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AmeriHealth Medicare Core (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AmeriHealth Medicare Core (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on AmeriHealth Medicare Core (PPO) in 2025, please refer to our full plan details page.
AmeriHealth Medicare Core (PPO) is a PPO plan offered by Independence Health Group, Inc. available for enrollment in 2025 to people living in South Central New Jersey Area. The overall rating for this plan is not yet available for 2025.
It's important to know that AmeriHealth Medicare Core (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about AmeriHealth Medicare Core (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For AmeriHealth Medicare Core (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $14000.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $14000.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The AmeriHealth Medicare Core (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay varying costs based on the drug tier and pharmacy type. For example, you will pay no copay for preferred generic drugs at preferred and standard mail pharmacies, but a $20 copay at standard pharmacies. After your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The AmeriHealth Medicare Core (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay of $300-$335 for the initial days, and then no copay. Outpatient services and emergency services have copays between $10 and $235. This plan also covers primary care with no copay, and offers coverage for hearing, vision, and dental services with copays or coinsurance. Additional benefits include ambulance services, home health services with no copay, and coverage for medical equipment and diagnostic services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the AmeriHealth Medicare Core (PPO) plan, with a copay of $300 for days 1-5 and no copay for days 6-90 for Inpatient Hospital-Acute, and a copay of $335 for days 1-6 and no copay for days 7-90 for Inpatient Hospital Psychiatric; however, Non-Medicare-covered Stays and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. Additional days for Inpatient Hospital-Acute have no copay.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a $235 copay, ASC services have a $225 copay, and individual and group sessions for outpatient substance abuse have a copay between $30 and $30. Outpatient blood services have no copay.
Partial Hospitalization See details
AmeriHealth Medicare Core (PPO) covers partial hospitalization with a $40 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the AmeriHealth Medicare Core (PPO) plan. Ground and Air Ambulance Services have a $275 copay, and Transportation Services to a Plan Approved Health-related Location has no copay for up to 12 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the AmeriHealth Medicare Core (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services have a copay between $10 and $40; all have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The AmeriHealth Medicare Core (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $30 copay, and physician specialist services with a $20 copay. Mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services are also covered, each with varying copays.
Preventive Services See details
Preventive Services are covered, including an annual physical exam and additional preventive services. The annual physical exam has no copay, while other services include a $0 copay for health education, medical nutrition therapy, home-based palliative care, fitness benefit, enhanced disease management, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit. In-home safety assessments, personal emergency response systems, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefit, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, and telemonitoring services are not covered.
Hearing Services See details
Hearing exams are covered with a $20 copay, and routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered with a copay between $699 and $999, while inner ear, outer ear, and over the ear prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams, eyewear, contact lenses, and eyeglasses. Eye exams have a copay of $0 - $20. Eyewear has a combined maximum plan benefit of $200 per year, and contact lenses and eyeglasses are limited to one pair per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The AmeriHealth Medicare Core (PPO) plan covers Medicare Dental Services with a $20 copay, and other dental services like oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments with no copay. The plan also covers restorative services with 20% coinsurance, endodontics and periodontics with 20% coinsurance, prosthodontics removable, implant services, and prosthodontics fixed with 40% coinsurance. Oral and Maxillofacial Surgery is covered with 20% - 40% coinsurance. Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the AmeriHealth Medicare Core (PPO) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the AmeriHealth Medicare Core (PPO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered under the AmeriHealth Medicare Core (PPO) plan, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Durable Medical Equipment has a 20% coinsurance, while prosthetics and medical supplies have a 20% coinsurance, and diabetic supplies have between 0-20% coinsurance. Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services and radiological services, are covered under the AmeriHealth Medicare Core (PPO) plan. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $200, Therapeutic Radiological Services have a $60 copay, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the AmeriHealth Medicare Core (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by AmeriHealth Medicare Core (PPO), but specific services like Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, and others are not covered. There is a copay for these services, but the exact amount is not specified in the provided information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the AmeriHealth Medicare Core (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture and over-the-counter (OTC) items. Acupuncture has a $15 copay per visit, and is limited to 6 treatments per year. OTC items are covered up to $50 every three months. Other services such as meal benefits, and several others are not covered.
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