AmeriHealth 65^® Plus

Individual Plan Frequently Asked Questions

What makes AmeriHealth 65 Plus different from a regular HMO?

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 Plus 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 Plus?

What makes AmeriHealth 65 Plus different from a regular HMO?

With an HMO all your care must be provided, arranged or authorized by your Primary Care Physician and you must use plan providers except in a few emergency situations.  AmeriHealth 65 Plus gives you the option to use out-of-network providers and no referrals are needed for most in-network services.

If I choose the medical-only option, can I join a different Medicare drug plan?

No. If you enroll in a Medicare Advantage Plan with prescription drug coverage (like AmeriHealth 65 Plus), you must get Medicare prescription drug coverage through the plan.

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

You may travel throughout the United States and use your AmeriHealth 65 Plus benefits.  For emergencies and out-of-area urgent care/renal dialysis, you're covered as if you were at home (at the in-network benefit level).  Not an emergency?  Don't forget you can also use non-network doctors and hospitals at any time although you’ll be responsible for additional costs.

Does AmeriHealth 65 Plus cover dental visits?

You'll be eligible for benefits to pay for routine dental exams, cleanings and more.  Dental benefits are available through network providers only.  Be sure to indicate your choice of primary dental office on your enrollment form.  You're also covered for vision and hearing services – and can get reimbursements for eyewear and hearing aids.

How do I know if the medications I take are covered?
The list of drugs covered by the AmeriHealth 65 Plus plan is our drug formulary. We've 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 Connections^SM  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 Plus?

No! With our automatic claims filing, there is virtually no paperwork for you to worry about (some services provided outside the service area may require minimal paperwork.)   In most cases you simply present your AmeriHealth 65 Plus ID card