AHMedicare

AmeriHealth 65® Preferred Rx HMO

Seeking medical-only coverage? Review information and enroll online for AmeriHealth 65 Preferred HMO.

AmeriHealth 65 Preferred Rx HMO is a Medicare Advantage plan offered by AmeriHealth HMO, Inc. The prescription benefits are administered by FutureScripts® Secure, a pharmacy benefit management program.

AmeriHealth 65 Preferred Rx HMO gives you all the benefits of Original Medicare plus many more. You can enroll in AmeriHealth 65 Preferred Rx HMO if you live in the service area that includes Burlington, Camden, Cumberland, Gloucester, and Salem counties in New Jersey.

AmeriHealth 65 Preferred Rx HMO provides members with:

  • comprehensive medical coverage;
  • Medicare Part D prescription drug coverage;
  • virtually no paperwork;
  • preventive care;
  • extensive network with more than 3,000 primary care physicians, 50,000 specialist sites, and 100 hospitals;
  • access to health resources and wellness programs;
  • help managing chronic conditions, such as asthma, diabetes, and Chronic Obstructive Pulmonary Disease (COPD).

Limitations, copayments, and restrictions may apply to certain benefits. For more detailed information on benefits, please review the Summary of Benefits.

AmeriHealth 65 Preferred Rx HMO
Monthly premium $74.90
Yearly deductible $0 – No deductible
Primary care physician visit $15
Specialist visit $35
Emergency room $65
Not waived if admitted
Ambulance $50
Urgent care $15 – $35
Inpatient hospital $245 per day, days 1 – 7;
$0 each additional day.
$1,715 maximum per stay. Unlimited days per stay.
Outpatient surgery (per date of service) Ambulatory surgical center: $100
Outpatient hospital: $350
Preventive services No copayments for outpatient lab services, routine physicals, most cancer screenings and more
Dental benefits Preventive dental: $10 every six months; for cleaning and exam
Vision services Medicare-covered eye exams: $40
Routine eye exams: $40 every two years
Medicare-covered eyewear: One pair of eyeglasses or contacts after cataract surgery
Other eyewear: Covered up to $100 every two years
Hearing services Medicare-covered hearing exams: $40
Routine hearing exams: $40 every three years
Hearing aids: Covered up to $500 every three years
Health/wellness education Reimbursements for several wellness programs, including weight management: $200; smoking cessation: $200; Silver Sneakers Program.

Prescription Drug Benefit
Deductible (what you pay before the plan starts to pay) $295
Initial Coverage Phase (what you and the plan pay in total covered prescription drug costs up to a certain level – the Initial Coverage Limit) After you pay your yearly deductible, you pay $4 for each generic drug, $45 for each preferred brand drug, $85 for each non-preferred brand drug, and 25% for specialty drugs until total yearly drug costs reach $2,970.
Coverage Gap (when you pay all drug costs until the catastrophic coverage begins) You pay 79% for generic drugs and 47.5% on brand name drugs until your true out-of-pocket (TrOOP) costs reach $4,750.
Catastrophic Coverage (starts after you have paid $4,750 out of pocket for covered drugs in a year) You pay the greater of 5% coinsurance or a $2.65 copay for generic (preferred or non-preferred) drugs and a $6.60 copay for all other drugs.

Enroll by mail

Review the Enrollment Instructions below before completing the paper application.

Download the PDF icon AmeriHealth 65 Preferred Rx HMO Application Y0041_H3156_AH_13_3501a Approved 09/11/2012

Mail to:

AmeriHealth 65 Preferred HMO
Medicare Department
P.O. Box 7576
Philadelphia, PA 19101-8951

Enroll by phone

Please call Customer Service for AmeriHealth Preferred HMO at 1-800-898-3492, seven days a week, 8 a.m. to 8 p.m. EST. (Speech- and heading-impaired users should call 1-877-219-5457). Please be aware that on weekends and holidays from February 15 through September 30, your call may be sent voicemail.

Summary of Benefits

The Summary of Benefits tells you about some of the plan’s features. You should refer to the Summary of Benefits for:

  • applicable conditions and limitations;
  • premiums;
  • cost-sharing (e.g., copayments, coinsurance, and deductibles);
  • any conditions associated with receipt or use of benefits.

PDF icon Download the AmeriHealth 65 Preferred Rx HMO Summary of Benefits Y0041_H3156_AH_13_2339 Accepted 09/22/2012

Evidence of Coverage

The Evidence of Coverage is our contract with you. It explains your rights, benefits, and responsibilities as a member of our plan.

PDF icon Download the AmeriHealth 65 Preferred Rx HMO Evidence of Coverage Y0041_H3156_AH_13_2933 Accepted 09/12/2012

Drug Formulary

A drug formulary is a list of generic and brand-name prescription drugs that are covered by the plan, are FDA-approved, and have been chosen for their reported medical effectiveness and value.

PDF icon Download the AmeriHealth 65 Preferred Rx HMO Formulary Y0041_H3156_AH_13_2680 Accepted 09/02/2012

Website last updated: 9/30/13
Y0041_HNS_14_9867 Approved 12/17/13

AmeriHealth HMO, Inc. is an HMO plan with a Medicare contract. Enrollment in AmeriHealth HMO, Inc. depends on contract renewal.

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

Please contact AmeriHealth Customer Service 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, premium and/or co-payments/co-insurance 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 (1-888-457-3002 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 (1-888-457-3002 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 Customer Service at 1-800-645-3965; AmeriHealth Rx PDP Customer Service 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 customer service 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, 08 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.

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