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.
- A complete Summary of Benefits — Spanish PDF.
- An Over-the-Counter Benefit Product Catalog (OTC) PDF
- To review information about your Over-the-Counter benefits online, visit www.firstchoiceflexcard.com. You can also call 1-800-384-2054 (TTY 711), Monday – Friday from 8 a.m. to 8 p.m. EST.
- Spanish Over-the-Counter Benefit Product Catalog (OTC) PDF
- A complete annual notice of changes (ANOC) PDF.
- The ANOC tells you about all plan changes in the next year.
- Spanish ANOC PDF.
- A complete Evidence of Coverage PDF.
- 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.
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||
Unlimited 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:
Unlimited trips to plan-approved locations every year (e.g., doctor’s office, pharmacy, and hospital).
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) and Special Supplemental Benefits for the Chronically Ill (SSBCI)/Food & Produce||
Up to $280 per quarter 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. Spanish OTC catalog (PDF). Members may purchase up to 6 products per category per quarter. There is no limit on the total number of items a member may purchase. OTC catalog and online ordering portal orders are limited to 3 orders per quarter. Additional limits may apply to some items.
Members with qualifying SSBCI chronic conditions may also use up to $100 of the $280 quarterly allowance towards qualifying Food & Produce at participating retail locations and/or FarmBox mail-order, items limits may apply. Any unused balance will automatically expire at the end of each quarter or upon disenrollment from the plan.
Refer to the Evidence of Coverage (EOC) (PDF) for more information on the qualifying SSBCI chronic conditions. The benefits mentioned are a part of special supplemental program for the chronically ill. Not all members qualify.
|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.
|Important message about what you pay for insulin||
You won’t pay more than $35 for a one- month supply of each insulin product covered by our plan, no matter what cost sharing tier it is on. In most cases you will not pay more than $10.35 for a one-month supply of each insulin product.