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• AmeriHealth 65

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AmeriHealth 65^®

Plan options

Features of AmeriHealth 65 AmeriHealth 65 contracts with the Federal Government and 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.

Enroll Now Complete our online enrollment form.

The chart below provides a comparison of the different plan options offered by AmeriHealth 65.

	AmeriHealth 65 NJ Value	AmeriHealth 65 NJ Preferred	AmeriHealth 65 NJ Plus
Medical only plan	$0 monthly premium No Part D coverage	$35 monthly premium No Part D coverage	$135 monthly premium No Part D coverage
Medical plus prescription drug	$36.10 monthly premium	$70.80 monthly premium	$174.00 monthly premium

AmeriHealth 65 NJ Value and Preferred 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 Preferred 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. If you obtain routine care from out-of plan providers neither Medicare nor AmeriHealth 65 will be responsible for the costs.

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.

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.

•  AmeriHealth 65 NJ Value and Preferred — Medical Only
•  AmeriHealth 65 NJ Value and Preferred — Medical Plus Prescription Drug
•  AmeriHealth 65 NJ Plus — Medical Only
•  AmeriHealth 65 NJ Plus — Medicare Plus Prescription Drug

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

• 1-800-MEDICARE (1-800-633-4227). TTY/TDD machine users should call 1-877-486-2048, 24 hours a day/7 days a week);
• 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; or
• Your State Medicaid Office.

Please note: In some cases, Medical Assistance copays will apply.

Benefits listed here are effective January 1, 2009. Benefits, formulary, pharmacy and provider networks, premiums, and/or copays may change on January 1, 2010.
AmeriHealth 65 prospective members should call 1-800-898-3492 (TTY/TDD: 1-877-219-5457), seven days a week, 8 a.m. to 8 p.m., for questions related to the product.

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 members with information on CMS Best Available Evidence 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.

The AmeriHealth 65 Medicare contract is renewed annually. The availability of coverage beyond the end of the current contract year is not guaranteed.