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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 Palm Beach, Broward, Miami-Dade. The overall rating for this plan is not yet available for 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 $20.30. 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 deductible of $590.00. If you qualify for the low-income subsidy (LIS), your monthly Part D premium is $20.30. During the initial coverage phase, you will pay the costs for drugs in each tier until your total drug costs reach $2000.00. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The AmeriHealth Caritas VIP Care (HMO D-SNP) plan offers a variety of benefits to help cover your healthcare needs. This plan covers inpatient hospital stays, with a copay for the first few days, and outpatient services with 35% coinsurance. Emergency services have a copay, while other services, such as ambulance, have a coinsurance. This plan also provides coverage for primary care, preventive services, hearing, vision, and dental services. Many services have no copay, but some have coinsurance. The plan also covers home health services, medical equipment, and dialysis.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a copay of $880 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, non-Medicare covered stays, and upgrades are not covered for either service.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services, observation services, ambulatory surgical center (ASC) 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, 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 no copay for ambulance services, but a 35% coinsurance for both ground and air ambulance services. Transportation services to any health-related location are not covered, but transportation to a plan-approved health-related location via taxi is covered.
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, while Urgently Needed Services have a 35% coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
AmeriHealth Caritas VIP Care (HMO D-SNP) covers Primary Care Physician Services with a 0-35% coinsurance, Chiropractic Services with a 35% coinsurance, Occupational Therapy Services with 35% coinsurance, Physician Specialist Services with a 0-35% coinsurance, and Mental Health Specialty Services with 35% coinsurance for individual and group sessions. This plan also covers Podiatry Services with 35% coinsurance, Other Health Care Professional with 35% coinsurance, Psychiatric Services with 35% coinsurance for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with 35% coinsurance, Additional Telehealth Benefits, and Opioid Treatment Program Services with 35% coinsurance. Routine Chiropractic Care has no copay, but is limited to 20 visits per year.
Preventive Services See details
The AmeriHealth Caritas VIP Care (HMO D-SNP) plan covers preventive services, including Medicare-covered preventive services with no copay, and additional preventive services. The plan does not cover annual physical exams, health education, in-home safety assessments, 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, or support for caregivers of enrollees. The plan also covers the following services: Personal Emergency Response System (PERS) with a maximum plan benefit coverage amount of $0, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit (Memory Fitness), Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training with a 35% coinsurance, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Kidney Disease Education Services and Other Preventive Services are covered with a 35% coinsurance.
Hearing Services See details
Hearing Services include Routine Hearing Exams with no coinsurance, and Fitting/Evaluation for Hearing Aid, both covered once per year. Prescription Hearing Aids (all types) are covered with a maximum benefit of $2000 per year, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered. OTC Hearing Aids are not covered.
Vision Services See details
Vision services are covered, including routine eye exams with no coinsurance, and eyewear with a combined maximum of $400 per year. Contact lenses and eyeglasses (lenses and frames) are covered, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, and other diagnostic services, with limitations on the number of visits and periodicity. Adjunctive general services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B insulin drugs, are covered with prior authorization. For Medicare Part B insulin drugs, there is a $35 copay and a coinsurance between 0% and 20%.
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 under the AmeriHealth Caritas 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. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the AmeriHealth Caritas VIP Care (HMO D-SNP) plan. Diagnostic Procedures/Tests, Lab Services, and Outpatient X-Ray Services have a coinsurance of at most 35%, while Therapeutic Radiological Services have a coinsurance of at most 20%; all services have no copay.
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. 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 under the AmeriHealth Caritas VIP Care (HMO D-SNP) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
AmeriHealth Caritas VIP Care (HMO D-SNP) covers acupuncture with no copay, up to 20 visits per year. Over-the-counter items are covered with a maximum benefit of $225 per month, and the plan offers nicotine replacement therapy and naloxone. A meal benefit is also covered with a doctor referral. The plan does not cover Dual Eligible SNPs with Highly Integrated Services, and other services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services are also not covered.
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