Reviewing The Best Medicare Plans and Medicare Insurance

American Health Medicare Plans Opal, Platino Plus, and Standard 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 Opal (HMO-POS)

  • 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
  • Tier 1 = $5; Tier 2 = $10; Tier 3 = $35; Tier 4 = $50 and Tier 5 = 33%
  • 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 Platino Plus (HMO-SNP)

  • Only for Medicare and MEDICAID beneficiaries
  • $0 Monthly Premium including up to $25 Part B Reduction
  • Covers both Medical and Prescription Drugs
  • $2,500 Max Out-of-Pocket in-network
  • $0-$3/day hospital co-pay
  • $0-$1 co-pay for primary and $0-$1 co-pay for specialist
  • $0-$1 co-pay for outpatient surgery
  • $0-$1 co-pay for labs and diagnostic procedures and tests
  • No Part D Drug Deductible
  • Part D drugs $0 – $.50
  • Offers Dental Vision and Hearing benefits

AHM Standard (HMO)

  • Offered to Members with Diabetes
  • $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 $5 co-pay for specialist
  • $0-$10 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 = $45 and Tier 5 = 33%
  • Covers many generic drugs through the Coverage Gap
  • Offers Dental Vision and Hearing benefits

Take note that the Opal and Standard plans cover erectile dysfunction drugs which is uncommon for most Medicare PDP’s.  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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