AHMedicare

Health Plans

2015

AmeriHealth 65 Preferred HMO Medical and Prescription Drug Coverage

AmeriHealth 65 Preferred Rx HMO is a Medicare Advantage Health Maintenance Organization (HMO) plan with prescription drug coverage for individuals. Our AmeriHealth 65 Preferred Rx HMO plan is available to eligible residents in the entire state of New Jersey.

AmeriHealth 65 Preferred HMO Medical-only Coverage

AmeriHealth 65 Preferred Medical-only HMO is a Medicare Advantage Health Maintenance Organization (HMO) plan. Our AmeriHealth 65 Preferred Medical-only HMO plan is available to eligible residents in the entire state of New Jersey.

For more information about our plans, please contact us. We have free interpreter services to answer any questions you may have about our health or drug plan. To get an interpreter, contact us and someone who speaks your language can help you. This is a free service.

With a Medicare Advantage plan from AmeriHealth 65 Preferred HMO, you are covered for more benefits and your out-of-pocket costs may be less than Original Medicare.

  • For routine exams and physicals from your Primary Care Physician, you are responsible for only your copayment.
  • For medical expenses in or out of the hospital (medical and surgical services, physical therapy, diagnostic tests, and durable medical equipment), you will be responsible for your copayment or no copayment at all.

AmeriHealth Medigap Plans

Medicare Supplement plans (also known as Medigap) provide traditional, supplemental protection — it's the kind of insurance you can use with any health care provider who accepts Original Medicare patients.

AmeriHealth Medigap Plans offer a choice of four plans. To join, you must be enrolled in Medicare Part A and B and must continue to pay your Medicare Part A (if applicable) and Part B premiums. Our Medigap plans are available to eligible residents in the entire state of New Jersey.

Original Medicare does not pay all your health care costs. People who have only Medicare coverage pay a lot of money out of their own pockets for deductibles and coinsurance payments and services not covered by Medicare.

Here are some examples of 2015 costs you may have to pay if you have only Original Medicare Part A and Part B coverage.*

  • Routine exams and physicals are not generally covered by Medicare. You are responsible for the entire cost of these visits.
  • Just one day in the hospital can cost you up to $1,260.
  • Skilled nursing facility care is covered by Medicare Part A for up to 100 days per benefit period. After 20 days, you could be responsible for a copayment of up to $157.50 per day.
  • For medical expenses in or out of the hospital (medical and surgical services, physical therapy, diagnostic tests, and durable medical equipment), Medicare Part B requires a $147-per-year deductible. After the deductible, Medicare covers only 80% of approved charges.

How can you avoid the costs not paid by Medicare?

For more information, compare our plans.

*Amounts noted are for 2015 and may change.

Website last updated: 12/31/2014
Y0041_H3156_AH_15_20731d Pending

AM6640 (1/15)

AmeriHealth HMO, Inc. is an HMO plan with a Medicare contract. Enrollment in AmeriHealth HMO, Inc. depends on contract renewal. Benefits underwritten or administered by AmeriHealth HMO, Inc.

Please contact the Member Help Team for more information.

You must continue to pay your Medicare Part B premium.

The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on January 1 of each year.

Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.

Medicare beneficiaries may enroll in AmeriHealth 65® NJ HMO or AmeriHealth 65® Preferred HMO through the CMS Medicare Online Enrollment Center located at www.medicare.gov.

A sales person will be present with information and applications. For accommodation of persons with special needs at sales meetings, call 1-800-898-3492 (TTY: 711).

You may receive prescription drugs shipped to your home through our network mail order delivery program. Usually a mail-order pharmacy order will get to you in no more than 14 days. If you should not receive your prescription drugs, please call FutureScripts Secure at 1-888-678-7015, 7 days a week, 24 hours a day. Or, you can visit our website at www.amerihealthmedicare.com.

To file an appeal or grievance for your medical benefit coverage or your prescription drug coverage, contact AmeriHealth 65 Preferred HMO Member Help Team at 1-866-569-5190 or AmeriHealth Medigap Plans Member Help Team at 1-866-406-5967; 7 days a week, 8 a.m. to 8 p.m. Please note that on weekends and holidays from February 15 through September 30, your call may be sent to voicemail.

This information is available for free in other languages. Please call our Member Help Team number at 1-800-898-3492, seven days a week, 8 a.m. to 8 p.m. However, please be aware that on weekends and holidays from February 15 through September 30 your call may be sent to voicemail.

Esta información está disponible gratis en otros idiomas. Por favor llame a nuestro número de servicio al cliente al 1-800-898-3492, los siete días de la semana, 8 a.m.-8 p.m. Sin embargo, tenga en cuenta que los fines de semana y festivos del 15 de febrero al 30 de septiembre la llamada puede ser enviada al correo de voz.

AmeriHealth Medigap Plans are offered through AmeriHealth Insurance Company of New Jersey. AmeriHealth Medigap Plans are not connected with or endorsed by the U.S. government or the federal Medicare program. You must continue to pay your Medicare Part A (if applicable) and Part B premiums. If applying during a non-open enrollment or non-guaranteed issue period, your eligibility may be subject to medical underwriting and/or a rate increase due to tobacco usage. The rates shown are non-tobacco rates. These rates apply to applications submitted during the 6-month open enrollment or in a guaranteed issue situation. Applicants NOT enrolling during the 6-month open enrollment period or in a guaranteed issue situtaion will be evaluated for tobacco usage and charged the corresponding tobacco or non-tobacco rates. All rates are subject to change. Any rate change will apply to all members of the same class insured under your plan.

For additional information from the Centers for Medicare and Medicaid Services (CMS) visit www.medicare.gov. If you prefer to file a grievance through CMS, please complete the Medicare Complaint Form. For additional assistance, visit The Office of the Medicare Ombudsman.

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