Since 2011 the Centers for Medicare & Medicaid Services (CMS) has mandated a
maximum out-of-pocket (MOOP) limit for all Medicare enrollees. The MOOP
establishes an annual limit to the cost-sharing (e.g., deductibles, copayments,
coinsurance) amount AmeriHealth 65® NJ HMO and AmeriHealth
65® Preferred HMO members have to pay out-of-pocket each year
for medical services covered under Medicare Part A and Part B. The MOOP dollar
amount is established annually by CMS and does not change during the course of
a calendar year.
AmeriHealth identified an issue from 2014 where some AmeriHealth 65 NJ HMO
and AmeriHealth 65 Preferred HMO member claims were erroneously processed with
member cost-sharing for Part A and Part B medical services and drugs when their
MOOP limit was met for the year. AmeriHealth has adjusted the affected claims,
and providers who collected this additional member cost-sharing should work as
expeditiously as possible to refund members accordingly.
If you have any questions, please contact Customer Service at
1-800-275-2583.