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Important Medicare Announcement

Amerihealth 65 HMO to Exit New Jersey for 2017

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AmeriHealth HMO, Inc. has announced it will not renew its Medicare contract for 2017.  All Medicare beneficiaries currently enrolled in the AmeriHealth 65 Preferred and AmeriHealth 65 Medical Only plans will receive, or may have already received, letters explaining their rights and eligibility for new plans.  

For all Medicare beneficiaries currently enrolled in one of these plans you must take action to ensure you have coverage for January 1st, 2017.  

If you take no action you will be placed back on Original Medicare.  You may join a plan between October 15th, 2016 and February 29th, 2017.  

If you do not choose a plan with prescription drug coverage by February 29th you will not have prescription drug coverage in 2017.  

If you choose a plan between October 15th and December 31st coverage will begin on January 1st of 2017.  If you choose a plan after January 1st it will begin February 1st, 2017.  Choosing a plan after February 1st will result in coverage beginning March 1st, 2017.

Medicare Beneficiaries have 3 options to choose from:  

  1. You can choose another Medicare Advantage plan that does or does not include prescription drug coverage.
  2. You can do nothing and go back to Original Medicare (Parts A and B only).  You will not have prescription coverage and will be subject to large hospital deductibles, a medical deductible, 20% of all medical costs and no maximum out of pocket.
  3. You can go back to Original Medicare and add a Medigap policy with Part D prescription drug coverage.  Due to your loss of coverage you have a special right to purchase a Medigap policy.  Save your letter to present to the Insurance Carrier you purchase your Medigap policy from.

For answers to all of your questions and for assistance in determining which available plans will best suit your medical needs please contact an agent at BGA Insurance Group, 855-494-0097.  

You might be wondering – does this affect my coverage?

Should I be worried?

At BGA Insurance Group, we will make everything 100% clear.

Request a free consultation to find out if this change affects your 2017 coverage.


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An additional take from Greg Gudis, co-owner of BGA Insurance Group

It comes every year for seniors; their chance to make changes to their Medicare plans.  Sometimes nothing changes and they stay right where they are, but not this year.  For seniors in New Jersey they are getting (or maybe already received) a letter from Amerihealth 65 explaining they have chosen not to renew their contract with Medicare.  The opening to the letter goes like this:

“AmeriHealth 65® HMO won’t offer your Medicare plan in 2017. This means your coverage through AmeriHealth 65 HMO will end December 31, 2016. You need to make some decisions about your Medicare coverage. It is important you take action before December 31, or you will only have Original Medicare starting January 1, 2017.”

Amerihealth has not given an official reason why they are leaving; just that they have carefully considered their decision to exit the Medicare market in New Jersey. One can only speculate why a large insurer like Amerihealth, with enrollment of over 20,000 people in their plans, would withdraw.  

Plans do this for many reasons but profitability is usually the culprit.  With a Medicare Advantage plan the insurer must design the plan based on the information they have from prior year’s claims, reimbursements and bonus payments from Medicare, and premium and copayments to be paid by the insured.   

Factor in star ratings that can affect their bonus payments from Medicare, which Amerihealth has been in steady decline since the Amerihealth 65 HMO plan inception in 2014, and the plan decides it is time to cut losses and move on.

What Are My Options?

Most importantly for a senior is “What do I do now”?  Well first and foremost don’t throw that letter away.  It is your golden ticket to a new plan.  You now have a few options.  First, you can do nothing.  You will go back to Original Medicare (A & B only), have no Part D prescription coverage, and have large copayments and deductibles when you need to go to a hospital or see a doctor.  

Your second option is to pick another Medicare Advantage plan.  There are several plans available in New Jersey including 2 new PPO options coming to many of the counties.  

Your third option (and the one you will need your letter for) is your special right to buy a Medigap policy.  In this case you will go back to Original Medicare for January 1st and purchase a Medigap plan to pick up some or all of the deductibles and coinsurances of Original Medicare.  

If you need prescription drug coverage you would also purchase a Part D plan.  While there are no health questions to purchase a Medicare Advantage plan, Medigap plans will underwrite you.  If you have your letter you are a Guarantee Issue for several plans regardless of your current health status.

You have from October 15th to December 7th to pick a plan during the Annual Enrollment Period which will take effect on January 1st 2017.  Because you are being dropped you can also continue searching and choose a plan after December 7th and up until February 28th.

If you pick a plan after December 7th but before January 1st the plan will begin January 1st.  If you choose a plan between January 1st and January 31st it will begin February 1st (which means you will have Original Medicare from January 1st until January 31st.  

If you choose a plan between February 1st and February 28th your plan will begin March 1st.  Failure to pick a plan by February 28th means you will have only Original Medicare until next year’s Annual Enrollment where you would be able to pick a plan to start the following January 1st.  To make things easier, ACT NOW!!!  

Remember over 20,000 people are about to lose coverage so there is going to be a mad scramble for seniors to meet with agents, attend seminars, or even just search the web for available plans.  The longer you wait the more daunting a task this becomes.  Get started now and just remember, you get to do this every year!!!