American Health Medicare Plans Basic Classic and Plus Review

American Health Medicare offers Medicare Advantage plans throughout Puerto Rico.  They offer a total of five plans that are either (HMO), (HMO-SNP), or (HMO-POS).  They claim to have a wide network of health providers and pharmacies throughout the island in order to provide the most access to the car you need.  The plans are called:  AHM Basic, AHM Classic, AHM Classic Plus, AHM Opal, AHM Platino Plus, and AHM Standard.  Take note that since the plans are all a form of an HMO that you must use network providers!  Below is a summary of the costs and coverage for each plan:

AHM Basic (HMO)

  • Premium is $0/month
  • Covers ONLY Medical services and NOT prescription drugs
  • $2,500 Max Out-of-Pocket in-network
  • $0/day hospital co-pay
  • $0 co-pay for primary and $0 co-pay for specialist
  • $0 co-pay for outpatient surgery
  • $0 co-pay for labs and diagnostic procedures and tests
  • NO DRUG COVERAGE
  • Offers $0 co-pay for hearing and vision exam including eyewear and hearing aids
  • Offers $5 co-pay for dental cleanings/x-rays and $750 of comprehensive dental benefits

AHM Classic (HMO)

  • $0 Monthly Premium
  • Covers both Medical and Prescription Drugs
  • $2,500 Max Out-of-Pocket in-network
  • $0/day hospital co-pay
  • $0 co-pay for primary and $10 co-pay for specialist
  • $0  co-pay for outpatient surgery
  • $0 co-pay for labs and diagnostic procedures and tests
  • No Part D Drug Deductible
  • Tier 1 = $5; Tier 2 = $10; Tier 3 = $35; Tier 4 = $50 and Tier 5 = 33%
  • Covers many generic drugs through the Coverage Gap
  • Offers Dental Vision and Hearing benefits

AHM Classic Plus (HMO SNP)

  • Offered to Members with Diabetes
  • $0 Monthly Premium
  • Covers both Medical and Prescription Drugs
  • $3,400 Max Out-of-Pocket in-network
  • $0/day hospital co-pay
  • $5 co-pay for primary and $5 co-pay for specialist
  • $0  co-pay for outpatient surgery
  • $0 co-pay for labs and diagnostic procedures and tests
  • No Part D Drug Deductible
  • Tier 1 = $3; Tier 2 = $6; Tier 3 = $30; Tier 4 = $50 and Tier 5 = 33%
  • Covers many generic drugs through the Coverage Gap
  • Offers Dental Vision and Hearing benefits

Take note that the basic plan does not cover drugs at all.  Also, the plans with drug coverage only cover drugs at in-network pharmacies.  Check with the plan website to find out if your pharmacy and medical providers are in network.

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