Amerigroup Medicare Advantage Review: Are Plans Right for You?
Editor's Rating
Amerigroup offers health insurance plans for Medicare Advantage, Medigap, Medicare Part D and Medicaid.
Available in only nine states, Amerigroup is best for budget-minded shoppers who want a cheap plan and are willing to navigate health insurance frustrations. The company's Medicare plans are usually very low cost but have mediocre star ratings, making a clear tradeoff between cost and quality.
Our thoughts on Amerigroup
Amerigroup Medicare Advantage plans are affordable, but depending where you live, they may not be the best deal you can get.
Amerigroup Medicare Advantage plans cost an average of $11 per month and have an average rating of 3.3 stars. The average cost is similar to other cheap insurance companies, but the star rating is on the low end, indicating that policyholders could face frustrations about customer service and access to health care.
For example, Aetna has a lower average cost of $7 per month and a better rating of 3.9 stars, which is why it topped our list as the best cheap Medicare Advantage provider.
Importantly, the performance measures that go into Amerigroup's overall star rating reveal the company does not perform well in critical areas. Surveyed Medicare policyholders say Amerigroup did not make it easy to get health care and prescriptions when they needed it, and the health care they received was of poor quality.
One advantage of Amerigroup is that those who qualify for special needs plans (SNP) have access to a range of plan options, a category of Medicare coverage that's not offered by many providers. There are SNPs for those who qualify for both Medicare and Medicaid. The company also offers SNPs that provide expanded benefits for nursing homes, diabetes care, heart care, lung care or end-stage renal disease, providing good coverage options for those who qualify.
What is Amerigroup insurance?
Amerigroup offers health insurance plans through government programs including Medicare, Medicaid and CHIP. There are Medicare-Medicaid plans for those who qualify for both programs. The company also provides dental and vision insurance as a part of their bundled insurance plans such as Medicare Advantage. It does not sell individual health insurance directly to shoppers or sell individual insurance through the marketplace.
Amerigroup is a subsidiary of Anthem, one of the country's largest insurance companies. However, it's not the best-rated subsidiary. Amerigroup has lower performance than Anthem's overall star rating of 3.9.
Where is Amerigroup available?
Amerigroup offers plans in nine states. However, state availability varies based on the type of plan.
Medicare Advantage is available in seven states — Arizona, Iowa, New Jersey, New Mexico, Tennessee, Texas and Washington. In Iowa, only SNPs are offered.
Medigap and Medicare Part D are available in two states — Arizona and Texas.
Medicaid is available in seven states — Georgia, Iowa, Maryland, New Jersey, Tennessee, Texas and Washington.
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Medicare plan options
Amerigroup Medicare plans are available to seniors and those who have qualifying disabilities or medical conditions. Plan options include:
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Medicare Advantage: Amerigroup sometimes calls these plans Amerivantage. The bundled plans cover hospital care, medical care and usually prescription drugs. The majority of Medicare Advantage plans are HMOs, but a few PPO options are available for those who want some out-of-network coverage or who prefer doctor flexibility.
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Medicare Part D prescription drug plans: For those enrolled in Original Medicare rather than the bundled Medicare Advantage plan, Medicare Part D lets you add on a standalone prescription drug plan. Amerigroup's Part D plans are expensive. Amerivantage Rx Basic averages $56 per month, and Amerivantage Rx Plus averages $73 per month and has no deductible.
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Medicare Supplement (Medigap) plans: Amerigroup also offers Medigap plans, which can be added on to Original Medicare to reduce out-of-pocket expenses. We sampled multiple cities and found costs ranged between $103 and $122 per month for a 65-year old female. Available options include Plan G, which is the best Medicare supplement and the most popular plan among new enrollees. The company also offers Plan N, which is a little cheaper than Plan G, Plan A, which has a basic set of benefits, and Plan F, which is only available to enrollees who qualify for Medicare before 2020.
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Medicare Advantage SNPs: Amerigroup offers all three types of SNPs. Institutional plans (I-SNP) are for those in nursing homes or who need nursing care. Chronic illness plans (C-SNP) are designed for those who have qualifying conditions such as cancer or heart disease. Dual-eligible plans (D-SNP) are available for those who qualify for both Medicare and Medicaid.
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Medicare-Medicaid plans: Those who qualify for both programs can enroll in the Amerigroup STAR+PLUS MMP (Medicare-Medicaid). This option is similar to the company's dual-eligible plan (D-SNP), but it's only available for those who have full Medicaid benefits.
Cost of Amerigroup Medicare Advantage
Amerigroup Medicare Advantage plans cost an average of $11 per month. That's cheaper than the nationwide average of $33 per month.
Most plans cost $0 per month, and the most expensive option is $35 per month. In some cases, plans are a very good deal with no monthly cost, no deductible for prescription drugs and capping covered medical costs at $3,500 or less.
Though not all plans are worth it. We recommend you watch out for plans with an out-of-pocket maximum of $7,000 or more. With these plans, those who need expensive medical care like surgery could face very high out-of-pocket costs before the plan starts paying for all of your medical treatment.
Among Amerigroup's Medicare Advantage SNPs, plans cost an average of $26 per month. That's typical compared to other providers, and the average cost of all SNP plans is $27 per month.
Coverage, member resources and unique features
Although the coverage with Amerigroup's Medicare plans vary, some plan details and discounts are widely available.
Among plan benefits, Amerigroup's Medicare Advantage plans frequently require prior authorization for health services. This can add more paperwork and slow down how quickly you can get medical care. For example, with a sample plan in Phoenix, Ariz. prior authorization is needed for a specialist visit, diagnostic tests, lab services, X-rays, inpatient or outpatient hospital care, skilled nursing facilities and more. In some cases, you'll need both a referral from your doctor and prior authorization from the insurance company.
On the plus side, the Medicare plans include telehealth and a 24-hour Nurse HelpLine to help you answer medical questions.
Many Amerigroup Medicare Advantage plans also include the Everyday Extras package. This lets policyholders choose one or two benefits from options like a healthy groceries card, in-home support, assistive devices, credit toward dental, vision or hearing services, a fitness tracker and more.
Those with Medicare-Medicaid plans get Amerigroup Healthy Benefits Plus, which provides a set amount of money to purchase over-the-counter drug items and the option to earn rewards dollars based on healthy activities like check-ups.
The size of Amerigroup's provider network is not clear. Medicare policyholders need to use the online portal to search for in-network doctors, hospitals and pharmacies. In contrast, it's a little easier for Medicaid users to check the provider network because the company has an app for this, and the good rankings for iOS and Android show how useful it is.
For Medigap policyholders, Amerigroup offers several ways to get discounts. A household discount of 5% is available when multiple family members have Amerigroup Medigap. Policyholders can also save $2 per month by using an automatic bank draft or $48 per year by paying annually.
Customer reviews and complaints
As we've mentioned, Amerigroup's plans have a moderate performance. Amerigroup's Medicare Advantage plans earned 3.3 stars overall. This is the result of combined data from across 40 measurements about the plans' medical and prescription drug coverage.
The company's overall Medicare ratings are not a fluke. Amerigroup's Medicaid plans averaged 3.4 stars according to the National Committee for Quality Assurance (NCQA), indicating moderate performance for another division of the company.
When we look closely at the Medicare Advantage plan measurements, we get more insight into where the company excelled or performed poorly. Amerigroup does a good job of making accurate coverage decisions and ensuring call center accessibility and providing certain types of preventive or proactive health care for seniors.
Areas where Amerigroup did the best (ranking 4 to 5 stars)
- Plan makes timely decision about appeals
- How often appeals about coverage were upheld by an independent reviewer
- Call center accessible via a foreign language interpreter and TTY
- Care for older adults: review of all medications by doctor or pharmacist
- Care for older adults: pain assessment
- Osteoporosis management in women who had a fracture
However, the areas where Amerigroup performs poorly are largely focused on feedback from policyholders about customer satisfaction and access to high-quality health care.
Areas where Amerigroup did the worst (ranking 1.5 to 2.5 stars)
- Overall rating of health plan by policyholders
- Overall rating of prescription drug benefits by policyholders
- Ease of getting health care and seeing specialists
- Rating of the quality of health care received by policyholders
- Ability to get appointments and health care quickly
- Care coordination including recordkeeping and following up after tests
- Accuracy of drug prices listed on Medicare.gov
- Medication adherence for cholesterol prescriptions
- Preventative breast cancer screenings
In addition, common complaints on the Better Business Bureau (BBB) include excessive marketing tactics, long hold times for customer service and overall frustration.
However, Amerigroup's finances are strong. According to AM Best, Amerigroup has a financial strength rating of A (excellent), meaning the company has the resources to pay its insurance claims.
Frequently asked questions
Is Amerigroup a good company?
Amerigroup is an okay insurance company with an average Medicare star rating of 3.3 out of 5.0. Some companies have better star ratings — like Aetna’s 3.9 stars, for example — while still providing cheap Medicare Advantage plans. However, some Amerigroup Medicare Advantage plans can be a good deal, providing good coverage at very little cost.
Does Amerigroup have Medicare?
Yes, Amerigroup offers several types of Medicare plans including Medicare Advantage, Medicare Supplement plans (Medigap), Special Needs Plans (SNPs) and Medicare-Medicaid plans. Amerigroup's Medicare Advantage plans are available in seven states — Arizona, Iowa, New Jersey, New Mexico, Tennessee, Texas and Washington.
Does Amerigroup cover dental?
Some Amerigroup plans bundle dental coverage with medical benefits, allowing you to get both through a single plan. However, dental benefits are often managed by a third-party such as Liberty Dental Plan or DentaQuest.
Is Anthem the same as Amerigroup?
Amerigroup is a subsidiary of Anthem. While the companies are not the same, Amerigroup is a part of one of the largest health insurance companies in the country.
Is Amerigroup Medicaid?
Amerigroup does offer Medicaid plans, as well as insurance plans for Medicare and those who are dual-eligible for both Medicaid and Medicare.
Methodology and sources
Medicare plan costs and star ratings are sourced from the public use files from the Centers for Medicare and Medicaid Services. Average costs of Medicare Advantage plans exclude plans that don't have prescription drug benefits, employer-sponsored plans and special needs plans, which are calculated separately. The cost of Medigap plans is based on sample quotes for a 65-year-old woman in Phoenix and Dallas. Data on plan ratings were sourced from Medicare.gov, National Committee for Quality Assurance and the Better Business Bureau.
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Callers to QWIS will be directed to a licensed and certified representative of Medicare Supplement insurance and/or Medicare Advantage HMO, HMO SNP, PPO, PPO SNP and PFFS organizations. Calls to QWIS will be routed to a licensed agent who can provide you with further information about the insurance plans offered by one or more third-party partners of QWIS. Each of the organizations they represent has a Medicare contract. Enrollment in any plan depends on contract renewal.
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