Effective January 1, 2015, there will be several changes to
our current Medicare Advantage HMO plans, including the expansion of our
presence in all 21 counties of New Jersey?s Medicare market.
Medicare Advantage HMO members should have already received their 2015
Annual Notice of Changes/Evidence of Coverage. They will have until
December 7, 2014, to make any changes to their health care plans. The following
tables highlight some of the 2015 Medicare Advantage HMO benefits changes for
AmeriHealth 65 Preferred HMO. Please note that this is a list of our
significant benefits changes, not a comprehensive list of all benefits changes.
Contact your Network Coordinator or Hospital/Ancillary Services Coordinator
if you have any questions.
Medicare Advantage HMO monthly plan premiums
Region
AmeriHealth 65 Preferred HMO
AmeriHealth 65 Preferred Rx HMO
Region I: Atlantic County
$120
$147
Region II: Burlington, Camden, Cumberland, Essex, Gloucester,
Hudson, Hunterdon, Mercer, Middlesex, Ocean, Salem, Somerset, and Union
counties
$40
$62
Region III: Bergen, Cape May, Monmouth, Morris, Passaic,
Sussex, and Warren counties
$55
$87
Medicare Advantage HMO benefits highlights
Service category
AmeriHealth 65 Preferred HMO/AmeriHealth 65
Preferred Rx HMO
Primary care physician visit
$20 copay per visit
Specialist visits
$50 copay per visit
Emergency room (U.S. and worldwide)
$65 copay per visit (not waived if admitted)
Urgent care center
$35 copay (not waived if admitted to the hospital)
Outpatient surgery
$100 copay for surgery services in an ambulatory surgical center; $350 copay
for surgery services in an outpatient hospital facility
Inpatient hospital
$270 copay per day, days 1 ? 7, per admission ($1,890 per stay maximum)
Dental, vision, hearing (non-Medicare covered)
Dental: $0 copay once every 6 months for exams and cleanings
Vision: $50 copay once every 2 years for routine eye exams; covered up to
$100 every 2 years for eyewear
Hearing: $50 copay once every 3 years; covered up to $500 for hearing aids
(two aids) every 3 years
Using in-network retail clinics
Medicare Advantage HMO members who go to a network retail clinic for
preventive and urgent care will pay the same copayment amount as for a primary
care physician office visit. A retail clinic is a type of walk-in clinic
located in a supermarket, pharmacy, or retail store where members can receive
preventive care or treatment for uncomplicated minor illnesses in a
non-emergency setting. Retailers include Walgreens (Healthcare Clinics), CVS
(MinuteClinic®), and Walmart.
Since the types of services vary by location, members are encouraged to call
ahead to see if the retail clinic they want to use has the services they need
(e.g., some retail clinics do not offer urgent care or flu shots).
Note: Not all retail clinics are a part of our network. To see if a
retail clinic is part of the AmeriHealth network, members can use the Find a Provider tool. They can also
call the Member Help Team for more information using the number on the back of
their member ID card.
MinuteClinic, L.L.C. is a Delaware corporation,
accredited by The Joint Commission as a retail health provider licenses to
operate retail-based health clinics.