AmeriHealth® Advantage
Product description
How AmeriHealth Advantage Works
AmeriHealth Advantage is a Medicare prescription drug plan that is designed for people with Medicare who are interested in Standard Medicare Part D prescription drug coverage.
Anyone who is entitled to Medicare benefits under Part A or enrolled in Part B can join AmeriHealth Advantage. In addition, people who have both Medicare and Medicaid as well as limited incomes will receive additional help paying for prescription drugs. These beneficiaries will have lower cost sharing and will pay only a small amount for their prescription drugs.
Here is how the cost sharing will work for the Standard AmeriHealth Advantage Medicare Part D benefit:
If you have both Medicare and Medicaid as well as a Medicare Savings Program, you will pay no premium or deductible and have no gap in coverage.
To see if you qualify for extra help paying for prescription drugs, contact Medicare at 1-800-MEDICARE (TTY/TDD 1-877-486-2048) 24 hours a day, seven days a week; their state Medicaid office; or 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.
Learn more about the 
low-income subsidy.
Here is how the cost sharing will work for the Standard AmeriHealth Advantage Medicare Part D benefit without the low-income subsidy:
Premiums (what you pay to participate in the plan)
Premiums are the monthly charges you pay to participate in the plan. The monthly premium will vary depending on where you live or if you qualify for assistance programs. For your convenience, you can either have your monthly premiums deducted automatically from your Social Security check or be billed by the plan.
Monthly Premiums (what you pay to participate in the plan)
For Pennsylvania and West Virginia: $26.50
Deductible (what you pay before benefits start)
This is the amount you pay before your insurance starts. In Medicare prescription drug plans (like AmeriHealth Advantage) that provide the Standard Medicare Part D benefit, the deductible is $275.
Coinsurance (how you share costs with the plan)
This is the term for splitting costs on a percentage basis. For example, with the Standard Medicare prescription drug coverage, you pay 25 percent of the drug costs and the plan pays 75 percent of the cost until the combined total reaches $2,510.
Coverage Gap (when you pay 100%)
“Coverage gap” describes when the plan makes no contribution to drug costs, and you pay 100% out of pocket for drugs until you reach a pre-set maximum. Medicare prescription drug plans use a formulary (a government-approved list of drugs that it covers), and when you use the plan’s network pharmacies you’ll have access to discounted drugs. That means you’ll still have access to discounts during the coverage gap.
After $4,050 Out of Pocket (when the plan pays most of the cost)
Once you’ve paid $4,050 out of your own pocket for drugs in a year, the plan pays most costs. You pay a small portion, such as 5 percent, or a small fixed amount for each prescription.
Here’s another way to look at the Standard drug benefit:
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Steps:
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AmeriHealth Advantage Rx Option I
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Deductible
(what you pay before the plan starts to pay) |
$275
|
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Cost Sharing (what you and the plan pay in total covered prescription drug costs up to a certain level — the Initial Coverage Limit) |
You pay 25% coinsurance per prescription up to $2,510 in total drug costs. |
|
Coverage Gap (when you pay all drug costs until reaching the catastrophic coverage begins) |
You pay 100% at discounted prices after yearly drug costs reach $2,510. |
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Catastrophic Coverage (starts after you have paid $4,050 out of pocket for covered drugs in a year) |
You pay the greater of $2.25 per generic or $5.60 per brand-name drug, OR pay 5% coinsurance per prescription for the rest of the year. The plan pays the rest. |
More information on AmeriHealth Advantage Benefit Options.
If you have limited income and resources, you may qualify for a low-income subsidy. When you join AmeriHealth Advantage, 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
- 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
Please note: In some cases, Medical Assistance copays will apply.
If you live in Pennsylvania or West Virginia, AmeriHealth Advantage prospective members should call 1-866-456-1695 (TTY/TDD 1-866-456-1683), 8 a.m. to 8 p.m., seven days a week for questions related to the product.
Benefits, formulary, pharmacy and provider networks, premiums, and/or copays may change on January 1, 2009. Please contact AmeriHealth Advantage for details.
AmeriHealth Advantage (PA/WV)