First Choice VIP Care (HMO D-SNP)
Available to residents of Florence County, SC for 2026. Contract H4739, plan 001, segment 0.
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- Plan health benefits
- Benefits in plain text
- Rx cost-sharing for all pharmacies and tiers
- Other plans in Florence County
- Plan website
- Browse the First Choice VIP Care (HMO D-SNP) formulary
Consolidated into another plan for 2026. CMS carries this plan forward from 2025.
Plan details
| Monthly premium (Part C + D) | $35.70 |
|---|---|
| — medical (Part C) part | $0.00 |
| — drug (Part D) part | $35.70? |
| Drug premium in CMS's quarterly plan file | $0.00The CMS Landscape file above lists $35.70 for the drug part; the two CMS files differ for this plan. |
| Monthly premium with full Extra Help (LIS) | $0.00? |
| Part B premium reduction (giveback) | None |
| Health plan deductible (in-network) | $790.00 |
| In-network out-of-pocket maximum | $9,250.00? |
| Drug deductible | $615.00Tier 6 exempt |
| Drug out-of-pocket threshold | $2,100.00 |
| Plan type | HMO D-SNP? |
| Special needs plan | Dual-eligible SNP |
| Contract / plan | H4739-001-0 |
| Offered by | First Choice VIP Care (HMO D-SNP) |
| Parent organization | Independence Health Group, Inc. |
| Formulary drugs | 3,809 |
| Formulary exception tier | 4? |
| Pharmacy search | www.firstchoicevipcare.com |
| Member services | (833)961-3723TTY 711 |
CMS star ratings
- Overall
- —
- Health plan (Part C)
- —
- Drug plan (Part D)
- 3 out of 5 stars for Drug plan (Part D)
Published per contract — every plan under contract H4739 shares this rating.
Plan health benefits
| Service | In-network |
|---|---|
| Doctor visits | |
| Primary care doctor | 0%–30% coinsurance |
| Specialist | 0%–30% coinsurance |
| Other health care professional | 30% coinsurance(authorization required) |
| Additional telehealth services | Not covered |
| Preventive care | |
| Medicare-covered preventive services | $0 copay |
| Annual physical exam | Not covered |
| Kidney disease education | 30% coinsurance |
| Glaucoma screening | $0 copay |
| Diabetes self-management training | 30% coinsurance |
| Diagnostic tests, labs and imaging | |
| Diagnostic tests and procedures | 30% coinsurance(authorization required) |
| Lab services | 30% coinsurance(authorization required) |
| Diagnostic radiology (e.g. MRI, CT) | 30% coinsurance(authorization required) |
| Therapeutic radiology | 20% coinsurance(authorization required) |
| Outpatient x-rays | 30% coinsurance(authorization required) |
| Emergency and urgent care | |
| Emergency room | $115 copay |
| Urgent care | 30% coinsurance |
| Worldwide emergency coverage | $0 copay · $50,000 plan limit |
| Worldwide urgent care | $0 copay · $50,000 plan limit |
| Worldwide emergency transportation | $0 copay |
| Hospital care | |
| Inpatient hospital stay | $750 per day for days 1–2; $0 per day for days 3–90(authorization required) |
| Outpatient hospital services | 30% coinsurance(authorization required) |
| Outpatient observation | 30% coinsurance |
| Ambulatory surgical center | 30% coinsurance(authorization required) |
| Outpatient blood services | 30% coinsurance(authorization required) |
| Skilled nursing and home health | |
| Skilled nursing facility | $0 per day for days 1–20; $218 per day for days 21–100(authorization required) |
| Home health care | $0 copay(authorization required) |
| Kidney dialysis | 20% coinsurance |
| Rehabilitation | |
| Occupational therapy | 30% coinsurance(authorization required) |
| Physical therapy and speech-language therapy | 30% coinsurance(authorization required) |
| Cardiac rehabilitation | 30% coinsurance(authorization required) |
| Pulmonary rehabilitation | 30% coinsurance(authorization required) |
| Mental health and substance use | |
| Inpatient psychiatric hospital stay | $260 per day for days 1–8; $0 per day for days 9–90(authorization required) |
| Outpatient mental health, individual session | 30% coinsurance |
| Outpatient mental health, group session | 30% coinsurance |
| Psychiatrist, individual session | 30% coinsurance |
| Psychiatrist, group session | 30% coinsurance |
| Partial hospitalization | 30% coinsurance(authorization required) |
| Intensive outpatient program | 30% coinsurance(authorization required) |
| Outpatient substance use, individual session | 30% coinsurance(authorization required) |
| Outpatient substance use, group session | 30% coinsurance(authorization required) |
| Opioid treatment program | 30% coinsurance |
| Ambulance and transportation | |
| Ground ambulance | 30% coinsurance(authorization required) |
| Air ambulance | 30% coinsurance(authorization required) |
| Transportation to plan-approved locations | $0 copay(limits apply) |
| Medical equipment and supplies | |
| Durable medical equipment (e.g. wheelchairs, oxygen) | 20% coinsurance(authorization required) |
| Prosthetics (e.g. braces, artificial limbs) | 20% coinsurance(authorization required) |
| Medical supplies | 20% coinsurance(authorization required) |
| Diabetes supplies | 0%–20% coinsurance(authorization required) |
| Diabetic therapeutic shoes or inserts | 20% coinsurance(authorization required) |
| Chiropractic, acupuncture and foot care | |
| Chiropractic (Medicare-covered) | 30% coinsurance |
| Routine chiropractic care | $0 copay(limits apply) |
| Acupuncture | $0 copay(limits apply) |
| Foot exams and treatment (Medicare-covered) | 30% coinsurance |
| Routine foot care | $0 copay(limits apply) |
| Dental? | |
| Medicare-covered dental services | $0 copay |
| Oral exams | $0 copay(limits apply) |
| Cleanings | $0 copay(limits apply) |
| Fluoride treatment | $0 copay(limits apply) |
| Dental x-rays | $0 copay(limits apply) |
| Other diagnostic dental services | Not covered |
| Other preventive dental services | $0 copay(limits apply) |
| Comprehensive dental plan limit | $3,000 plan limit every year |
| Restorative services (fillings, crowns) | $0 copay(authorization required) |
| Endodontics (root canals) | $0 copay(authorization required, limits apply) |
| Periodontics (gum disease) | $0 copay(authorization required, limits apply) |
| Dentures and other removable prosthodontics | $0 copay(authorization required, limits apply) |
| Maxillofacial prosthetics | $0 copay(authorization required, limits apply) |
| Implants | $0 copay(authorization required, limits apply) |
| Bridges and other fixed prosthodontics | $0 copay(authorization required, limits apply) |
| Oral and maxillofacial surgery | $0 copay(authorization required, limits apply) |
| Orthodontics | Not covered |
| Adjunctive general services | Not covered |
| Vision? | |
| Eye exam (Medicare-covered) | $0 copay |
| Routine eye exam | $0 copay(limits apply) |
| Eyewear after cataract surgery (Medicare-covered) | $0 copay(limits apply) |
| Eyewear plan limit | $355 plan limit every year |
| Contact lenses | $0 copay(limits apply) |
| Eyeglasses (frames and lenses) | $0 copay(limits apply) |
| Eyeglass lenses | Not covered |
| Eyeglass frames | Not covered |
| Eyewear upgrades | Not covered |
| Hearing? | |
| Hearing exam (Medicare-covered) | $0 copay |
| Routine hearing exam | $0 copay(limits apply) |
| Hearing aid fitting and evaluation | $0 copay |
| Hearing aid plan limit | $2,500 plan limit every three years |
| Hearing aids (all types) | $0 copay(limits apply) |
| Hearing aids, inner ear | Not covered |
| Hearing aids, outer ear | Not covered |
| Hearing aids, over the ear | Not covered |
| Medicare Part B drugs | |
| Part B insulin | 0%–20% coinsurance(authorization required) |
| Chemotherapy and radiation drugs | 0%–20% coinsurance(authorization required) |
| Other Part B drugs | 0%–20% coinsurance(authorization required) |
| Other extra benefits? | |
| Over-the-counter (OTC) allowance | $106 allowance every three months |
| Meals after a hospital stay or for a chronic condition | $0 copay(referral required) |
| Fitness benefit | $0 copay |
| Health education | Not covered |
| Nutritional / dietary benefit | Not covered |
| Extra smoking and tobacco cessation counseling | $0 copay |
| Enhanced disease management | Not covered |
| Telemonitoring | Not covered |
| Remote access technologies (web/phone, nurse line) | $0 copay |
| Home and bathroom safety devices | Not covered |
| Counseling services | Not covered |
| In-home safety assessment | Not covered |
| Personal emergency response system (PERS) | $0 copay |
| Medical nutrition therapy | Not covered |
| Post-discharge in-home medication reconciliation | Not covered |
| Re-admission prevention | Not covered |
| Wigs for hair loss from chemotherapy | Not covered |
| Weight management programs | Not covered |
| Alternative therapies | Not covered |
| Therapeutic massage | Not covered |
| Adult day health services | Not covered |
| Home-based palliative care | Not covered |
| In-home support services | Not covered |
| Support for caregivers | Not covered |
In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2026). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed. Contact the plan for the full Evidence of Coverage.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 | 25% |
| Tier 2 | 25% |
| Tier 3 | 25% |
| Tier 4 | 25% |
| Tier 5 | 25% |
| Tier 6 | $0.00 |
Rx cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial deductible phase | ||||||
| Tier 6: Select Care Drugs | $0.00 | $0.00 | n/a | $0.00 | $0.00 | $0.00 |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | 25% | 25% | n/a | 25% | 25% | 25% |
| Tier 2: Generic | 25% | 25% | n/a | 25% | 25% | 25% |
| Tier 3: Preferred Brand | 25% | 25% | n/a | 25% | 25% | 25% |
| Tier 4: Non-Preferred Drug | 25% | 25% | n/a | 25% | 25% | 25% |
| Tier 5: Specialty Tier | 25% | 25% | n/a | 25% | 25% | 25% |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | n/a | $0.00 | $0.00 | $0.00 |
| Catastrophic coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 4: Non-Preferred Drug | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 5: Specialty Tier | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Also available in 45 other SC counties
- Abbeville
- Aiken
- Allendale
- Anderson
- Bamberg
- Barnwell
- Beaufort
- Berkeley
- Calhoun
- Charleston
- Cherokee
- Chester
- Chesterfield
- Clarendon
- Colleton
- Darlington
- Dillon
- Dorchester
- Edgefield
- Fairfield
- Georgetown
- Greenville
- Greenwood
- Hampton
- Horry
- Jasper
- Kershaw
- Lancaster
- Laurens
- Lee
- Lexington
- McCormick
- Marion
- Marlboro
- Newberry
- Oconee
- Orangeburg
- Pickens
- Richland
- Saluda
- Spartanburg
- Sumter
- Union
- Williamsburg
- York
Benefits in plain text
First Choice VIP Care (HMO D-SNP) (H4739-001-0) is a 2026 HMO D-SNP Medicare Advantage plan offered by First Choice VIP Care (HMO D-SNP), available to residents of Florence County, SC.
The monthly premium is $35.70 (Part C and Part D together).
With full Extra Help (the Low-Income Subsidy), the total monthly premium is $0.00.
The in-network deductible for health services is $790.00.
Its in-network out-of-pocket maximum is $9,250.00.
The drug deductible is $615.00. Tier 6 exempt.
It is a special needs plan (Dual-eligible SNP).
The plan's formulary lists 3,809 drugs.
At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1: 25%; tier 2: 25%; tier 3: 25%; tier 4: 25%; tier 5: 25%; tier 6: $0.00.
Email a copy of the plan benefit details
Plan facts come from the CMS quarterly prescription drug plan public use files; the premium split, Extra Help premium, MOOP and plan type from the CMS Landscape file; the Part B giveback and health benefits from the CMS plan benefit package (PBP) files.