Amerigroup Community Care Amerivantage Balance RX Review

Amerigroup Community Care is a company that focuses on providing health coverage to people in need.  They help cover the elderly by offering Medicare Advantage programs in several states.  One of these plans is the Amerivantage Balance + Rx plan available in New York and New Jersey.  The Amerivantage Balance plan is an HMO plan that offers an affordable alternative to Original Medicare.  The coverage does include Part D drug coverage as well as health benefits.  Below is a review of the benefits they offer:

Amerivantage Balance + RX (HMO)

  • Premium – $0
  • Deductible – $1,100
  • $3,400 out-of-pocket limit
  • Network – Must go to in-network doctors and hospitals to receive benefits
  • Referrals – No Referral Required
  • Inpatient hospital – $0 Co-pay
  • Doctors Visits – $5 = Primary Care; $20 = Specialist
  • Outpatient Surgery – $0 Co-pay
  • Labs – $0 Co-pay
  • X-rays and Diagnostic Procedures and tests – $0 – $25 Co-pay
  • Part D Drug Coverage Included – Tier 1 – $0; Tier 2 – $4; Tier 3 – $35; Tier 4 – $80; Tier 5 – 33%

Extra Benefits Included With Amerivantage Balance

  • Offers Additional coverage for generic drugs through the Coverage Gap!
  • Dental – No preventative dental
  • Hearing – No routine hearing exams or aids covered
  • Vision – $0 co-pay for an eye exam and glasses up to $150 limit on glasses
  • OTC Benefit – Over the Counter items are available $50 every three months
  • Transportation – $0 Co-pay for up to 12 One way trips
  • Assistive Devices – $50 every three months

Note:  This plan is unique because it does have an $1,100 deductible that you must meet in order to receive the hospital and surgery benefits at a $0 cost.  Most Medicare Advantage plans do not carry deductibles.  Of course, this would not be an issue as long as you are able to avoid the hospital or any major surgeries.

Since these plans are HMO’s you will have to use providers and facilities that are in the plan’s network, and you will not be covered for any services received outside the network.  You want to make sure your providers are in network by visiting their website.   You may also visit medicare.gov for more information regarding this plan.

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