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AmeriHealth 65^®

Individual plan frequently asked questions

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 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?

What makes AmeriHealth 65 NJ Plus different from a regular HMO?

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

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

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

You’re covered for emergency care, urgent care, or dialysis anywhere in the U.S. at the in-network benefit level. Not an emergency? AmeriHealth 65 NJ members may use out-of-network doctors and hospitals at any time; you will just have to pay more than if you used an in-network provider.

Does AmeriHealth 65 cover dental visits?

You’ll be eligible for benefits to pay for routine dental exams and cleanings. Dental benefits are available through network providers only. Be sure to indicate your choice of primary dental office on your enrollment form.

How do I know if the medications I take are covered?
The list of drugs covered by the AmeriHealth 65 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?

With our automatic claims filing, there is virtually no paperwork for you to worry about. In most cases, you simply present your AmeriHealth 65 ID card.

What makes AmeriHealth 65 NJ 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 NJ Plus is a Point-of-Service (POS) plan. You still choose a primary care physician, but you can use in- or out-of-network providers without a referral. You may have to pay more for services you receive outside the network.