With AmeriHealth 65 Preferred HMO, you have access to an extensive network of doctors and hospitals. While we want you to have the widest range of choices, we also want to make sure you have access to quality care. To achieve this, AmeriHealth collects information through private data sources and carefully review all physicians, hospitals, and health care providers before they become participating providers.
You must receive your care from a network provider. In most cases, care you receive from an out-of-network provider (a provider who is not part of our plan’s network) will not be covered. Here are three exceptions:
The plan covers emergency care or urgently needed care that you get from an out-of-network provider. For more information about this, and to see what emergency or urgently needed care means, contact us.
If you need medical care that Medicare requires our plan to cover and the providers in our network cannot provide this care, you can get this care from an out-of-network provider. In order to pay the same as you would pay if you got the care from a network provider, you must obtain prior authorization.
Kidney dialysis services that you get at a Medicare-certified dialysis facility when you are temporarily outside the plan’s service area.
Find Participating Doctors, Hospitals, and Ancillary Providers
The online provider directory provides information available through our network system on the physicians, hospitals, and ancillary providers who participate in AmeriHealth 65 Preferred HMO. Search for a provider.
AmeriHealth Vision Programs are administered by Davis Vision. If you are a member of the AmeriHealth Vision program, we offer a convenient way to search for a Davis Vision provider online. Search for a vision provider.
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.
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.