AmeriChoice Health

AmeriChoice Health Insurance Company offers an HMO/Managed Health Care alternative to Medicaid, and other state offered insurance, for low-income patients with the same benefits through a contract with the State Department of Health. AmeriChoice Health Insurance Company also employs Child Health Insurance Program (CHIP) in some states. 

AmeriChoice Health Insurance Company is part of UnitedHealth Group and serves around 1.7 billion people.  Currently AmeriChoice is only available in select counties in thirteen states; Arizona, Texas, Florida, Tennessee, Nebraska, Iowa, Wisconsin, Michigan, New York, Pennsylvania, Rhode Island, New Jersey and Maryland.

Depending on the state or area that you live in, AmeriChoice may go under different names such as Family Health Plus (New York), RIte Care (Rhode Island), Primary Adult Care (Maryland) or NJ Family Care (New Jersey).  In some areas, in certain states (Michigan, Tennessee, Texas, Arizona, and Nebraska) AmeriChoice is the underwriter of Medicaid services.

Services Provided By AmeriChoice Health Insurance Company

Services will vary from state to state but all health care is provided through UnitedHealth care providers and must be deemed medically necessary to be covered.

• Prescription drugs can be obtained for a small fee or co-pay.

• Visits to your primary care physician, as well as a counselor or psychiatrist if you need mental health care, is provided at no cost.

• X-rays

• Laboratory services

• Vision check ups and glasses every two years.

• Family Planning supplies and services

• Drug and Alcohol rehabilitation

• Limited dental services

• Medically necessary abortions or termination of pregnancy in the event of rape or incest

• In some areas, transportation services related to medical care.

• Ambulance service

• Special health care programs are available for patients with diabetes, asthma, sickle cell anemia, heart disease and those who are pregnant.  These health care programs help patients better understand their condition, as well as manage it, cutting down on doctor visits and complications.

• UnitedHealth Care also sponsors educational classes in some areas on asthma, high blood pressure, nutrition, pregnancy, birth control, cancer, vaccines, parenting and breastfeeding, smoking cessation, weight control, stress management, grief counseling, and arthritis.   If there are no United Health Care sponsored classes, you will be directed to either classes held by your doctor or to a community sponsored class or support group.

• A program called Health Check for those under 21.  The Health Check program will pay for any conditions or issues found during a routine physical check up which includes an exam, vaccines, lead screening, growth and developmental evaluation, and vision and hearing exam. 

• 24 hour customer help line

• Emergency services

• Up to 40 home health care visits agreed to by your doctor to prevent hospital stay.

• Durable Medical Equipment (wheelchairs, crutches, etc) when deemed medically necessary and you have a prescription from your doctor.

• Hearing Aids

• TB diagnosis and treatment

• Medically necessary cosmetic surgery

Services Not Covered By AmeriChoice Health Insurance Company

In some areas AmeriChoice Health Insurance does not cover hospital stays.  There are a variety of other services not covered including

• Cosmetic surgery that is not medically necessary

• Infertility treatments

• Abortion that is not medically necessary

• Private nurses

• Permanent nursing home placement

• Bandages and over the counter drugs

• Services provided by a non-AmeriChoice participant

• Personal Care Items

• Services not authorized by your Primary Care Physician

Services That Require Insurance Pre-Authorization By AmeriChoice Health Insurance Company

There are some services that require pre-authorization; meaning you have to get permission from AmeriChoice before you can receive them.  This is to help reduce costs and make sure that the services are medically necessary and that there are no alternative treatments that cost less.

• Sleep Studies

• Pain Management

• Evaluation for organ transplants

• Admission for inpatient services such as a hospital stay (hospital stay as part of labor and delivery is not something that needs pre-authorization)

• After six visits speech therapy, occupational therapy and physical therapy

• Medical equipment over $1,000

• Accidental dental repairs

• Home health care

• Certain surgeries

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