Features of AmeriHealth 65
AmeriHealth 65 gives you all the benefits of Original Medicare plus many more. You can enroll in AmeriHealth 65 if you live in the service area that includes Burlington, Camden, Cumberland, Gloucester, and Salem counties in New Jersey.
AmeriHealth 65 provides members with:
- comprehensive medical coverage;
- virtually no paperwork;
- preventive care;
- extensive network with more than 3,000 primary care physicians, 50,000 specialist sites, and 100 hospitals;
- access to health resources and wellness programs;
- help managing chronic conditions, such as asthma, diabetes, and COPD.
The chart below provides a comparison of the different plan options offered by AmeriHealth 65.
| |
AmeriHealth 65 NJ Value |
AmeriHealth 65 NJ Standard |
AmeriHealth 65 NJ Plus |
Medical only plan |
$0 monthly premium
No Part D coverage |
$35 monthly premium
No Part D coverage |
$86 monthly premium
No Part D coverage
|
Medical plus prescription drug |
$27.10 monthly premium |
$62.70 monthly premium |
$119.30 monthly premium |
AmeriHealth 65 NJ Value and Standard are both Medicare Advantage Health Maintenance Organization (HMO) plans. AmeriHealth 65 NJ Value is designed for people who wish to pay a lower monthly premium in exchange for higher copays, whereas AmeriHealth 65 NJ Standard is designed for people who wish to pay a higher monthly premium in exchange for lower copays.
AmeriHealth 65 NJ Plus is a Medicare Advantage Point-of-Service (POS) plan. AmeriHealth 65 NJ Plus is designed for people who want the freedom to see any provider in or out of the network. With AmeriHealth 65 NJ Plus, you get all the health care coverage of an HMO plan plus the freedom to seek care from any provider in or out of the network without a referral from your primary care physician and still be covered. If you choose to go outside of the network, your out-of-pocket costs may be higher.
Enroll
You may enroll by mail, by phone, or online.
Refer to your 
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 information on AmeriHealth 65’s hospital tiering.
Download an AmeriHealth 65 product brochure.
Download our Explanation of Benefits (EOB) Question and Answer.
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.
Need extra help with health plan and drug costs?
If you have limited income and resources, you may qualify for low-income subsidy. When you join AmeriHealth 65, Medicare will tell us how much extra help you are getting. Then, we will let you know the amount you will pay. If you qualify, your drug costs will also be lower.
You can see if you qualify for a low-income subsidy by calling:
- 1-800-MEDICARE (1-800-633-4227) (TTY/TDD: 1-877-486-2048), 24 hours a day, seven days a week
- Your State Medicaid Office
- The Social Security Administration at 1-800-772-1213 (TTY/TDD: 1-800-325-0778), 7 a.m. to 7 p.m., Monday through Friday
Benefits, formulary, pharmacy and provider networks, premiums, and/or copayments may change on January 1, 2009. Please contact AmeriHealth 65 for details.
Learn more about the low-income subsidy.
Best Available Evidence Policy
Early in 2006, a number of factors contributed to the problem of incorrect cost-sharing levels for full-benefit dual eligible’s and other LIS eligible individuals. The purpose of this link is to provide a member with information on CMS best available data policy.
In certain cases, CMS systems do not reflect a beneficiary’s correct low-income subsidy (LIS) status at a particular point in time. To address these situations, CMS created the best available evidence (BAE) policy. This policy requires Plans to establish the appropriate cost-sharing for low-income beneficiaries when presented with evidence that the beneficiary’s information is not accurate.
Learn more about the Best Available Evidence Policy.
AmeriHealth 65