AHMedicare

Health Plans

2014

For Medicare beneficiaries who are interested in comprehensive medical coverage, prescription drug coverage, and wellness programs, AmeriHealth offers a variety of Medicare Advantage products. We invite you to learn more about these plans — and how to enroll.

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 designed for Medicare beneficiaries living in our three regions. Region 1 includes Ocean County. Region 2 includes Burlington, Camden, Cumberland, Gloucester, Salem, Mercer, Hunterdon, Somerset, Union, Essex, and Hudson Counties. Region 3 includes Atlantic, Monmouth, Warren, Morris, and Bergen Counties.

AmeriHealth 65 Preferred HMO Medical-only Coverage

AmeriHealth 65 Preferred Medical-only HMO is a Medicare Advantage Health Maintenance Organization (HMO) plan designed for Medicare beneficiaries living in in two of our three regions. AmeriHealth 65 Preferred Medical-only HMO is not available at this time in Region 1 which includes Ocean County. Region 2 includes Burlington, Camden, Cumberland, Gloucester, Salem, Mercer, Hunterdon, Somerset, Union, Essex, and Hudson Counties. Region 3 includes Atlantic, Monmouth, Warren, Morris, and Bergen Counties.

AmeriHealth Prescription Drug Plans

AmeriHealth Prescription Drug Plans are Part-D prescription drug plans (PDP). These plans are available to people with Medicare living in Pennsylvania and West Virginia.

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.

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.

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.

What are the Benefits of Additional Coverage?

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 2014 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 $1,216.
  • 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 $152.00 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.

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 skilled nursing facility care, you are covered in full, after you have met your deductible.
  • 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.

How can you avoid the costs not paid by Medicare?

For more information on how a medical-only or a medical with prescription drug Medicare Advantage managed-care plan from AmeriHealth 65 Preferred HMO compares with Medicare coverage, compare our plans.

*Amounts noted are for 2014 and may change.

Website last updated: 9/30/2014
Y0041_H3156_AH_15_20731 Approved 10/6/2014
AM6479 10/14

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.

AmeriHealth Rx is a PDP plan with a Medicare contract. Enrollment in AmeriHealth Rx depends on contract renewal.

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

For accommodation of persons with special needs at sales meetings call toll-free 1-888-678-7007 (711 for the speech- and hearing-impaired), 8 a.m. to 8 p.m., seven days a week. A sales person will be present with information and applications. However, please be aware that on weekends and holidays from February 15 through September 30, your call may be sent to voicemail.

We also list pharmacies that are in our network but are outside of the New Jersey, Pennsylvania, and West Virginia area. Please contact the plan toll-free 1-888-678-7007 (711 for the speech- and hearing-impaired), 8 a.m. to 8 p.m., seven days a week, for additional information.

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; AmeriHealth Rx PDP Member Help Team at 1-888-678-7007. TTY/TDD users should call 1-888-857-4816 (AmeriHealth 65 Preferred HMO); 1-888-457-3002 (AmeriHealth Rx PDP), 7 days a week, 8 a.m. to 8 p.m.

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.

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.

This information is available for free in other languages. Please call our Member Help Team number at 1-866-569-5190, 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 1-866-569-5190, 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.

© 2014 AmeriHealth