First Choice VIP Care (HMO D-SNP)

Available to residents of Fairfield County, SC for 2027. Contract H4739, plan 001, segment 0.

2027 drug-by-drug coverage is not published by CMS yet. The drug lookup covers 2026, whose formulary is live.

Renewed for 2027. CMS carries this plan forward from 2026. Every SC plan’s 2026–2027 changes →

Plan details

Monthly premium (Part C + D)	$7.30
— medical (Part C) part	$0.00
— drug (Part D) part	$7.30?
Monthly premium with full Extra Help (LIS)	$0.00?
Part B premium reduction (giveback)	None
Health plan deductible (in-network)	$875.00
In-network out-of-pocket maximum	$9,850.00?
Drug deductible	$700.00Tier 1 and 2 exempt
Drug out-of-pocket threshold	$2,400.00
Plan type	HMO D-SNP?
Special needs plan	Dual-eligible SNP
D-SNP integration status	Highly Integrated (HIDE)
Zero-dollar cost sharing D-SNP	Yes
Contract / plan	H4739-001-0
Offered by	First Choice VIP Care (HMO D-SNP)
Parent organization	Independence Health Group, Inc.
Formulary tiers	5
Formulary exception tier	4?
Pharmacy search	www.firstchoicevipcare.com
Member services	(833)809-3767TTY 711

CMS star ratings

Overall: —
Health plan (Part C): —
Drug plan (Part D): 2.5 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; $221 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	$2,000 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	Not covered
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	$300 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(limits apply)
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, step therapy may apply)
Chemotherapy and radiation drugs	0%–20% coinsurance(authorization required, step therapy may apply)
Other Part B drugs	0%–20% coinsurance(authorization required, step therapy may apply)
Other extra benefits?
Over-the-counter (OTC) allowance	Covered (allowance not stated)
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	$0 copay
Counseling services	Not covered
In-home safety assessment	Not covered
Personal emergency response system (PERS)	Not covered
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, CY2027). 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 · Preferred Generic	$0.00
Tier 2 · Generic	$10.00
Tier 3 · Preferred Brand	25%
Tier 4 · Non-Preferred Drug	25%
Tier 5 · Specialty Tier	25%

Rx cost-sharing by coverage phase

Tier	30-day supply			90-day supply
Tier	Preferred	Standard	Mail Order	Preferred	Standard	Mail Order
Initial coverage phase
Tier 1: Preferred Generic	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 2: Generic	$10.00	$10.00	$10.00	$30.00	$30.00	$30.00
Tier 3: Preferred Brand	25%	25%	25%	25%	25%	25%
Tier 4: Non-Preferred Drug	25%	25%	25%	25%	25%	25%
Tier 5: Specialty Tier	25%	25%	25%	n/a	n/a	n/a

These are the initial coverage phase amounts, as the plan filed them in its benefit package. The deductible and post-threshold phases are not stated per tier in that filing, so they are not shown here rather than being inferred; the plan's annual out-of-pocket threshold is $2,400.00.

Star rating measures

Measures are paired between the two years by name, not by the C/D number: CMS reuses those numbers, and in 2027 nineteen of them refer to a different measure than they did in 2026. A measure introduced for 2027 has no 2026 score to show. Published per contract — every plan under H4739 shares it.

Benefits in plain text

First Choice VIP Care (HMO D-SNP) (H4739-001-0) is a 2027 HMO D-SNP Medicare Advantage plan offered by First Choice VIP Care (HMO D-SNP), available to residents of Fairfield County, SC.

The monthly premium is $7.30.

With full Extra Help (the Low-Income Subsidy), the total monthly premium is $0.00.

The in-network deductible for health services is $875.00.

Its in-network out-of-pocket maximum is $9,850.00.

The drug deductible is $700.00. Tier 1 and 2 exempt.

It is a special needs plan (Dual-eligible SNP).

At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1 (Preferred Generic): $0.00; tier 2 (Generic): $10.00; tier 3 (Preferred Brand): 25%; tier 4 (Non-Preferred Drug): 25%; tier 5 (Specialty Tier): 25%.

Email a copy of the plan benefit details

Plan facts come from the CMS plan Landscape file and the CMS plan benefit package (PBP) files.