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Effective January 1, 2014, there will be several changes
to our current Medicare Advantage HMO plans. Not only are we expanding our
presence in New Jersey?s Medicare market with the addition of 12 new counties,
but we?re also offering decreased premiums in 2014 for existing members.
Medicare Advantage HMO members should have already received their 2014
Annual Notice of Changes/Evidence of
Coverage. They will have until December 7, 2013, to make any changes to
their health care plans.
The following tables highlight some of the 2014 Medicare Advantage HMO
benefits changes for AmeriHealth 65
Preferred HMO plan. Please note that this is a list of our significant benefits
changes, not a comprehensive list of all
benefits changes.
Please contact your Network Coordinator or Hospital/Ancillary Services
Coordinator if you have any questions.
Monthly plan premium
Region
AmeriHealth 65 Preferred HMO
AmeriHealth 65 Preferred Rx HMO
Region I: Ocean County
Not Available
$0
Region II: Burlington, Camden,
Cumberland, Essex, Gloucester,
Hudson, Hunterdon, Mercer, Salem,
Somerset, and Union Counties
$15
$39
Region III: Atlantic, Bergen, Morris,
Monmouth, and Warren Counties
$30
$69
Benefit highlights
Service category
AmeriHealth 65 Preferred HMO
AmeriHealth 65 Preferred Rx HMO
Primary care physician visits
$20 copay per visit
$20 copay per visit
Specialist visits
$45 copay per visit
$50 copay per visit
Emergency room (United States and worldwide)
$65 copay per visit
(not waived if admitted)
$65 copay per visit (not waived if admitted)
Urgent care
$20 - $45 copay; not waived
if admitted to the hospital
(urgent care center: $35
copay)
$20 - $50 copay; not waived
if admitted to the hospital
(urgent care center: $35
copay)
Outpatient surgery
$100 copay per visit for
ambulatory surgical centers;
$0 - $350 copay per visit for
outpatient hospital facility
$100 copay per visit for
ambulatory surgical centers;
$0 - $350 copay per visit for
outpatient hospital facility
Inpatient hospital
$245 per day for days 1 ? 7
($1,715 per stay maximum);
unlimited days each benefit
period
$245 per day for days 1 ? 7
($1,715 per stay maximum);
unlimited days each benefit
period
Dental, vision, hearing
Dental: $0 copay once every 6 months and cleanings
Vision: $40 copay once every 2 years for routine eye exams;
$100 every 2 years for eyewear
Hearing: $40 copay once every 3 years; up to $500
for hearing aids (two aids) every
3 years
Dental: $0 copay once every 6 months and cleanings
Vision: $40 copay once every 2 years for routine eye exams;
$100 every 2 years for eyewear
Hearing: $40 copay once every 3 years; up to $500
for hearing aids (two aids) every
3 years
]