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AmeriHealth 65® NJ Rx HMO
AmeriHealth 65 NJ Rx HMO is a Medicare Advantage plan with a Medicare contract and is offered by AmeriHealth HMO, Inc. The prescription benefits are administered by FutureScripts® Secure, a pharmacy benefit management program.
AmeriHealth 65 NJ Rx HMO gives you all the benefits of Original Medicare plus many more. You can enroll in AmeriHealth 65 NJ Rx HMO if you live in the service area that includes Burlington, Camden, Cumberland, Gloucester, and Salem counties in New Jersey.
AmeriHealth 65 NJ 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 NJ Rx HMO |  |
| Monthly premium | $242.10 |
| Yearly deductible | $1,500 |
| Primary care physician visit | $15 |
| Specialist visit | $40 |
| Emergency room | $50 Not waived if admitted |
| Ambulance | Covered in full after $1,500 deductible |
| Urgent care | $15 - $40 |
| Inpatient hospital | Covered in full after $1,500 deductible |
| Outpatient surgery (per date of service) | Outpatient hospital: Covered in full after $1,500 deductible Ambulatory surgical center: Covered in full, after $1,500 deductible |
| Preventive services | No copayments for outpatient lab services, routine physicals, most cancer screenings and more |
| Dental benefits | Preventive dental: $10 every six months; comprehensive dental: covered in full |
| 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: $100 every two years ($65 frames and $35 lenses) |
| Hearing services | Medicare-covered hearing exams: $40 Routine hearing exams: $40 every three years Hearing aids: $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) | $320 |
| 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 25% until total yearly drug costs reach $2,930. |
| Coverage Gap (when you pay all drug costs until the catastrophic coverage begins) | You pay 86% for generic drugs and a discount on brand name drugs until your true out-of-pocket (TrOOP) costs reach $4,700. |
| Catastrophic Coverage (starts after you have paid $4,700 out of pocket for covered drugs in a year) | You pay the greater of 5% coinsurance or a $2.60 copay for generic (preferred or non-preferred) drugs and a $6.50 copay for all other drugs. |
Enroll by mail
Download 
AmeriHealth 65 NJ Rx HMO Form Y0041_H3156_AH12_09 CMS Approved 08252011.
Mail to:
AmeriHealth 65 NJ HMO
Medicare Department
P.O. Box 7576
Philadelphia, PA 19101-8951
Enroll by phone
Please call Customer Service for AmeriHealth NJ 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 to an answering machine.
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.
Download the AmeriHealth 65 NJ Rx HMO Summary of Benefits Y0041_H3156_AH12_03 CMS Approved 09092011.
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 NJ Rx HMO Evidence of Coverage Y0041_H3156_AH12_02 File & Use 09/13/2011.
Errata Sheet
The information contained in this errata sheet replaces certain language and/or benefits found in your Evidence of Coverage. Please refer to this document along with the EOC for information about your plan’s benefits.
Download the AmeriHealth 65 NJ Rx HMO Errata Sheet Y0041_H3156_AH_12_1100 CMS Approved 01/12/12.
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.
Download the AmeriHealth 65 NJ Rx HMO Formulary Y0041_H3156_AH12_11 File & Use 09/03/2011.
Learn more
Read some of the most frequently asked questions about the AmeriHealth 65 NJ Rx HMO.
You must continue to pay your Medicare Part B premium.
The Medicare Contract is renewed annually, and the availability of coverage beyond the end of the current year is not guaranteed.
The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change January 1, 2013. Members may enroll in the plan during specific times of the year. Contact the plan for more information. Please reference the Evidence of Coverage for information on premiums, cost-sharing, out-of-network coverage, rights and responsibilities upon disenrollment and any applicable conditions associated with using the plan benefits, as well as limitations, copayments, and restrictions.
Members must use network pharmacies to access their prescription drug benefit, except under non-routine circumstances, and quantity limitations and restrictions may apply.
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call:
- 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week;
- The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or
- Your State Medicaid Office.
People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you qualify, Medicare could pay for up to seventy-five (75) percent or more of your drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don't even know it. For more information about this Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.
You must use plan providers except in emergency or urgent care situations or for out-of-are renal dialysis or other services. If you obtain routine care from out-of-network providers neither Medicare nor AmeriHealth 65 NJ HMO will be responsible for the costs.
Please contact AmeriHealth 65 HMO for more information.
In lots of cases, your prescriptions are covered under AmeriHealth 65 NJ HMO, AmeriHealth Rx PDP if they are filled at a network pharmacy or through our mail-order pharmacy service. There are thousands of network pharmacies, including:
- national chain and independent retail pharmacies
- long-term care and home-infusion pharmacies
- Indian Health Service/Tribal/Urban Indian Health (I/T/U) Program pharmacies
Website last updated: 12/30/11
Y0041_HNS_12_301a Pending CMS Approval
