What are the Benefits of Additional Coverage?

Traditional Medicare does not pay all your health care costs. People who have only Medicare coverage pay a lot of money out of their own pockets for deductibles and coinsurance payments and services not covered by Medicare.

Here are some examples of costs you may have to pay if you have only Traditional Medicare Part A and Part B coverage.

Routine exams and physicals are not generally covered by Medicare. You are responsible for the entire cost of these visits.
Just one day in the hospital can cost you up to $1,100.
Skilled nursing facility care is covered by Medicare Part A for up to 20 days. From day 21 to 100, you could be responsible for $137.50 per day.
For medical expenses in or out of the hospital (medical and surgical services, physical therapy, diagnostic tests, and durable medical equipment), Medicare Part B requires a $155-per-year deductible. After the deductible, Medicare covers only 80% of approved charges.

With a Medicare Advantage managed-care plan from AmeriHealth 65 NJ HMO, you are covered for more benefits and your out-of-pocket costs are minimal.

For routine exams and physicals from your Primary Care Physician, you are responsible for only your copayment.
For skilled nursing facility care, you are covered in full, after you have met your deductible.
For medical expenses in or out of the hospital (medical and surgical services, physical therapy, diagnostic tests, and durable medical equipment), you will be responsible for your copayment or no copayment at all.

How can you avoid the costs not paid by Medicare?

For more information on how a Medicare Advantage managed-care plan from AmeriHealth 65 NJ HMO compares with Medicare coverage, download the summary of benefits:

2012 Summary of Benefits

2012 AmeriHealth 65 NJ HMO Summary of Benefits Y0041_H3156_AH12_03 CMS Approved 09/09/2011

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