Amerigroup Medicare Advantage 2023 Review

Amerigroup plans offer flexible benefits, but they have below-average ratings and a limited service area.
Kate Ashford, CSA®
By Kate Ashford, CSA® 
Edited by Chris Hutchison

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Amerigroup is one of the brands of parent company Elevance Health. Amerigroup-branded Medicare Advantage plans are available in seven states as part of the Blue Cross Blue Shield collective.

Amerigroup plans offer competitive premiums and $0-premium options, but their ratings for both quality and member satisfaction are below average.

Here’s what you should know about Amerigroup Medicare Advantage.

Amerigroup Medicare Advantage pros and cons

Amerigroup’s offerings have advantages and disadvantages.

Pros

  • Low-cost plans: Seven out of 10 Amerigroup Medicare Advantage plans are $0 premium.

  • Flexible benefits: Some Amerigroup Medicare Advantage plans offer “Everyday Extras,” which lets members choose two extra benefits for their plan from a list including money toward assistive devices, money toward healthy groceries, or money toward dental, vision or hearing care.

  • 24/7 nurse line access: Amerigroup members may have access to a 24/7 nurse line.

Cons

  • Limited availability: Amerigroup offers Medicare Advantage plans in only seven states. Most of Amerigroup's competitors have a larger footprint.

  • Low star and satisfaction ratings: Amerigroup plans' average star rating from the Centers for Medicare & Medicaid Services, weighted by enrollment, is 3.21 stars (the national average for all providers is 4.15 stars), and Amerigroup's parent company, Elevance Health, came in seventh out of nine providers in J.D. Power’s latest member satisfaction study.

  • Low-rated drug plans: Amerigroup’s stand-alone prescription drug plans receive 2 stars from the Centers for Medicare & Medicaid Services.

Available Medicare Advantage plans

There are several kinds of Amerigroup Medicare Advantage plans, and they vary in terms of structure, costs and benefits. Amerigroup offers Medicare Advantage prescription drug plans, or MAPDs, as well as stand-alone prescription drug plans and Medicare Advantage plans without drug coverage.

Plan offerings include the following types:

A health maintenance organization, or HMO, generally requires that you use a specific network of doctors and hospitals. You may need a referral from your primary doctor in order to see a specialist, and out-of-network benefits are usually very limited.

Preferred provider organization, or PPO, plans provide the most freedom, allowing you to see any provider that accepts the insurance. You may not need to choose a primary doctor, and you don’t need referrals to see specialists. You can seek out-of-network care, although it may cost more than seeing an in-network doctor.

Special needs plans, or SNPs, restrict membership to people with certain diseases or characteristics. Hence, the benefits, network and drug formularies are tailored to the needs of those members. Amerigroup offers three types of SNPs:

  • Chronic Condition SNP: Designed to meet the needs of members living with certain chronic conditions, such as diabetes, congestive heart failure and cardiovascular disease.

  • Dual-Eligible SNP: For people who are entitled to Medicare and who also qualify for assistance from a state Medicaid program.

  • Institutional SNP: For people living in an Amerigroup network nursing home or assisted living community, or another plan-approved location.

Available Part D prescription drug plans

Most of Amerigroup’s Medicare Advantage plans include Part D drug coverage, but the company also sells stand-alone Part D prescription drug plans, or PDPs, in two states: Arizona and Texas. These plans provide drug coverage for people enrolled in Medicare Part A and Part B, so they don’t provide medical coverage.

Amerigroup offers two plan options in each state where it sells stand-alone prescription drug plans: a basic option and a “plus” option with enhanced coverage. For example, if you live in Dallas, Texas, you have these two options from Amerigroup:

  • Amerivantage Rx Basic (PDP).

  • Amerivantage Rx Plus (PDP).

Here’s how those two plans compare:

Plan feature

Amerivantage Rx Basic (PDP)

Amerivantage Rx Plus (PDP)

Monthly premium

$79.30.

$66.60.

Annual deductible

$505.

None.

Drug copay, Tier 1*

$0.

$1.

Drug copay, Tier 2*

$1.

$4.

Drug copay, Tier 3*

$40.

$47.

*For a 30-day supply of a covered Part D prescription drug at a preferred retail pharmacy after meeting any applicable deductible.

Premiums, deductibles, covered drugs, costs for each tier and pharmacy arrangements all differ by plan. You can enter information about your prescriptions and choose your pharmacy on Amerigroup’s website to check how each available plan would cover your medications.

Additional benefits

Amerigroup Medicare Advantage plans include a variety of benefits, some that are built into the plan and others that members select from a menu of “Everyday Extras,” if the plan includes them. Here are some examples, although availability varies by plan:

  • SilverSneakers: Members can visit gyms and access live and pre-recorded online fitness classes tailored to older adults.

  • Fitness tracker: Members may be eligible for a health and fitness tracker to help them stick to their fitness goals.

  • Meals for your chronic condition: If members have a chronic condition requiring specific nutrition, they may be able to receive up to two meals per day for 90 days.

  • Over-the-counter allowance: Members may receive an allowance each quarter that they can spend on eligible non-prescription over-the-counter items.

  • Pest control: For certain chronic conditions, members may be eligible to have their home treated regularly for standard pests.

  • 24/7 nurse line: Members may have phone access to a registered nurse 24 hours a day.

  • Transportation: Members may be covered for a certain number of rides to and from plan-approved locations.

  • Access to extras: Plans with “Everyday Extras” let members choose two of several extra benefits, including money toward assistive devices, hours of in-home companionship, or money toward dental, vision or hearing needs.

Customer service

Here’s how Amerigroup members can contact customer service:

Amerigroup Medicare Advantage service area

Amerigroup offers Medicare Advantage plans in seven states. The company also offers Medicare prescription drug plans in two states.

Amerigroup's parent company, Elevance Health, is the second-largest health insurer in the country by market share

. Amerigroup-brand plans cover more than 175,000 Medicare Advantage beneficiaries as of October 2022.

Costs

Costs for Medicare Advantage plans depend on your plan, your geographic location and your health needs. One of the costs to consider is the plan’s premium. Seven in 10 Amerigroup Medicare Advantage plans have $0 premiums

Centers for Medicare & Medicaid Services. 2023 MA Landscape Source File (v 10 14 2022) (ZIP). Accessed Nov 28, 2022.
.

For 2023 Medicare Advantage plans with a premium, the monthly consolidated premium (including Part C and Part D) ranges from $9.30 to $19.20. For special needs plans, or SNPs, with a premium, monthly premiums range from $17 to $35.20

Centers for Medicare & Medicaid Services. 2023 SNP Landscape Source File (v 10 14 2022) (ZIP). Accessed Nov 28, 2022.
.

Even as a Medicare Advantage user, you’ll still be responsible for paying your Medicare Part B premium, which is $164.90 per month in 2023, although some plans cover part or all of this cost. (Most people pay this standard amount, but if your income is above a certain threshold, you'll pay more.)

Other out-of-pocket costs to consider include:

  • Whether the plan covers any part of your monthly Medicare Part B premium.

  • The plan’s yearly deductibles and any other deductibles, such as a drug deductible.

  • Copayments and/or coinsurance for each visit or service. For instance, there may be a $10 copay for seeing your primary doctor and a $45 copay for seeing a specialist.

  • The plan’s in-network and out-of-network out-of-pocket maximums.

  • Whether your medical providers are in-network or out-of-network, or how often you may go out of network for care.

  • Whether you require extra benefits, and if the plan charges for them.

To get a sense of costs, use Medicare’s plan finding tool to compare information among available plans in your area. You can select by insurance carrier to see only Amerigroup plans or compare across carriers. You can also shop directly from Amerigroup’s website by entering your ZIP code.

Medicare star ratings

Average star rating, weighted by enrollment: 3.21

The Centers for Medicare & Medicaid Services maintains star ratings for Medicare Advantage and Medicare Part D plans on a 5-point scale, ranking plans from best (5 stars) to worst (1 star). The agency bases these ratings on plans’ quality of care and measurements of customer satisfaction, and ratings may change from year to year.

Based on the most recent year of data and weighted by enrollment, Amerigroup’s 2023 Medicare Advantage plans get average ratings of 3.21 stars. There are no Amerigroup Medicare Advantage plans with a higher rating than 3.5 stars

Centers for Medicare & Medicaid Services. 2023 Star Ratings Data Table (ZIP). Accessed Nov 28, 2022.
.

The average star rating for plans from all providers is 4.15

Centers for Medicare & Medicaid Services. 2023 Medicare Star Ratings Fact Sheet (PDF). Accessed Nov 28, 2022.
.

To get an overall star rating, the CMS ranks contracts on 40 plan factors. (You can find definitions for each of these factors in the CMS Star Ratings Technical Notes.) Here are the measures for which Amerigroup plans scored an average of 4.5 (out of 5) and above:

  • Care for older adults — medication review.

  • Reviewing appeals decisions.

  • Health plan: Call center — foreign language interpreter and TTY availability.

  • Drug plan: Call center — foreign language interpreter and TTY availability.

Amerigroup plans averaged sub-3.0 scores in half of measured categories. (You can find definitions for each of these factors in the CMS Star Ratings Technical Notes.)

  • Special needs plan care management.

  • Controlling blood pressure.

  • Improving bladder control.

  • Medication reconciliation post-discharge.

  • Getting needed care.

  • Getting appointments and care quickly.

  • Health plan: Customer service.

  • Rating of health care quality.

  • Rating of health plan.

  • Care coordination.

  • Health plan: Members choosing to leave the plan.

  • Health plan quality improvement.

  • Drug plan: Members choosing to leave the plan.

  • Drug plan quality improvement.

  • Rating of drug plan.

  • Getting needed prescription drugs.

  • Medicare plan finder price accuracy.

  • Medication adherence for diabetes medications.

  • Medication adherence for hypertension.

  • Medication adherence for cholesterol (statins).

You can find a plan’s rating with the Medicare plan finding tool.

Third-party ratings

There are a few companies that weigh in on health plans or on the strength of the company in question, and we’ve included two here:

AM Best Financial Strength Rating: A (Excellent)

AM Best is a credit rating agency that specializes in the insurance industry. In December 2021, AM Best affirmed its Financial Strength Rating of A for the core Blue Cross Blue Shield-branded insurance subsidiaries of parent company Anthem, which is now Elevance Health

. An A rating in this category indicates that AM Best believes the company has an excellent ability to meet its ongoing insurance obligations.

J.D. Power Ranking: 7th out of 9

In its 2022 U.S. Medicare Advantage Study — the eighth it has done so far — J.D. Power measured member satisfaction with Medicare Advantage plans based on six factors: coverage and benefits, provider choice, cost, customer service, information and communication, and billing and payment. On these measures, Amerigroup's parent company, Elevance Health, scored 791 points out of 1,000 and came in seventh out of the top nine Medicare Advantage providers

.

Compare Medicare Advantage providers

Get more information below about some of the major Medicare Advantage providers. These insurers offer plans in most states. The plans you can choose from will depend on your ZIP code and county.

About Elevance Health (formerly Anthem)

Amerigroup’s parent company, Elevance Health, is headquartered in Indianapolis, Indiana, and was formed in 2004 out of a merger between WellPoint Health Networks and Anthem. In 2022, the company changed its name from Amerigroup to Elevance Health, but sells Medicare Advantage plans under a number of brands, including Amerigroup.

Elevance Health offers commercial health insurance for individuals and employers; Medicare Advantage and Medicaid plans; life, disability, dental and vision insurance; and services for other government health insurance programs.

In 2021, Elevance Health had $138.6 billion in annual revenue.

If you have additional questions about Medicare, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048).

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