Amerigroup is a Medicaid managed care plan, not Medicaid itself

Amerigroup is a private insurance company that contracts with state Medicaid programs to deliver coverage to Medicaid members. When your state assigns you to Amerigroup or you choose it from a list of plans, Amerigroup becomes the organization that processes your claims, manages your doctor network, and handles prior authorizations — but the Medicaid program itself still pays for your care. You remain a Medicaid member; Amerigroup is simply the middleman handling the day-to-day operations.

Amerigroup operates in multiple states, but not all. The states where Amerigroup offers Medicaid plans include Texas, Louisiana, Florida, Georgia, Indiana, Kentucky, Missouri, New Mexico, Ohio, Pennsylvania, South Carolina, and Virginia, though this list can change. If you live in a state where Amerigroup operates, your state Medicaid office may have assigned you to an Amerigroup plan automatically, or you may have selected it during open enrollment.

The key distinction matters for how you get help: if you have a question about whether you remain covered by Medicaid, you contact your state Medicaid office. If you have a question about which doctors are in your network or how to file a claim, you contact Amerigroup directly.

Key Takeaways

  • Amerigroup is a managed care company hired by your state to run Medicaid benefits, not a separate program you join instead of Medicaid.
  • Your state Medicaid office determines whether you remain covered; Amerigroup handles claims, networks, and prior authorizations on behalf of your state.
  • Amerigroup operates in about a dozen states but not nationwide, so whether it serves you depends on where you live.
  • If you are assigned to Amerigroup, you will receive a member ID card and a handbook listing your plan's rules, copays, and covered services.
  • You can usually switch to a different Medicaid plan during open enrollment, even if your state assigned you to Amerigroup initially.

How Amerigroup receives and pays your Medicaid claims

When you see a doctor or fill a prescription, the provider or pharmacy submits a claim to Amerigroup, not directly to your state. Amerigroup then uses the Medicaid funds your state sends it to pay the provider. This is called managed care — the state pays Amerigroup a fixed monthly amount per member, and Amerigroup is responsible for paying all claims within that budget.

From your perspective, this usually means faster claim processing than some fee-for-service Medicaid programs, because Amerigroup has financial incentive to process claims quickly. However, it also means Amerigroup may deny claims if they believe a service is not covered under your specific plan, even though the same service might be covered under a different Medicaid plan in your state.

You do not pay Amerigroup a premium — your state Medicaid coverage is still free. Amerigroup's payment comes from your state's Medicaid budget. Some plans charge small copays for certain services (like a doctor visit or prescription), but these are set by your state and Amerigroup together, and they are typically low or zero for people with very low incomes.

What to do if Amerigroup denies a service or claim

If Amerigroup denies a claim or refuses to cover a service your doctor says you need, you have the right to appeal. The appeal process is called a grievance (for complaints about service) or an appeal (for coverage decisions). Amerigroup must tell you in writing why the denial happened and how to request a review.

You typically have 60 days from the denial letter to file an appeal. Amerigroup must respond within 30 days for routine appeals or 72 hours for urgent appeals (for example, if you need surgery soon). If Amerigroup upholds the denial, you can request a state-level review called a fair hearing, which is conducted by your state Medicaid office, not by Amerigroup.

Keep copies of all denial letters and your appeal requests. If you need help filing an appeal, contact your state Medicaid office or a local legal aid organization — many offer free help with Medicaid disputes.

How to contact Amerigroup or switch to a different plan

Your Amerigroup member ID card lists a customer service phone number specific to your state. Call that number with questions about your coverage, to find doctors in your network, or to request a prior authorization. Amerigroup also maintains a website where you can view your member information and claims history; the web address is usually printed on your card.

If you want to switch to a different Medicaid managed care plan, you can do so during your state's open enrollment period, which typically runs once per year (dates vary by state). Some states allow you to switch at any time if you have a good reason, such as your doctor leaving the Amerigroup network. Contact your state Medicaid office to ask about switching options and deadlines.

If you move to a different state, your Amerigroup coverage ends on the date you move. You will need to contact your new state's Medicaid office to determine whether you remain covered and which plans are available there.

Differences between Amerigroup and other Medicaid plan types

Some states offer Medicaid through fee-for-service programs, where the state pays providers directly and you can see any doctor who accepts Medicaid. Other states use managed care plans like Amerigroup, where you must choose a plan and usually see doctors within that plan's network. A few states offer both options.

Managed care plans like Amerigroup typically offer benefits beyond basic Medicaid — for example, dental, vision, or transportation to medical appointments. Fee-for-service Medicaid may not cover these extras. However, managed care plans also require you to pick a primary care doctor and get referrals for specialists, whereas fee-for-service usually does not.

Your state Medicaid office can tell you which type of program you are in and whether you have options to switch. If you are in a managed care plan and want fee-for-service instead, or vice versa, ask your state office about the process and timing.

What happens to your Amerigroup coverage if your income changes

Amerigroup does not determine whether you remain covered by Medicaid — your state does. If your income rises above your state's Medicaid income limit, your state will end your Medicaid coverage, and your Amerigroup plan ends with it. If your income drops, you may become newly covered by Medicaid and be assigned to an Amerigroup plan (or another plan) by your state.

Income changes, household size changes, and changes in citizenship or immigration status can all affect your Medicaid coverage. You are required to report these changes to your state Medicaid office, usually within 30 days. Failing to report changes can result in overpayments that you may be asked to repay later.

If you lose Medicaid coverage because of an income change, you may be able to enroll in a health plan through the federal marketplace (Healthcare.gov) or your state's health insurance marketplace. Some people also become covered by Medicare or employer insurance. Your state Medicaid office can explain what options are available to you.

Frequently Asked Questions

Does Amerigroup cost money?

No. Amerigroup is a Medicaid plan, and Medicaid is free. Your state pays Amerigroup to manage your coverage. You may have small copays for certain services (like a doctor visit), but these are set by your state and are typically very low or zero if your income is very low.

Can I see any doctor I want with Amerigroup?

No. Amerigroup plans have a network of doctors, hospitals, and specialists. You must see doctors within that network, or pay out of pocket. Your Amerigroup member handbook or website lists which doctors are in-network. If your current doctor is not in the network, you can ask Amerigroup about exceptions or consider switching to a different Medicaid plan during open enrollment.

What if I move to a state where Amerigroup does not operate?

Your Amerigroup coverage ends when you move. You will need to contact your new state's Medicaid office to determine whether you remain covered and which plans are available. Some states have Amerigroup plans and some do not, so your options will depend on where you move.

How do I know if I am in an Amerigroup plan?

You will receive a member ID card in the mail that says "Amerigroup" on it. The card also lists a customer service phone number and website. If you are unsure, call your state Medicaid office and give them your Medicaid number — they can tell you which plan you are in.

Can I appeal if Amerigroup denies my prescription or treatment?

Yes. Amerigroup must send you a written denial letter explaining why and how to appeal. You have 60 days to file an appeal. If Amerigroup denies the appeal, you can request a fair hearing through your state Medicaid office. Keep all letters and file your appeal on time.