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As a reminder, effective January 1, 2014, there are several changes to our
current Medicare Advantage
HMO plans. We have expanded our service area, leading to substantial enrollment
of new members. The expansion now covers the following 17 counties in New
Jersey:
- Atlantic
- Bergen
- Burlington
- Camden
- Cumberland
- Essex
- Gloucester
- Hudson
- Hunterdon
- Mercer
- Monmouth
- Morris
- Ocean
- Salem
- Somerset
- Union
- Warren
A few local health insurance carriers are no longer offering Medicare Advantage
plans in several counties in New Jersey
for 2014. Members who were in these plans in 2013 would have received a
notification in October from their health plan
as well as a reminder in November from the Centers for Medicare & Medicaid
Services letting them know they need
to choose a new plan. These Medicare beneficiaries will receive a Special
Enrollment Period which gives them until
February 28, 2014, to choose a new plan. If they do not choose a new plan, they
will be enrolled in Original Medicare.
The following tables highlight some of the 2014 Medicare Advantage HMO benefits
changes for the 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 Customer Service if you have any questions.
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
Service category
AmeriHealth 65? Preferred HMO
AmeriHealth 65? Preferred Rx HMO
Primary care physician visit
$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 exams 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 exams and cleanings
Vision: $50 copay once every
2 years for routine eye exams;
$100 every 2 years for eyewear
Hearing: $50 copay once every
3 years; up to $500 for hearing aids (two
aids) every 3 years
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