ConnectiCare VIP Medicare Advantage Plans
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ConnectiCare VIP Custom 1 Plan
We understand that, when you have a chronic condition like diabetes, you need health care
coverage that does everything possible to help you stay healthy.
ConnectiCare's VIP Custom 1 Plan offers:
- Coverage designed specifically to help you manage your diabetes
- $1,500 Annual In-Network Out-of-Pocket Limit
- Preventive Care - $0 copay for annual physicals
- $0 copay for inpatient hospital care
- $0 copay for Primary Care Physicians office visits
- $0 copay for Podiatry Office Visits
- Prescription drug coverage (including $0 copay for preferred diabetic drugs)
- Dental benefit ($150 annually)
- Vision and Hearing Benefits
- Disease Management Programs
- Personal Fitness Programs offered by Silver&Fit®
- Access to an independent personal health advocate
*Some services require pre-authorization. -
Medical Coverage Custom 1* Monthly Premium Plus Medicare Part B Premium
$99
Annual Deductible NO
Annual In-Network
Out-of-Pocket Limit$1,500
Prescription Drug Coverage YES
Primary Care
Physician Office Visit$0
Specialist Physician
Office Visit$15
Routine Annual
Physical Examination$0
Preventative Immunizations
& Screenings$0
Routine Annual
Eye Examination$0
Urgent Care $15
Outpatient Surgery $0
Emergency Care
$100,000 limit for services
outside of the U.S.$50
Inpatient Hospital Care Daily Copayment
$0
Dental Coverage
(Including Preventive Services)$150 annual limit for dental benefits
$0
Personal Fitness Programs $0
Unless otherwise noted, all services must be provided by a ConnectiCare contracted provider for the ConnectiCare VIP Custom 1 (In-network) plans. If you obtain routine care from out-of-plan providers, neither Medicare nor ConnectiCare will be responsible for the costs.
*ConnectiCare VIP Medicare Custom 1 is available to those who qualify, as determined by CMS guidelines.
**Preventive immunizations and screenings include: Part B Immunizations (Flu, Hepatitis B, and Pneumonia), Mammograms, Colorectal Screening Exams, Prostate Cancer Screening Exams, Pap Smears, Pelvic Exams and Bone Mass Measurement and Abdominal Aortic Aneurysm Screenings.
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Helpful Questions
Here are some helpful questions so you can choose a ConnectiCare Medicare plan that really fits you.
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For More Information
Call toll-free: 1-877-224-8221 (TTY/TDD 1-800-842-9710), Monday - Friday, 8 am - 8 pm. Extended hours 11/15 - 3/1, 8 am - 8 pm, 7 days a week.
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VIP Prime Plans
VIP Prime Drug Coverage