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2026 Medicare Advantage plan changes, effective January 1

​AmeriHealth Insurance Company of New Jersey (AmeriHealth) will continue to offer Medicare Advantage health plans in 2026. There are some plan updates that have been designed to help us ensure that we can continue to focus on our members' health and well-being for years to come.  

What's changing

AmeriHealth will retire its Secure PPO plan on January 1, 2026. AmeriHealth will continue to offer other Medicare Advantage options for 2026.  

Who is affected

Members who are currently enrolled in the plan AmeriHealth is retiring will be affected by this change. These members were notified via mail in early October that their plan will no longer be available in 2026.

There are other AmeriHealth plan options for 2026. To enroll in another AmeriHealth plan, members must use our enrollment application process.

Continuity of care and authorizations

  • If an affected member moves to another AmeriHealth Medicare Advantage plan with no coverage gap, their existing approved authorization (medical and pharmacy) will generally remain valid through the original approval dates.
  • If an affected member changes to a non-AmeriHealth plan or has a coverage lapse, new authorizations may be required, and provider continuity is not guaranteed. 
  • Exact coverage, copays, and plan rules are based on members' new 2026 plan benefits.

Procedures for providers to follow regarding members in plans being retired

  • Do not schedule any procedures or services on or after January 1, 2026, for members with the AmeriHealth Medicare Secure PPO plan that is being retired without checking 2026 eligibility.
  • Check eligibility at each visit starting January 1, 2026, and capture new ID card/plan information for remitting claims.
  • Confirm active authorizations in the Provider Engagement, Analytics & Reporting (PEAR) provider portal. Also, only submit new prior authorizations when required by the member's new plan or when the prior approval has expired.
  • Update billing systems after January 1, 2026, with the correct payer/plan and 2026 cost-sharing amounts.
  • Tell patients who have plan questions to call AmeriHealth Member Services and speak to a representative who can help.

Key dates members should know

Please remind your patients (our members) who are eligible for Medicare to stay informed on key deadlines, especially when considering a Medicare plan with prescription drug coverage or a stand-alone Prescription Drug Plan with Original Medicare.

Failure to meet certain deadlines can result in losing prescription drug coverage in 2026. Patients who join a Medicare prescription drug plan late may have to pay a lifetime Part D late-enrollment penalty.

  • October 15 – December 7, 2025: Medicare Annual Enrollment Period (AEP). This is when all Medicare beneficiaries may choose their 2026 plan. Coverage chosen begins January 1, 2026.
  • Impacted members have a Special Enrollment Period (SEP) extending to February 28, 2026. Members should enroll in a new plan by December 31, 2025, for coverage beginning January 1, 2026. Note: If your patient does not choose a plan by the end of the year, their coverage will revert to Original Medicare (with no Prescription Drug coverage).
  • January 1 – March 31, 2026: Medicare Advantage Open Enrollment Period. This is when members are allowed one change (switch Medicare Advantage plans or return to Original Medicare and enroll in a stand-alone Part D plan).

Learn more

If you have any questions about these changes, call 1-866-406-3882 or visit amerihealthmedicare.com.

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