Frequently Asked Questions about AmeriHealth 65 NJ HMO

1. I travel a lot. What if I have an emergency?

2. Does AmeriHealth 65 NJ HMO cover dental visits?

3. What resources do you have for managing health conditions like asthma?

4. Do I have to file claims with AmeriHealth 65 NJ HMO?

5. How does AmeriHealth 65 NJ HMO compare with a Medicare supplement?

6. If I chose a medical-only option, can I join a different Medicare Part D drug plan?

7. Why is it important to choose a primary care physician (PCP) when I enroll?

8. What if I need to go outside the network area?

9. Do I need a referral to see a specialist?

10. Does AmeriHealth 65 NJ HMO cover vision and hearing visits?

11. What if I have AmeriHealth 65 NJ coverage through my employer?

12. Do I qualify for low-income subsidy?

I travel a lot. What if I have an emergency?

You’re covered for emergency care, urgent care, or dialysis anywhere in the U.S. at the in-network benefit level. Not an emergency? You may use out-of-network doctors and hospitals at any time; you will just have to pay more than if you used an in-network provider.

Does AmeriHealth 65 NJ HMO cover dental visits?

With AmeriHealth 65 NJ HMO, you’re eligible for benefits to pay for routine dental exams and cleanings. Dental benefits are available through network providers only. Be sure to indicate your choice of primary dental office on your enrollment form.

What resources do you have for managing health conditions like asthma?

If you have asthma, diabetes, or another chronic condition, you can get the one-on-one support you need to manage your health through ConnectionsSM Health Management Programs. You’ll have access to a Health Coach whom you can talk to any time, day or night, seven days a week.

Do I have to file claims with AmeriHealth 65 NJ HMO?

With our automatic claims filing, there is virtually no paperwork for you to worry about. In most cases, you simply present your AmeriHealth 65 NJ HMO ID card.

How does AmeriHealth 65 NJ HMO compare with a Medicare supplement?

AmeriHealth 65 NJ HMO provides more coverage than a typical Medicare supplement and Original Medicare combined —often at a much lower monthly premium. There’s emphasis on preventative care, —with many services covered at no cost to you.

If I chose a medical-only plan, can I join a different Medicare Part D drug plan?

No. If you enroll in a Medicare Advantage plan that offers prescription drug coverage, you must get your prescription drug coverage through that plan.

Why is it important to choose a primary care physician (PCP) when I enroll?

Because AmeriHealth 65 NJ HMO is a managed-care plan, all your health care must be provided, referred, or authorized by your PCP. The doctor you select from our extensive network —who may be the doctor you see —will coordinate your care. This coordination lessens the likelihood that your medications and treatments conflict. You can choose from more than 3,000 PCPs in the AmeriHealth 65 NJ HMO network.

What if I need to go outside the network area?

The use of non-plan providers, except for emergency care and out-of-area urgent care and renal dialysis, may result in you having to pay for services rendered. Neither AmeriHealth 65 NJ HMO nor Medicare will pay for these services.

Do I need a referral to see a specialist?

Yes. Keep in mind that your primary care physician (PCP) coordinates all of your care except for emergencies. If you need to see a specialist, your PCP will give you a referral.

Does AmeriHealth 65 NJ HMO cover vision and hearing visits?

With AmeriHealth 65 NJ HMO, you’re covered for vision and hearing services —and can get reimbursed for eyewear and hearing aids.

What if I have AmeriHealth 65 NJ coverage through my employer?

If you have coverage through your former (or current) employer, Health and Welfare Fund, or an Association Group, your benefits may vary. Contact us for more information.

Do I qualify for low-income subsidy?

If you have limited income and resources, you may qualify for low-income subsidy. When you join AmeriHealth 65 NJ HMO, Medicare will tell us how much extra help you are getting. Then, we will let you know the amount you will pay. If you qualify, your drug costs will also be lower.

To see if you qualify for extra help, call:

• 1-800-MEDICARE (1-800-633-4227). TTY machine users should call 1-877-486-2048, 24 hours a day/7 days a week);
• The Social Security Administration 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.

Please note: In some cases, Medical Assistance copays will apply.