Amerigroup insurance company offers Medicare Advantage plans in seven U.S. states. It also offers Medicaid health plans in several states and a combined Medicare-Medicaid plan only in Texas.
This article looks at the Amerigroup company and plans, including Medicare Advantage, Medicaid, and combined Medicare-Medicaid plans. It also discusses enrollment options and costs.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Amerigroup insurance company (Amerigroup) is a healthcare company that offers various programs including those related to Medicare, the Children’s Health Insurance Program (CHIP), and Medicaid.
Founded in 1994, it is based in Virginia. In addition to plans, the company offers outreach and education programs based in local communities.
Amerigroup offers several programs and services, including Medicare Advantage, which it calls the Amerivantage plan. It also offers programs related to Medicaid, and a combined Medicare and Medicaid plan for people older than 21.
Not all programs are available in all U.S. States. This online tool will help a person find Medicare plans in their state.
Medicare Part C is also known as Medicare Advantage. The plans combine the benefits of original Medicare (Part A and Part B), and are offered by private insurance companies, including Amerigroup.
The Amerigroup Advantage plan is called Amerivantage. In addition to the basic coverage provided by all Advantage plans, Amerivantage also provides optional coverage for vision, dental, and hearing care, along with prescription drugs benefits.
The plans may also offer benefits such as food deliveries and transportation, and membership in the SilverSneakers program.
The company offers two Advantage plans:
The Amerigroup Health Maintenance Organization (HMO) plans offer a person a choice of doctors within the network, who can refer them to a specialist if necessary.
The Amerigroup Special Needs plans (SNP) are available for a person who qualifies for both Medicaid and Medicare.
Deductibles, premiums, and copays vary between states and among the plans.
In addition to Advantage plans, Amerigroup offers a Medicaid plan.
Medicaid is a social welfare government program that helps people on a low income. The Amerigroup plan assists a person to get the health-related services.
Combined plan in Texas
Amerigroup has a combined Medicare and Medicaid plan available only in Texas.
It is called the Amerigroup STAR+PLUS Medicare-Medicaid plan (MMP) and offers the combined benefits of both Texas Medicaid and Medicare benefits. It had additional features including annual amounts for hearing aids, dental care items, eyeglasses and contacts, and over-the-counter items at Walmart.
Amerigroup offers its plans and services in several states, although not all programs in all states.
The chart below shows in which states the various plans are available. It includes only the U.S. states in which Amerigroup offers services.
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A person can find Medicare plans in their state by using this online tool.
Amerivantage plans have several HMO options and SNPs.
The options and benefits vary depending on the location. An online search tool will help a person find plans in their state.
There are four Amerivantage plans, including:
- Amerivantage Select (HMO)
- Amerivantage Classic (HMO)
- Amerivantage Balance (HMO)
- Amerivantage Plus (HMO)
Amerigroup plans also include three types of SNPs for specific conditions:
- The dual-eligible special needs plan (D-SNP) plan is for a person who is eligible for both Medicare and Medicaid.
- The chronic conditions special needs plan (C-SNP) is designed for people with diabetes, heart conditions, and end stage renal disease.
- The institutional special needs plan (I-SNP) includes coverage for people in long-term care or in skilled nursing facilities.
Some of the added benefits with the Amerigroup SNP Advantage plans include:
- no monthly premiums
- no copay for visits to the primary care doctor
- no copay for diabetes supplies, lab services, dialysis and more
- prescription drug coverage
- routine teeth, eye, foot, and hearing care
- membership to SilverSneakers
A person who has original Medicare Part A and Part B can enroll in a Amerigroup Advantage plan during their initial enrollment period when they turn 65.
A person can also enroll during two other enrollment periods.
The Medicare open enrollment is from October 15–December 7 each year. During this period, a person can buy, switch, or leave Advantage plans.
During the Advantage open enrollment from January 1–March 31 every year, a person can switch or leave an Advantage plan. However, a person may not switch from original Medicare to an Advantage plan.
Under some circumstances, a person may qualify for a special enrollment period, such as when a person relocates, qualifies for Medicaid, qualifies for Extra Help, or moves to a skilled nursing or long-term care facility.
Specific rules and exclusions
From January 1, 2021 people with end stage renal disease can enroll in a Medicare Advantage plan.
When a person delays joining an Advantage plan after their initial enrollment period, the company that issues the plan may use medical underwriting. The company hires an outside company to evaluate a person’s health, which then helps the company decide if they will offer a plan and how much to charge.
Costs for Advantage plans include the monthly Part B premium, any out-of-pocket costs, and deductibles, copays, and coinsurance.
For example, the average monthly premium for an Advantage plan that included prescription drug coverage is estimated to be $23 in 2020.
Many plan’s have out-of-pocket limits, and after a person has paid that amount they will not have to pay any more for the covered services. According to the Kaiser Family Foundation (KFF), the average out-of-pocket limit in 2020 is $4,925 for HMO in-network services.
However, out-of pocket limits may increase in 2021 to $7,550 (in-network) and $11,300 (in-network and out-of-network), according to KFF.
Amerigroup offers Medicare Advantage plans that combine the benefits of original Medicare Part A and B. The company also offers Medicaid health plans in several U.S. states and a combined Medicare-Medicaid plan only in Texas.