Effective January 1, 2016, there will be several changes to
our current Medicare Advantage HMO plans, including a lower premium for members
in Regions I and II and valuable new member benefits.
Medicare Advantage HMO members should have already received their 2016
Annual Notice of Changes/Evidence of Coverage. They will have until
December 7, 2015, to make any changes to their health care plans.
The following tables highlight some of the 2016 Medicare Advantage HMO
benefits changes for the AmeriHealth 65 Preferred HMO plan. Note: The
majority of copays remained the same for 2016.
Medicare Advantage HMO monthly plan premiums
| Region | AmeriHealth 65 Preferred HMO |
AmeriHealth 65 Preferred Rx HMO |
|---|
| Region I: Atlantic | $110 | $119
|
| Region II: Burlington, Camden, Cumberland, Essex,
Gloucester, Hudson, Hunterdon, Mercer, Middlesex, Ocean, Salem, Somerset, and
Union | $20 | $36 |
| Region III: Bergen, Cape May, Monmouth, Morris, Passaic, Sussex, and
Warren | $67 | $100 |
Medicare Advantage HMO benefits highlights
| Service Category | AmeriHealth 65 Preferred HMO/AmeriHealth 65
Preferred Rx HMO |
|---|
| Cardiac and pulmonary rehabilitation | $5 copay
(reduced from 2015), referral required |
| Routine chiropractic* | $20 copay, for up to 6
visits per year. Referral required |
| Routine podiatry* | $50 copay, for up to 6
visits per year. Referral required |
| Hearing services | $50 copay once every 3
years. Hearing aid copay, $699 (standard) or $999 (premium) (one aid per ear
per year) through TruHearing®. Includes $0 copay for fitting and
evaluation. |
| SilverSneakers®
| Included |
| Primary care physician visit | $20 copay per
visit |
| Specialist visits | $50 copay per visit
|
| Emergency room (U.S. and worldwide) | $75 copay
per visit (not waived if admitted) |
| Urgent care center | $35 copay (not waived if
admitted to 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 and vision | Dental: $0
copay once every 6 months for exams and cleanings
Vision: $50 copay once every 2 years for routine eye exams;
$100 every 2 years for eyewear |
*This is addition to Medicare covered services.
Please contact your Provider Partnership Associate if you have any
questions.
TruHearing is a registered trademark of TruHearing,
Inc.
SilverSneakers is a registered mark of Healthways,
Inc.