Hospital benefits are covered, including both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a copay of $395 for days 1-2, and no copay for days 3-90; for Inpatient Hospital Psychiatric, you will pay a copay of $240 for days 1-8, and no copay for days 9-90. Additional days and non-Medicare-covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.

Outpatient Services See details

Outpatient Services include coverage for Outpatient Hospital Services and Observation Services, each with a 35% coinsurance. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services are also covered, with a coinsurance of 35%. Outpatient Blood Services are not covered.

Partial Hospitalization See details

Partial Hospitalization is covered by the First Choice VIP Care (HMO D-SNP) plan, but requires prior authorization. You will pay a 35% coinsurance for this benefit.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and air ambulance services have a 35% coinsurance, and there is no copay. Transportation Services to a Plan Approved Health-related Location are covered for up to 50 one-way taxi trips per year. Transportation Services to any Health-related Location are not covered.

Emergency Services See details

Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by First Choice VIP Care (HMO D-SNP). Emergency Services have a $110 copay and no coinsurance, while Urgently Needed Services have a 35% coinsurance and no copay. Worldwide Emergency Services have a maximum plan benefit of $50,000, with Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each having no copay.

Primary Care See details

The First Choice VIP Care (HMO D-SNP) plan covers primary care services with a coinsurance of 0% - 35%. Chiropractic services are covered with a 35% coinsurance, and routine chiropractic care has no copay. Occupational therapy, physical therapy, speech-language pathology, individual and group sessions for mental health and psychiatric services, and other healthcare professional services are covered with a 35% coinsurance. Podiatry services are covered with a 35% coinsurance for routine foot care, with a limit of 9 visits per year. Opioid treatment program services have a 35% coinsurance.

Preventive Services See details

The First Choice VIP Care (HMO D-SNP) plan covers preventive services, including Medicare-covered services with no copay, and additional services like a Personal Emergency Response System (PERS) with no copay. The plan does not cover annual physical exams, and some additional preventive services are not covered.

Hearing Services See details

Hearing Services include routine hearing exams with no coinsurance, and fitting/evaluation for hearing aids with no coinsurance. Prescription hearing aids are covered up to a maximum of $2500 every three years, but 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 coverage for eye exams with no coinsurance and routine eye exams once per year. Eyewear is covered up to a combined maximum of $400 per year, and contact lenses and eyeglasses (lenses and frames) are covered once per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.

Dental Services See details

Dental services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, endodontics, periodontics, prosthodontics (removable, fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery. Orthodontic services are covered up to a maximum of $3600 per year, while adjunctive general services and orthodontics are not covered.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay with coinsurance between 0-20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0-20%.

Dialysis Services See details

Dialysis Services are covered under the First Choice VIP Care (HMO D-SNP) plan. You will pay 20% coinsurance for these services.

Medical Equipment See details

Medical Equipment is covered by the First Choice VIP Care (HMO D-SNP) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetics and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a coinsurance between 0% and 20%, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services are covered under the First Choice VIP Care (HMO D-SNP) plan. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 35%, while Therapeutic Radiological Services have a coinsurance of at most 20%, and Diagnostic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 35%. There is no copay for any of these services.

Home Health Services See details

Home Health Services are covered by the First Choice VIP Care (HMO D-SNP), with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.

Cardiac Rehabilitation Services See details

Cardiac Rehabilitation Services are not covered by the First Choice VIP Care (HMO D-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $214.

Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.

Other Services See details

The First Choice VIP Care (HMO D-SNP) plan covers acupuncture with no copay for up to 20 visits per year, and also provides over-the-counter items with a maximum benefit of $250 per month. This plan also offers a meal benefit and covers some other services, though many other services are not covered.