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AmeriHealth

AmeriHealth is a group of health insurance companies based in the Northeast with plans that supplement Medicare and Medicaid.

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What Is AmeriHealth?

AmeriHealth is a group of health insurance plans based in New Jersey, Delaware, and Pennsylvania with coverage also available in other states. The companies included in AmeriHealth are a branch of the largest insurance provider in Philadelphia, Independence Blue Cross which covers 2.5 million people locally and 10 million nationally. Since its creation in 1995, AmeriHealth has served over 265,000 members through their wide range of plans for individuals and employers. AmeriHealth insurance companies include:

  • AmeriHealth Pennsylvania
  • AmeriHealth New Jersey
  • AmeriHealth Caritas
  • AmeriHealth Administrators
  • AmeriHealth Casualty Services

Both New Jersey and Delaware’s Healthcare maintenance programs have been recognized for their commitment to providing high quality health care service by the National Committee For Quality Assurance (NCQA).

AmeriHealth’s Plans

The structure and specifics of AmeriHealth’s plans vary based on the specific provider. In general, their plans offer these types of plans:

Health Maintenance Organization (HMO)

HMO plans give access to specific doctors and hospitals who work for or are in contract with the network. Aside from emergency purposes, care outside of the network is not covered. Picking a primary care physician, who will treat general health needs and refer to specialists within the network when necessary, is required.

Point Of Service (POS)

A POS plan offers the flexibility to choose doctors and hospitals, even if they are out-of-network. When seeing a doctor that is not in the network, out-of-pocket costs will be higher. A referral is needed to see a specialist.

Preferred provider organization (PPO)

PPO plans are like POS plans with the ability to see doctors in and out of the network. They differ when it comes to referrals as a PPO does not require referrals from primary care physicians to see a specialist.

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AmeriHealth Medigap

AmeriHealth offers plans that supplement federally managed health insurance programs like Medicare and Medicaid. Medicare covers people over the age of 65 and individuals with disabilities. Medicaid offers insurance options to individuals with low incomes. Medicare and Medicaid plans are broken into 2 parts, part A and part B. The combination of the 2 parts is called original Medicare. Hospital insurance is covered by part A and includes hospital visits, skilled nursing care, and home health visits. Part b is the medical insurance coverage which accounts for doctor’s visits, outpatient services, and other medical expenses. To help with out-of-pocket costs, those covered by Medicare/Medicaid can buy additional coverage from a private health insurance company like AmeriHealth’s Medigap plans. These plans are designed to either partially or fully cover the expenses not covered by original Medicare.

Medicare recipients also have the option to add a prescription drug coverage to their plan through AmeriHealth’s Medicare Advantage plans. Prescription drug plans help meet the costs of prescription medications. At each coverage level, plans have specific generic and brand name medications included which are outlined in the plan’s Drug Formulary List. This type of plan can be added with or without a Medigap policy.

Substance Use Disorder Treatment

Substance use disorders (SUD) are a major issue in the United States. This is especially true when it comes to the nationwide abuse of Opioids known as the Opioid epidemic. In 2015, there was a reported 12 million people in the US abusing Opioid pain relievers and over 1 million using Heroin. Because of this widespread substance use problem, health insurance plans are now required to cover a full range of SUD treatment services. This requirement is due to changes made by the Affordable Care Act (ACA) which expanded coverage through Medicaid and declared mental health and SUDs services as 1 of the 10 essential health benefits. It is estimated that 1.6 million Americans with an SUD have been able to gain treatment through these expansions. The most important facet of the ACA pertaining to SUD treatment is parity laws. These laws make it so health insurance plans must give the same importance to behavioral health benefits as they do to medical benefits. This means expenses for SUD treatments cannot exceed those of medical or surgical procedures.

Treatment Centers That Accept AmeriHealth Insurance

AmeriHealth prides themselves in being a “leader in promoting ways to prevent Opioid misuse.” They do so by supplementing the insurance plans offered through Medicaid. Because AmeriHealth views each battle with an SUD as unique to each member, their benefit plans offer behavioral health services that specialize in “whole person care.” This approach focuses not just on physical health needs but also addresses the behavioral and social dynamics that contribute to an individual’s well-being. Some of the SUD treatment services that most AmeriHealth plans cover are:

  • Screening, brief intervention, and referral to treatment.
  • Individual, group, and family therapy.
  • Intensive outpatient services.
  • Partial hospitalization programs.
  • Medical withdrawal.
  • Crisis intervention.
  • Continuous recovery monitoring.
  • Opioid treatment.
  • Residential treatment services.

Treatment must be determined medically necessary by AmeriHealth to be covered by their insurance plans. Individuals seeking treatment must be provided with the criteria that is being used to evaluate their need for treatment. AmeriHealth must also provide reasoning should a person be denied coverage of treatment.

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AmeriHealth’s Metallic Categories

The ACA also requires that all health insurance companies sort their plans into categories that correspond to metal levels. These metallic categories describe the specifics of how costs of care are divided between AmeriHealth and the individual receiving coverage. They do not reflect quality or amount of care provided.

Bronze

AmeriHealth’s plans that fall into the bronze category have the lowest monthly premium but the highest out-of-pocket expenses. Bronze plans are ideal for those who do not plan on needing health care services often.

Silver

The silver category has plans with slightly higher monthly premiums and more affordable out-of-pocket expenses than bronze. For those who plan on seeing doctors or specialists occasionally, silver plans are a good choice.

Gold

Plans in the gold category have higher monthly premiums than both silver and bronze. This causes the out-of-pocket costs to be lower than both as well. These plans work well for those who need to see doctors or specialists more often.

Platinum

Platinum plans have the highest monthly premiums and the lowest out-of-pocket expenses. A person with specific medical needs that require frequent doctor visits or has the potential need for hospitalization should pick a plan from the platinum category.

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AmeriHealth works to enhance the health and wellness of the people and communities they serve by supplementing the care offered by Medicare and Medicaid. They aim to cover SUD treatment services that are specific to the individual and all their overall well-being. For more information on AmeriHealth health insurance plans, substance use disorder treatments, or addiction in general, contact a treatment provider today.

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