Send Page
Print Page
FAQ
If I choose the medical-only option, can I join a different Medicare drug plan?
I travel a lot. What if I have an emergency?
Does AmeriHealth 65 NJ HMO cover dental visits?
How do I know if the medications I take are covered?
What resources do you have for managing health conditions like asthma?
Do I have to file claims with AmeriHealth 65 NJ HMO ?
If I choose a medical-only option, can I join a different Medicare drug plan?
No. If you enroll in a Medicare Advantage plan that offers prescription drug coverage (like AmeriHealth 65 NJ HMO) and you would like to obtain Medicare Part D prescription drug coverage through a health care plan, you must get your Medicare prescription drug coverage through the same plan as your Medicare Advantage plan.
I travel a lot. What if I have an emergency?
You are covered for emergency care, urgent care, or dialysis anywhere in the U.S. at the in-network benefit level.
Does AmeriHealth 65 NJ HMO cover dental visits?
You will be 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.
How do I know if the medications I take are covered?
The list of drugs covered by the AmeriHealth 65 NJ HMO plan is our drug formulary. We have been able to negotiate special prices with drug companies for the medications in our formulary. Savings are passed on to you when your prescriptions are filled at network pharmacies.
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 you can talk to any time of day or night, seven days a week.
Do I have to file claims with AmeriHealth 65 NJ HMO?
No! 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 to your provider.
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
