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.
|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.
- AmeriHealth 65 HMO Enrollment Instructions Y0041_H3156_AH12_18 File & Use 09/04/2011
Download the AmeriHealth 65 Preferred Rx HMO Application Y0041_H3156_AH_13_3501a Approved 09/11/2012
AmeriHealth 65 Preferred HMO
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;
- cost-sharing (e.g., copayments, coinsurance, and deductibles);
- any conditions associated with receipt or use of benefits.
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.
Download the AmeriHealth 65 Preferred Rx HMO Evidence of Coverage Y0041_H3156_AH_13_2933 Accepted 09/12/2012
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.
Download the AmeriHealth 65 Preferred Rx HMO Formulary Y0041_H3156_AH_13_2680 Accepted 09/02/2012
Website last updated: 1/1/2013
Y0041_HNS_13_3647c Approved 1/15/2013