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 (D-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.
Below is a brief summary of key benefits.
You may also view:
- A pre-enrollment checklist PDF.
- A complete Summary of Benefits PDF (October 15, 2021).
- A complete Summary of Benefits — Spanish PDF (October 15, 2021).
- A complete Evidence of Coverage PDF (October 15, 2021).
- The EOC tells you how to get medical care and prescription drugs through our plan. The booklet explains what's covered, how much you'll pay for services, and all about your rights and responsibilities.
- Spanish Evidence of Coverage (PDF) (December 23,2021).
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.|
$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:
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:
*Prior authorization is required for comprehensive dental services. Service limitations may apply.
Diagnostic hearing and balance evaluations are:
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.
Covered services include everything Original Medicare covers PLUS:
$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.
|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.