Summary of Benefits

You have options for your Medicare Advantage coverage. Think about your needs and what type of benefits will help you most. First Choice VIP Care (HMO-SNP) offers all the benefits of regular Medicare, plus more.

First Choice VIP Care provides:

  • Coverage for inpatient hospital care, as well as skilled nursing facility and home health care coverage.
  • Preventive services to help you stay healthy.
  • A large network of doctors, hospitals, specialists, and pharmacies.
  • Great service and personal attention.

Plus, you'll get extra benefits, including:

  • Dental, vision, and hearing benefits not covered by Original Medicare.
  • Wellness education including smoking cessation and a nurse hotline.
  • Transportation to your provider.

Questions? Call us toll free at 1-833-961-3723 (TTY/TDD 711), 8 a.m. - 8 p.m., 7 days a week.

Below is a brief summary of key benefits.

You may also view:

You can also contact First Choice VIP Care for more information.

Find a provider in our network for the benefits below.

Premium $0 monthly plan premium.
Doctor office visits $0 copay for each Medicare-covered primary care provider (PCP) visit.
Specialist visits

$0 copay for each Medicare-covered specialist visit.

No referral required.

Preventive and comprehensive dental

$1,000 plan coverage limit for preventive dental benefits every year.

$0 copay for the following preventive dental benefits:

  • Up to one oral exam every six months.
  • Up to one cleaning every six months.
  • Up to one fluoride treatment every six months.
  • Up to four dental X-rays every year.

The combined total comprehensive dental benefits cannot exceed $3,000 every year. The comprehensive dental benefits include the following services up to a $3,000 combined limit every year:

  • minor restorations (fillings)
  • simple extractions
  • dentures
  • denture repair and reline
  • surgical extractions
  • Oral surgery
  • Periodontics
  • Endodontics
  • Crowns
  • Mini-implants (lower arch only) and implant supported denture (lower arch only).

*Prior authorization is required for comprehensive dental services. Service limitations may apply.

Hearing

Diagnostic hearing and balance evaluations are:

  • $0 for up to 1 routine hearing exam every year
  • $0 for up to 3 fittings for a hearing aid every three years
  • $0 for 48 batteries per aid for non-rechargeable models every three years
  • $1,500 allowance for hearing aids every 3 years

You must receive your care from a network provider. We will only pay for covered hearing services if you go to an in-network hearing provider. In most cases, you will have to pay for care that you receive from an out-of-network provider.

Vision services

Covered services include everything Original Medicare covers PLUS:

  • $0 copay for up to 1 routine vision exam every year.
  • The plan will cover up to $350 every year towards eyeglasses or contact lenses.

Transportation

$0 for up to 100 one-way trips to plan-approved locations every year. May consist of car, shuttle, or van service depending on appropriateness for situation.

Authorization and scheduling rules apply.

Over-the-counter (OTC) items

You may spend up to $250 per quarter for (OTC) items from our OTC catalog (PDF). Money not spent in a quarter does not roll over into the next quarter.

Spanish OTC catalog (PDF).

Home health care $0 copay for Medicare-covered home health visits.
Outpatient mental health care

$0 copay for each Medicare-covered individual therapy visit.

$0 copay for each Medicare-covered group therapy visit.

$0 copay for each Medicare-covered individual therapy visit with a psychiatrist.

$0 copay for each Medicare-covered group therapy visit with a psychiatrist.

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