Summary of Benefits
First Choice VIP Care Plus is a plan designed for people who have Medicare and Healthy Connections Medicaid. Our health plan can help you get more from your coverage. And that means having a personal care team and Care Coordinator to help you get the care you need.
Our large network of providers, hospitals, and pharmacies makes it easy for you to get care. Choose First Choice VIP Care Plus and be treated like the VIP you are.
First Choice VIP Care Plus provides:
- $0 copay for Medicare-covered benefits.
- $0 copay for all prescription drugs on the formulary.
- Routine Vision Services.
- Up to one routine eye exam every year.
- Up to one pair of eyeglasses (lenses and frames) every two years or up to $150 of contact lenses every two years.
- $150 plan coverage limit for eye wear every two years.
- $1,500 allowance for hearing aids every 3 years for both ears combined.
- Long-term services and supports waiver benefits if medically necessary.
- Coverage for inpatient hospital care, skilled nursing facility services, and home health care services.
- A large network of providers, hospitals, specialists and pharmacies.
Below is a brief summary of key benefits. You can also view:
- Complete Summary of Benefits (PDF)
- Member Handbook (PDF)
- Spanish Member Handbook (PDF)
- A complete Annual Notice of Changes — ANOC (PDF)
- The Annual Notice of Changes (ANOC) tells you about all plan changes for 2025.
- Spanish Annual Notice of Changes — ANOC (PDF)
- An Over-the-Counter Benefit Product Catalog (OTC) (PDF)
Contact First Choice VIP Care Plus Member Services for more information at 1-888-978-0862 (TTY/TDD 711), 8 a.m. - 8 p.m., seven days a week.
Find a provider in our network for the benefits listed below.
| Premium | $0 monthly plan premium. |
|---|---|
| Provider office visits | $0 copay for each Medicare-covered primary care provider (PCP) visit. |
| Specialist visits |
$0 copay for each Medicare-covered specialist visit (authorization rules may apply). |
| Inpatient hospital visits |
$0 copay for Medicare-covered visits (authorization rules may apply). |
| Over-the-counter (OTC) items |
Up to $100 per quarter may be spent for specific OTC items. Get more information from the OTC catalog (PDF). Money not spent in a quarter does not roll over into the next quarter. |
| Environmental modifications | $0 copay for minor changes to your home, up to a $7500 lifetime limit. Includes pest control and physical changes to the home that are necessary to ensure your health, welfare, and safety (only available to waiver members, and authorization rules may apply). |
| Hearing |
Diagnostic hearing and balance evaluations performed by your PCP to determine if you need medical treatment are covered as outpatient care when furnished by a physician, audiologist, or other qualified provider.
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. |
| Home-delivered meals |
$0 copay for home-delivered meals (only available to waiver members, and authorization rules may apply). |
| Home health care |
$0 copay for home health visits (authorization rules may apply). |
| Outpatient mental health care |
$0 copay for each individual therapy visit. Referral and authorization rules may apply. |
| 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. |
This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or refer to the First Choice VIP Care Plus Member Handbook (PDF).