​​​​Important information about the AmeriHealth New Jersey Medicare Primary process

May 4, 2023

​Medicare coverage can be a confusing and intimidating topic for patients approaching Medicare eligibility. For this reason, it is important that your patients (our members) are well-informed on the Medicare Primary process for AmeriHealth HMO, Inc. and AmeriHealth Insurance Company of New Jersey (collectively, AmeriHealth New Jersey).

What providers need to know

Every month, AmeriHealth New Jersey mails letters to impacted AmeriHealth New Jersey fully insured group members and AmeriHealth New Jersey members in individual or consumer plans who currently have, or will soon be eligible for, Medicare. The letters explain that AmeriHealth New Jersey will move to the secondary payer and only pay their claims for the amount not covered by Medicare (usually 20 percent) – even if your patient is not currently enrolled in Medicare (but is eligible). This means patients may be responsible for 80 percent of their claims if they are not enrolled, or do not enroll, in Medicare.

What patients need to know

All letters include important information for eligible patients, as well as an FAQ about the Medicare Primary process. Eligible patients must enroll in Medicare by the effective date on their letter to maximize their health plan benefits and minimize expenses. Patients who are not eligible for Medicare must obtain eligibility status from the Social Security Administration (SSA) – usually a letter defining why they are not eligible.

For more information or to apply for Medicare, eligible patients are advised to:

  • Visit an SSA office
  • Call the SSA at 1-800-772-1213 (TTY/TDD: 1-800-325-0778)
  • Go to the SSA website at socialsecurity.gov

The AmeriHealth Medicare website, amerihealthmedicare.com, is also a great resource to help patients understand Medicare and guide them through the enrollment process.