AmeriHealth Advantage PDP

AmeriHealth Advantage PDP is a prescription drug plan with a Medicare contract. It is designed for people with Medicare who are interested in Standard Medicare Part D prescription drug coverage.

Anyone who is entitled to Medicare benefits under Part A or enrolled in Part B can join AmeriHealth Advantage PDP. In addition, people who have both Medicare and Medicaid as well as limited incomes will receive additional help paying for prescription drugs. These beneficiaries will have lower cost sharing and will pay only a small amount for their prescription drugs.

Steps:	AmeriHealth Advantage PDP
Monthly premium	$30.10
Deductible (what you pay before the plan starts to pay)	$310
Cost Sharing (what you and the plan pay in total covered prescription drug costs up to a certain level —the Initial Coverage Limit)	You pay 25% coinsurance per prescription up to $2,830 in total drug costs.
Coverage Gap (when you pay all drug costs until the catastrophic coverage begins)	You pay 100% at discounted prices until yearly drug costs reach $4,550.
Catastrophic Coverage (starts after you have paid $4,550 out of pocket for covered drugs in a year)	You pay the greater of $2.50 per generic or $6.30 per brand-name drug, OR 5% coinsurance per prescription for the rest of the year. The plan pays the rest.

Here is how the cost sharing will work for AmeriHealth Advantage PDP:

• If you have both Medicare and Medicaid as well as a Medicare Savings Program, you will pay no premium or deductible and have no gap in coverage.
• To see if you qualify for extra help paying for prescription drugs, contact Medicare at 1-800-MEDICARE (TTY 1-877-486-2048) 24 hours a day, seven days a week; their state Medicaid office; or the Social Security Administration at 1-800-772-1213 (TTY 1-800-325-0778) 7 a.m. to 7 p.m., Monday through Friday. Learn more about the low-income subsidy. [1.3.2]

Your cost sharing for AmeriHealth Advantage PDP without the low-income subsidy will include:

• A monthly premium —This is what you will pay to participate in the plan. The monthly premium will vary depending on where you live or if you qualify for assistance programs. For your convenience, you can either have your monthly premiums deducted automatically from your Social Security check or be billed by the plan. For Pennsylvania and West Virginia the monthly premium is: $30.10
• A deductible —This is the amount you must pay before your insurance will pay. In Medicare prescription drug plans (like AmeriHealth Advantage PDP) that provide the Standard Medicare Part D benefit, the deductible is $310.
• Coinsurance — This is how you will split costs on a percentage basis with your insurance company. For example, with the Standard Medicare prescription drug coverage, you pay 25 percent of the drug costs and the plan pays 75 percent of the cost until the combined total reaches $2,830.
• A coverage gap — This describes the gap in coverage when you are paying 100 percent out-of-pocket for drugs because you have not yet reached your pre-set maximum. During this time, the plan makes no contribution to drug costs. Medicare prescription drug plans use a formulary (a government-approved list of drugs that it covers), and when you use the plan’s network pharmacies you’ll have access to discounted drugs. That means you’ll still have access to discounts during the coverage gap.
• After $4,550 Out of Pocket — Once you’ve paid $4,550 out of your own pocket for drugs in a year, the plan pays most costs. You pay a small portion, such as 5 percent, or a small fixed amount for each prescription.

Enroll by mail

Download AmeriHealth Advantage PDP Form.

Mail to:

AmeriHealth Advantage
PO Box 41514
Philadelphia, PA 19101-1514

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 Advantage PDP Summary of Benefits.

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 Advantage PDP Evidence of Coverage.

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 Advantage PDP Formulary.

Search our drug formulary by search tool:

Alphabetical Drug Name and Drug Class

Contact us

For more information, please contact us.

Learn more

Read some of the most frequently asked questions about the AmeriHealth Advantage PDP.