Amerigroup, which is headquartered in Virginia Beach, Virginia, provides services for just under 8 million people in the country. From its roots in 1994, Amerigroup committed to solving the healthcare problems of the most vulnerable people. It set its sights on helping children, pregnant women and other people who were enrolled in the federal Medicaid program. In 2006, it added the Medicare Advantage program to serve individuals who qualify for Medicare and Medicaid. Just a year later, it added CHIP as part of its offerings.
Amerigroup now offers all policy options for health plans except for EPO.
| Offers HMO? | Yes |
| Offers PPO? | Yes |
| Offers EPO? | No |
| Offers POS? | Yes |
HMO policy options: Amerigroup offers Medicare Advantage HMO plans. These HMO plans allow policyholders the option to choose a doctor from the Amerigroup network for regular care as part of a Medicare Advantage Plan.
PPO policy options: Amerigroup offers Medicare Advantage Plans with an option for a PPO. These plans may be limited to a particular service area.
POS policy options: POS policy options, also known as point-of-service plans, are a hybrid plan for people who have Medicaid and Medicare. This type of plan is also called MMP or a Medicare-Medicaid Plan. Currently, POS policy options are only available in the state of Texas.
Both HMO and PPO plans offer options for dental, vision, hearing and prescription drug options.
Amerigroup covers visits with a primary care provider. It will also cover a specialist visit, as long as a referral comes from the primary care provider. In addition, patients can get emergency care, preventative care, lab work and x-ray services. Those who need physical therapy, occupational therapy or speech therapy can get those services, too.
Moreover, Amerigroup plans cover medical supplies, prescriptions and home health services.
Children who have an Amerigroup plan can also get dental services, speech services and screenings for hearing, vision and behavioral health. Additionally, children can get eyeglasses and frames paid for by Amerigroup plans.
What’s more, Amerigroup offers services under the Special Needs Plans (SNP). This type of Medicare Advantage Plan provides services for people with specific diseases or characteristics such as diabetes, End-Stage Renal Disease (ESRD), HIV/AIDS, dementia or chronic heart failure.
Services are designed to best meet the needs of specific demographics of people. Some of these services can be accessed out of network.
Customers can easily find providers by doing a search at Medicare.gov.
Amerigroup customers are happy to learn that customer service is merely a phone call away. Customer service representatives are standing by 24/7 every day of the year, with the exception of Thanksgiving and Christmas.
The wait times are reasonably short, and when someone picks up, customers get to speak with a real person. The quality of help on the other end of the line is also quite good. Most customers are happy with the assistance they receive.
Customers in Arizona, New Jersey, Tennessee, Texas and Washington can contact an Amerigroup representative by calling a local number. Those who reside in New Jersey and Texas who are enrolled in an HMO-POS plan or Special Needs Plan have access to local phone numbers, too.
Depending on what customers need assistance with, Amerigroup has special phone numbers for the pharmacy and disease management departments.
Amerigroup representatives are also available via email.
Unlike other types of health plans, members of Amerigroup plans do not typically have to file their medical claims with the company and wait to be reimbursed. Amerigroup bills Medicaid, Medicare or CHIP directly, and patients may not even see a bill.
The financial strength and quality ratings for Amerigroup are high where it is available, as the chart below indicates.
| BBB Rating | Not rated |
| AM Best Rating | A |
| NAIC Complaint Index | 0 |
| Moody’s Rating | A2 (under Anthem) |
Each state administers rules for copayments, coinsurance, deductibles and other charges. The amounts for charges vary based on income, but they are usually at no-cost or low cost, thereby making them highly affordable for seniors and low-income families. The low cost is one of the premier benefits of Amerigroup.
Amerigroup advertises policies that start at $0 premiums, which is amazing considering current health insurance costs, but made possible because many of Amerigroup’s programs are Medicare or Medicaid. However, these policies offer limited benefits.
People who are enrolled in Medicare Special Needs Plans can take advantage of Medicaid and Medicare under one plan. In most cases, patients do not have to pay anything at all. Patients may need to pay a small amount for certain services. As with all Medicaid and Medicare services, Special Needs Plans limit what they cover.
Additionally, Amerigroup offers more robust Medicare Advantage policies that are advertised at $25.10 per month.
Amerigroup members can make payments using a credit card.
| Maximum Annual out of Pocket | $11,300 |
| Minimum Deductible | $0 |
Copays range from $0 to $35. Some Amerigroup plans call for a 20% coinsurance. Most Amerigroup plans are $0 deductible plans. The maximum expenses customers pay out of pocket range from $3,400 to $11,300.
Amerigroup specializes in Medicare and Medicaid programs, making it a niche market with limited eligibility. Amerigroup also has limited regional availability. Competitors with Amerigroup have more program options and a larger provider network.
Since states regulate Medicaid, Medicare and CHIP health plans, Amerigroup has different websites for each state where it operates.
The website for applicants describes who is eligible for the program so no time is wasted for those who do not qualify.
Applicants can easily apply for Amerigroup plans online. Alternatively, applicants can call in and apply over the phone. Applicants also have the option of downloading a paper application in English or Spanish and filling it out manually. Anyone who prefers to visit their state health department in person can apply that way as well. Applicants will be notified once their application has been approved.
Group members can change primary care providers, print member ID cards, communicate with customer service and learn about their health plan benefits via the online platform. Additionally, Amerigroup has a handy mobile app that allows members to access their member ID and benefits on their cell phones. It is ultra-easy to log in with a touch ID, fingerprint or Face ID, and the platform is secure.
The mobile app also has a symptom checker feature and sends out notifications about benefits.
Amerigroup vs. Competitors
Amerigroup specializes in low-cost Medicare and Medicaid options. For eligible members, Amerigroup stands out in its specialized, low-cost benefit programs.
One of the major competitors with Amerigroup is Aetna. Aetna provides plans over a much larger geographical area than Amerigroup. Nonetheless, Aetna’s star ratings are only slightly higher than Amerigroup’s ratings.
According to the J.D. Power 2021 U.S. Medicare Advantage Study, Kaiser Foundation Health Plan ranked the highest for Medicare Advantage plans, Highmark ranked second and Cigna HealthSpring ranked third. The study was based on the following six factors:
- Coverage and benefits
- Provider choice
- Health insurance cost
- Customer service
- Information and communication
- Billing and payments
Amerigroup outshines its competitors such as Community Health Choice, Molina Healthcare, Texas Children’s Health Plan and UnitedHealthcare by offering greater availability of customer services and supplying rides to patients who lack transportation for healthcare. Moreover, Amerigroup offers gift services to help pay for healthcare, and it has an excellent health and wellness program.
Overall, Amerigroup’s competitors offer better service, wider availability and more provider network participation. The smaller number of states Amerigroup operates in could be reflective of these results as well.
- Best For:Nationwide coveragesecurely through Blue Cross Blue Shield Health Insurance's website
- Best For:No enrollment period health insurancesecurely through Sidecar Health Access Plan's website
Plans referred to above are excepted benefit fixed indemnity insurance products marketed and administered by Sidecar Health Insurance Solutions, LLC and underwritten by Sirius America Insurance Company or United States Fire Insurance Company, depending on the state. As an excepted benefit plan, it does not provide comprehensive/major medical expenses coverage, minimum essential coverage, or essential health benefits. You cannot receive a subsidy (premium tax credit and/or cost-sharing reduction) under the ACA in connection with your purchase of such an excepted benefit fixed indemnity insurance plan. Also, the termination or loss of this policy does not entitle you to a special enrollment period to purchase a health benefit plan that qualifies as minimum essential coverage outside of an open enrollment period. Coverage and plan options may vary or may not be available in all states.
Amerigroup is a group of subsidiary companies under the corporate entity, Anthem. The subsidiaries get different overall ratings, varying based on their region and the volume of feedback.
Overall, Amerigroup’s health insurance receives high marks for the availability of customer service representatives and the ability to talk to a live person on the phone. Amerigroup also gets high marks for offering health services at low cost, and in many cases, no cost at all.
Consumers appreciate having multiple options for applying for Amerigroup including via online, phone, paper application and in-person.
Considering the plans for Medicaid, Medicare, Medicare Advantage and CHIP, Amerigroup offers a variety of plans, but only for those who qualify for them.
Benzinga gives Anthem, the parent company, and its Amerigroup subsidiaries an average overall review of 3.5 out of 5 stars because of the valuable benefits of Amerigroup.
Frequently Asked Questions
Is Amerigroup the same as Medicaid?
No. Amerigroup is an entity of its own. It is a subsidiary of the parent group, Anthem. Medicaid is a joint federal and state program that can be administered by Amerigroup or other health insurance providers.
Where can I find physicians who accept Medicare and Medicaid?
The Centers for Medicare and Medicaid Services, also known as CMS, has a website that allows members to search for healthcare professionals by name, group practice name, medical specialty, medical condition, a body part or an organ system. Amerigroup members can also call physicians in their local areas to see if they accept Amerigroup plans. Senior Centers and other associations that serve populations with specific or chronic diseases may know which medical practices accept Amerigroup plans as well.
Is Amerigroup the same as AmeriHealth?
The names sound quite similar, but AmeriHealth and Amerigroup are two entirely different health insurance providers. Much like Amerigroup, AmeriHealth services vulnerable populations including seniors, low-income families and people living with disabilities, and offers plans for Medicaid, Medicare, CHIP and Special Needs Plans.
Amerigroup specializes in Medicare and Medicaid programs, making it a niche market with limited eligibility. Amerigroup also has limited regional availability. Competitors with Amerigroup have more program options and a larger provider network.
About Maurice Draine
Maurice Draine is a former insurance agent, broker, underwriter tech, and agent sales support rep with over 15 years of professional writing experience. Maurice helps insurance, financial, and various online and ad agencies, create the words that drive customers to their websites and keeps them there.