Our Plans 2011
Our plans provide the following benefits:
In addition to offering all the benefits covered by Original Medicare, American Health Medicare offers you important supplementary benefits that Medicare Original doesn’t cover. Such benefits include:
- Blood Pressure Monitors *
- Glasses and hearing aids
- Dental Services
- Acupuncture
- Out-of-state coverage
- Adult Diapers *
- Oral Nutritional Supplements *
- Gym Memberships
- Durable Medical Equipment
- Ambulance services
* Certain restrictions apply.
Benefits may vary according to the plan selected.
AHM_Basic (HMO)
The AHM_Basic (HMO) is a plan without prescription drug coverage that is designed for Medicare beneficiaries who has Part D Prescription Medicines coverage. These might include private sector retirees or veterans.
$0 monthly premium
$0 deductible
$0 copayment on hospitalizations
$0 copayment on PCP visits and visits to participating specialists
$0 copayment on laboratories and X-rays
$0 copayment on Oral Nutritional Supplements *
$0 copayment on Adult Diapers (incontinence) *
$0 copayment on Shower Chairs *
Up to $750 annually on Comprehensive Dental Services
* Certain restrictions apply.
Plan is available to beneficiaries residing in one of the 78 municipalities of Puerto Rico.
Please refer to the Evidence of Coverage and/or the Summary of Benefits for information on copayments/coinsurance.
Evidence of Coverage AHM_Basic (HMO) H5774_1027 _11_05_E File & Use 092720
Summary of Benefits AHM_Basic (HMO) H5774_1001_11_05_Er1 CMS Approved 10202010
AHM_Classic (HMO)
The AHM_Classic (HMO) plan is designed for Medicare beneficiaries who need additional benefits such as adult diapers and/or nutritional oral supplements. Furthermore, it is promoted in elderly homes for patients who are not beneficiaries of “Mi Salud”.
$0 monthly premium
$0 deductible
$0 copayment on PCP Visits
$10 copayment on visits to participating specialists
$0 copayment on laboratories and X-rays
$0 copayment on Oral Nutritional Supplements *
$0 copayment on Blood Pressure Monitors *
$0 copayment on Adult Diapers (incontinence) *
$0 copayment on Shower Chairs *
* Certain restrictions apply.
Plan is available to beneficiaries residing in one of the 78 municipalities of Puerto Rico.
Please refer to the Evidence of Coverage and/or the Summary of Benefits for information on copayments/coinsurance.
Evidence of Coverage AHM_Classic (HMO) H5774_1027_11_02_E File & Use 0921201
Summary of Benefits AHM_Classic (HMO) H5774_1001_11_03_E CMS Approved 10042010
Errata Sheet to AHM_Classic (HMO) Summary of Benefits H5774_1009_11_15_E CMS Approved 12172010
AHM_Classic Plus (HMO SNP)
The AHM_Classic Plus (HMO SNP) plan has been designed for Medicare beneficiaries who had been diagnosed with diabetes and are interested in a detailed program that caters to their specific medical needs.
$0 monthly premium
$0 deductible
$0 copayment on visits to PCP
$5 copayment on visits to participating Specialists
$0 copayment on laboratories and X-rays
$0 copayment on Diabetes monitoring and supplements
$0 copayment on Podiatrist visits
$0 copayment on Oral Nutritional Supplements *
$0 copayment on Blood Pressure Monitors *
$0 copayment on adults diapers (Incontinence) *
$0 copayment on Shower Chairs *
* Certain restrictions apply.
Plan is available to beneficiaries residing in one of the 78 municipalities of Puerto Rico.
This plan is available to all people with Medicare who have been diagnosed with diabetes.
Please refer to the Evidence of Coverage and/or the Summary of Benefits for information on copayments/coinsurance.
Evidence of Coverage AHM_Classic Plus (HMO SNP) H5774_1027_11_03_E File & Use 09252010
Summary of Benefits AHM_Classic Plus (HMO SNP) H5774_1001_11_04_E CMS Approved 10042010
AHM_Opal (HMO POS)
The AHM_Opal (HMO POS) plan is designed for Medicare beneficiaries who want to receive the benefits of a Medicare Advantage Plan and still have the flexibility of being able to visit non-participating providers.
$0 monthly premium
$0 deductible
$0 copayment on PCP visits and visits to participating specialists
$0 copayment on laboratories and X-rays Up to
$750 annually on Comprehensive Dental Services
Erectile Dysfunction Medicines*
$0 copayment on Blood Pressure Monitors*
$0 copayment on Shower Chairs
* Certain restrictions apply.
Plan is available to beneficiaries residing in one of the 78 municipalities of Puerto Rico.
Some of the “out-of-network” services covered:
40% of costs from visits to primary physicians
20% of costs from visits to participating specialists
20% of costs from other services not covered in the network
Please refer to the Evidence of Coverage and/or the Summary of Benefits for information on copayments/coinsurance.
Evidence of Coverage AHM_Opal (HMO POS) H5774_1027_11_04_E File & Use 101022010
Summary of Benefits AHM_Opal (HMO POS) H5774_1001_11_06_Er1 CMS Approved 10182011
AHM_Standard (HMO)
The AHM_Standard (HMO) plan is designed for Medicare beneficiaries who require a high frequency use of monthly prescription medicines, since the co-payments are lower.
$0 monthly premium
$0 deductible
$0 copayment on PCP visits
$5 copayment on visits to participating specialists
$0 copayment on laboratories and X-rays
$0 copayment on Shower Chairs
Erectile Dysfunction Medicines*
$0 copayment on Blood Pressure Monitors
$50 every six months for over-the-counter drugs (OTC)
$2-$4 copayment on generic prescription drugs
$25-$40 copayment on brand prescription drugs
* Certain restrictions apply.
Plan is available to beneficiaries residing in one of the 78 municipalities of Puerto Rico.
Please refer to the Evidence of Coverage and/or the Summary of Benefits for information on copayments/coinsurance.
Evidence of Coverage AHM_Standard (HMO) H5774_1027_11_01_E File & Use 0921201
Summary of Benefits AHM_Standard (HMO) H5774_1001_11_02_E CMS Approved 10042010
AHM_Platino Plus (HMO SNP)
The AHM_Platino Plus (HMO SNP) is a plan designed for Medicare beneficiaries subscribed to Part A and Part B and who, at the same time, are eligible for the Medicaid coverage.
$25 reduction to the Medicare Part B Premium, up to $300 annually
$0 monthly premium
$0 deductible
$0 copayment on prescription drugs: brand or generic
$0 copayment on PCP and Specialist visits
$0 copayment on ambulance services (only when medically necessary)
$0 copayment on laboratories and X-rays
Oral Nutritional Supplements (3 units per day for 4 weeks per year) *
Adult diapers (3 diapers per day) *
One shower chair (every 5 years) *
One Blood Pressure Monitor (every 5 years) *
$25 monthly for health programs such as gym memberships
* Certain restrictions apply.
Plan is available to beneficiaries residing in one of the 78 municipalities of Puerto Rico.
To enroll, you must have Medicare Parts A and B and Medicaid.
Please refer to the Evidence of Coverage and/or the Summary of Benefits for information on copayments/coinsurance.
Premiums, copayments, coinsurance and deductibles may vary based on the level of help received.
Evidence of Coverage AHM_Platino Plus (HMO SNP) H5774_1025_11_02_E CMS Approved 12012010
Summary of Benefits AHM_Platino Plus (HMO SNP) H5774_1001_11_01_E CMS Approved 08262010
Last Updated 10/06/2011
