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AmeriHealth Medicare Secure (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AmeriHealth Medicare Secure (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on AmeriHealth Medicare Secure (PPO) in 2025, please refer to our full plan details page.
AmeriHealth Medicare Secure (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 Secure (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 Secure (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 Secure (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. Additionally, this plan comes with a Part B Premium reduction of $74.00. You must continue to pay paying your reduced 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 a $200.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
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 Secure (PPO) plan has an enhanced alternative drug benefit. The plan has a $200 deductible. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you will have no copay at preferred mail pharmacies and $0 copay at preferred pharmacies. For standard generic drugs, you pay 25% coinsurance. For preferred brand drugs, you pay 50% coinsurance. For non-preferred drugs, you pay 30% coinsurance. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The AmeriHealth Medicare Secure (PPO) plan offers comprehensive coverage, including inpatient hospital stays with a copay of $370 for days 1-6, and no copay for days 7-90. Outpatient services have varying copays, with no copay for outpatient blood services. The plan also covers primary care and many preventive services with no copay, as well as hearing, vision, and dental services with varying costs. Additional benefits include ambulance services with a $300 copay, and emergency services with a $110 copay. Prescription hearing aids have copays between $699-$999, and eye exams have copays between $0-$30. The plan also covers home health services, skilled nursing facilities, and other services such as acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits with the AmeriHealth Medicare Secure (PPO) plan include a $370 copay for days 1-6 and no copay for days 7-90 for Inpatient Hospital-Acute, and a $335 copay for days 1-6 and no copay for days 7-90 for Inpatient Hospital Psychiatric; Additional Days for Inpatient Hospital-Acute has no copay for days 91-999. Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a $400 copay, ambulatory surgical center services have a $375 copay, and outpatient substance abuse individual and group sessions have a $30 copay. Outpatient blood services have no copay.
Partial Hospitalization See details
AmeriHealth Medicare Secure (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 Secure (PPO) plan. Ground and air ambulance services have a $300 copay, with no coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the AmeriHealth Medicare Secure (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services have a copay of $15-$40; all services have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
AmeriHealth Medicare Secure (PPO) covers primary care physician services with no copay and covers chiropractic services with a $15 copay. Occupational Therapy Services have a $35 copay, and Physician Specialist Services have a $30 copay. Mental Health Specialty Services, including individual and group sessions, have a $30 copay. Podiatry Services and Routine Foot Care have a $15 copay. Other Health Care Professional services have a copay ranging from $0-$30, and Psychiatric Services have a $30 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $35 copay, and additional telehealth benefits have a copay ranging from $0-$35. Opioid Treatment Program Services have a $5 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and the following services are also covered with no copay: Health Education, Medical Nutrition Therapy, Home-Based Palliative Care, Fitness Benefit, Enhanced Disease Management, Remote Access Technologies, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. In-Home Safety Assessment, Personal Emergency Response System (PERS), 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, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing services include coverage for hearing exams with a $30 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $699 and $999, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a copay between $0 and $30, and eyewear with a combined maximum benefit of $200 every year. Routine eye exams have no copay, and contact lenses and eyeglasses (lenses and frames) are covered. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $30 copay, and other dental services such as oral exams, dental x-rays, cleaning, and fluoride treatment with no copay. Restorative, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery have a 20-40% coinsurance, while maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. 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 Secure (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
The AmeriHealth Medicare Secure (PPO) plan covers Durable Medical Equipment (DME) with 20% coinsurance, and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. Diagnostic procedures/tests have no copay, while lab services have no copay. Diagnostic radiological services have a maximum copay of $350.00, therapeutic radiological services have a copay of $60.00, and outpatient X-ray services have a copay of $40.00.
Home Health Services See details
Home Health Services are covered by the AmeriHealth Medicare Secure (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 the AmeriHealth Medicare Secure (PPO) plan, but there is no information on the cost sharing for these services. However, the plan does not cover any specific cardiac rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by AmeriHealth Medicare Secure (PPO) with prior authorization. For days 1-20, there is no copay, and for days 21-100, there is a $214 copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for Skilled Nursing Facility (SNF) are not covered.
Other Services See details
Other Services includes coverage for acupuncture and over-the-counter (OTC) items. Acupuncture has a $15 copay and covers up to 6 treatments per year. OTC items are covered up to $30 every three months.
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