AmeriHealth 65® Basic
Frequently asked questions
Who can join AmeriHealth 65 Basic?
How much does AmeriHealth 65 Basic cost?
I already have Medicaid and Original Medicare. Why join AmeriHealth 65 Basic?
Do I have to pick a primary care physician (PCP)?
Which doctors can I see?
Do I need a referral to see a specialist?
If I don’t join AmeriHealth 65 Basic, will Medicaid still pay for my prescriptions?
The government picked my drug plan for me. Can I switch to AmeriHealth 65 Basic?
What programs does AmeriHealth 65 Basic offer to help keep me healthy?
Do I have to send in my bills or claim forms?
Do I qualify for low-income subsidy?
How can I get more information?
Who can join AmeriHealth 65 Basic?
You must be entitled to Medicare Part A and enrolled in Medicare Part B, and you must be enrolled in a Medicaid program, such as Healthy Horizons. You must live in Berks, Lancaster, Lehigh, Northampton, or York counties. AmeriHealth 65 Basic is designed for people who have most of their Medicare out-of-pocket costs covered by Medicaid and Healthy Horizons.
How much does AmeriHealth 65 Basic cost?
If you are eligible to join, AmeriHealth 65 Basic has a $0 monthly premium. You may have a copay for prescription drugs.
I already have Medicaid and Original Medicare. Why join AmeriHealth 65 Basic?
With AmeriHealth 65 Basic, you’ll get more benefits and services than you have now with Original Medicare, and you will keep your Medicaid coverage.
Do I have to pick a primary care physician (PCP)?
Yes. AmeriHealth 65 Basic is a managed care plan. That means all your health care goes through one main doctor (a primary care physician), whom you pick when you join. You’ll see this doctor for most medical care. If you need to go to a specialist or to the hospital, your PCP must coordinate it, except for emergency care. There’s a good chance your current doctor is already in our network.
Which doctors can I see?
AmeriHealth 65 Basic has a network of doctors, specialists, and hospitals. You can use any doctor who is part of our network. You are even eligible for round-trip transportation to plan-approved providers at no cost to you.
Do I need a referral to see a specialist?
Yes. Keep in mind that your PCP coordinates all of your care except for emergencies. If you need to see a specialist, your PCP will give you a referral.
If I don’t join AmeriHealth 65 Basic, will Medicaid still pay for my prescriptions?
No. As of January 1, 2006, Medicaid stopped paying for prescription drugs for people who have both Medicare and Medicaid. Now, Medicare pays for prescription drugs, but only if you are in a Medicare-approved plan like AmeriHealth 65 Basic. With AmeriHealth 65 Basic, you’ll pay $1 for generic drugs and $3.10 for brand-name drugs.
The government picked my drug plan for me. Can I switch to AmeriHealth 65 Basic?
Yes. Even if the government sent you a letter and told you what drug plan you are in, you don’t have to stay in it. You can switch to AmeriHealth 65 Basic and get coverage — plus many more health benefits than you have now — for $0 per month. All you need to do is send in a completed enrollment form. We will do the rest.
What programs does AmeriHealth 65 Basic offer to help keep me healthy?
We believe it’s important for members to take an active role in their health care. We offer a full range of programs to help members live healthy and stay healthy, such as AmeriHealth Healthy LifestylesSM Programs, including smoking cessation, weight management, ConnectionsSM Health Management Programs, and more!
Do I have to send in my bills or claim forms?
No. In most cases, you’ll just show your AmeriHealth 65 Basic ID card and your Medicaid ACCESS card. We will take care of the rest.
Do I qualify for low-income subsidy?
If you have limited income and resources, you may qualify for a low-income subsidy. When you join AmeriHealth 65 Basic, 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;
- the Pennsylvania Office of Medical Assistance Programs (Medicaid) at 717-787-1870;
- 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.
How can I get more information?
Call us, toll-free, at 1-800-898-3492 (TTY/TDD: 1-877-219-5457), from 8 a.m. to 8 p.m., seven days a week. You can also request a home visit or attend one of our seminars at a location near you. For accommodations of persons with special needs, call the number above.
