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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 2026 to people living in Macomb and Wayne counties. The overall rating for this plan is not yet available for 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 $8.80. 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) prescription drug plan has an annual drug deductible of $615. For medications in Tiers 1 through 5, which cover preferred generic, generic, preferred brand, non-preferred, and specialty drugs, members pay a 25% coinsurance. This 25% coinsurance rate applies to 1-month, 2-month, and 3-month supplies at standard pharmacies, as well as 2-month and 3-month supplies filled through standard mail order. For Tier 6 select care drugs, the plan offers coverage with no copay for 1-month, 2-month, and 3-month supplies at standard retail pharmacies. Members can also obtain Tier 6 select care drugs with no copay for 2-month and 3-month supplies through standard mail-order services. This plan structure provides predictable savings on select care drugs while maintaining a standard coinsurance rate for other drug tiers.
Additional Benefits
The AmeriHealth Caritas VIP Care (HMO D-SNP) provides comprehensive medical coverage, featuring primary care and preventive services with no copays and coinsurance up to 30%. For hospital stays, acute inpatient services require a $900 copay for the first two days and no copay thereafter, while outpatient hospital services require no copay and a 30% coinsurance. Emergency care is covered with a $115 copay, while urgent care services require no copay and a 30% coinsurance. This plan also features valuable supplemental benefits, including dental, vision, and hearing care with no copays or coinsurance for routine and preventive services. Members receive a $520 annual allowance for eyewear, up to $2,500 every three years for hearing aids, and an $80 allowance every three months for over-the-counter items. Additionally, home health care and unlimited one-way transportation to approved medical locations are covered with no copay or coinsurance.
Inpatient Hospital See details
AmeriHealth Caritas VIP Care (HMO D-SNP) covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute stays require a $900 copay for days 1 to 2 and no copay for days 3 to 90, while psychiatric stays require a $260 copay for days 1 to 8 and no copay for days 9 to 90; additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
AmeriHealth Caritas VIP Care (HMO D-SNP) covers outpatient services with no copay, but a 30% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Prior authorization is required for most of 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 receive coverage for these services.
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, subject to prior authorization. Unlimited one-way transportation to plan-approved health-related locations is offered 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, while urgently needed services are covered with a 30% coinsurance and no copay. Worldwide emergency, urgent, and transportation services are also covered with no copay or coinsurance up to a $50,000 maximum limit.
Primary Care See details
Primary care and professional services are covered by AmeriHealth Caritas VIP Care (HMO D-SNP) with no copays and coinsurance ranging from no coinsurance to 30%. The benefit is partially covered because other chiropractic services are not covered, though routine chiropractic care is covered for up to 12 visits per year.
Preventive Services See details
Preventive Services are partially covered by AmeriHealth Caritas VIP Care (HMO D-SNP) with no copay and no coinsurance for most additional services, though kidney disease education and diabetes self-management training require a 30% coinsurance with no copay. Sub-services that are not covered under this plan include annual physical exams, health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional or dietary benefits, home-based palliative care, in-home support, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Hearing services are covered by AmeriHealth Caritas VIP Care (HMO D-SNP) with no copay and no coinsurance for routine hearing exams and fitting evaluations. Prescription hearing aids are partially covered with no copay or coinsurance up to a $2,500 limit every three years, though OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
AmeriHealth Caritas VIP Care (HMO D-SNP) provides partially covered vision services with no copay, no coinsurance, and no deductible. Covered benefits include one routine eye exam and up to $520 yearly for one pair of eyeglasses (lenses and frames) or contact lenses, while other eye exam services, individual eyeglass lenses or 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 preventive and comprehensive care, though other diagnostic dental services, adjunctive general services, and orthodontics are not covered. Covered dental benefits feature a $5,000 annual maximum for orthodontic services, and select procedures require prior authorization.
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. Covered Medicare Part B drugs, including chemotherapy, radiation, and other drugs, require no copay and coinsurance ranging from no coinsurance up to 20%, while Medicare Part B insulin drugs have a $35 copay and coinsurance ranging from no coinsurance up to 20%.
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
AmeriHealth Caritas VIP Care (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay, subject to prior authorization. A 20% coinsurance applies to most of these covered items, while diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
AmeriHealth Caritas VIP Care (HMO D-SNP) covers diagnostic and radiological services with no copay, though prior authorization is required. Covered diagnostic procedures, lab services, diagnostic radiological services, and outpatient X-rays require a 30% coinsurance, while therapeutic radiological services require a 20% coinsurance.
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
Cardiac Rehabilitation Services are provided by AmeriHealth Caritas VIP Care (HMO D-SNP) with no copay and prior authorization required, though only some services are covered. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and require a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
AmeriHealth Caritas VIP Care (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
AmeriHealth Caritas VIP Care (HMO D-SNP) partially covers other services, which include over-the-counter (OTC) items up to $80 every three months and a chronic illness meal benefit with no copay and no coinsurance. Acupuncture is not covered under this plan, and a referral is required to receive the meal benefit.
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