AmeriHealth 65 Basic

Eligibility Requirements

Medicare Part D prescription drug plans are available to anyone who is eligible for Medicare in the United States, regardless of age, income, or health conditions. You must live in the service area of the plan you join. Participation is voluntary.

In order to be eligible, you must:

1. Be entitled to Medicare Part A and enrolled in Medicare Part B.

2. Continue to pay your Medicare Part B premiums (and Part A, if applicable) if not otherwise paid for by Medicaid or another third party. If you enroll in AmeriHealth 65 PA, you must choose an AmeriHealth 65 Basic plan with prescription drug benefits to receive Medicare Part D prescription drug coverage.

3. Be a resident of Berks, Lancaster, Lehigh, Northampton, and York Counties in Pennsylvania.

4. You may elect an AmeriHealth 65 Basic plan that includes (Part D) prescription drug coverage. If you join AmeriHealth 65 Basic, you must obtain your Part D benefits through this Medicare Advantage plan. If you are enrolled in a Medicare Advantage plan (like AmeriHealth 65 Basic), you may not enroll in a stand-alone Prescription Drug Plan.

5. The Federal Government will not allow us to accept people with End Stage Renal Disease, unless converting from AmeriHealth 65 Employer Group Coverage, or if their current Medicare Advantage plan stops providing coverage in their area

6. AmeriHealth 65 Basic is a Special Needs Plan designed for full benefit dual-eligibles (people who qualify for both Medicaid & Medicare). You must be enrolled with the state and federally funded Medical Assistance program (including Healthy Horizons) and have either a Medicaid access card or Medicaid HMO card to join this plan.

People with limited incomes and resources may receive full prescription drug coverage at little or no cost. Eligibility depends on income (money received from retirement benefits and other reported income) and in some cases, assets. Depending on level of need, premiums, copays, and deductibles may be reduced or eliminated and the coverage gap may be eliminated. If you qualify for extra help with your Medicare Prescription Drug Plan costs, your premium and drug costs will be lower. When you join AmeriHealth65, Medicare will tell us how much extra help you are getting. Then, we will let you know the amount you will pay.

You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call:

• 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048 (24 hours a day / 7 days a week),
• Your State Medicaid Office, or
• The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call-1-800-325-0778.

For additional information, read our Frequently Asked Questions about Medicare Part D.

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