Medicare Advantage-

AmeriHealth Ultimate PPO

 

We've made a list of resources that may be helpful for you to use your new insurance coverage fully. 

Your Medicare Plan Details:

• Plan: You enrolled in a Medicare Advantage, AmeriHealth Ultimate
• Monthly Premium: $0 per month
• Network Details: This plan includes in-network and out-of-network benefits. Be advised that out-of-network doctors may have higher co-pays – check that the doctor will bill out of network before scheduling your appointment.

Helpful Links about your plan:

• Member Services Phone Number - 1-866-569-5190
• You can create an online account with your insurance to be able to access claims and plan information.
• Summary of Benefits reviews the more popular plan details and the Evidence of Coverage goes through the full details of the coverage.
• The AmeriHealth plan is too new to have a Star Rating.
• If you'd like to appoint a representative to speak on your behalf, use the following link. 

Below are the online search tools to find IN-NETWORK healthcare providers:

• Doctor and Hospital
• Dentist
• Behavioral/Mental Health Providers
• Eye Care (Vision) Providers
• Hearing Aid Providers

Below are online search tools for your Prescription Drug Benefits:

• The Formulary has a complete list of medications covered by your insurance.
• Mail Orders Prescription option is available by calling 1-888-678-7015.  You can also download the prescription mail order form.
• In-Network Pharmacy Search
• There is a new Medicare Prescription Payment Plan (MPPP) option that allows you to spread your cost‑sharing over the remaining months of the plan year.
• In 2025 there is a $2,000 annual out of pocket maximum on covered medications. 
• There is a $150 annual deductible for tier 3-5 medications prior to medications being covered. After the deductible is met, prescription costs are based on the tier of the prescription.  Below are pricing at a preferred pharmacy.
  • Tier 1 Preferred Generic- $0
  • Tier 2 Generic- $0
  • Tier 3 Prefered Brand- 25%
  • Tier 3 Insulin - $35 (no deductible)
  • Tier 4 Non-preferred Brand- 50%
  • Tier 5 Specialty- 31%

Additional Benefits:

• Free gym membership is offered at participating gyms.  You can find gyms in your area with OnePass.
• Dental, Hearing, and Vision Coverage Guide