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 711), Monday through Friday, 8 a.m. – 8 p.m., from April 1 to September 30; or seven days a week, 8 a.m. – 8 p.m., from October 1 to March 31.

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

Unlimited 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 one routine hearing exam every year
  • $0 for up to three fittings for a hearing aid every three years
  • $0 for 80 batteries per aid for non-rechargeable models every three years
  • $1,500 allowance for hearing aids every three 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 one routine vision exam every year.
  • The plan will cover up to $350 every year towards eyeglasses or contact lenses.

Transportation

80 trips to plan-approved locations every year (e.g., doctor's office, pharmacy, and hospital). May consist of a car, shuttle, or van service depending on appropriateness for the situation and the member's needs. Rides must be scheduled at least one business day in advance except in special circumstances.

Prior authorization is required for trips that exceed 50 miles for a one‐way ride. Other prior authorization and scheduling rules apply.

Over-the-counter pharmacy (OTC)/VBID/Food & Produce/General Supports for Living

Up to $185 per month may be spent for over-the-counter (OTC) items included in the OTC catalog (PDF), online ordering portal and/or qualified items at participating retail settings via a restricted spend debit card. There is no limit on the total number of items or orders a member may purchase. Any unused balance will automatically expire at the end of each month or upon disenrollment from the plan.

Members who qualify based on socioeconomic (LIS) status may use $185 of the monthly allowance towards qualifying Food & Produce at participating retail locations and/or FarmBox mail-order, item limits may apply and/or qualifying rent and utility services. Any unused balance will automatically expire at the end of each month or upon disenrollment from the plan.

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.

Important message about what you pay for vaccines

Our plan covers most Part D vaccines at no cost to you. Call Member Services for more information.

Y0093_005_232794220