AmeriHealth Caritas runs Medicaid plans, but it is not Medicaid itself

AmeriHealth Caritas is a private insurance company that administers Medicaid coverage in certain states and regions. It is not the government program — Medicaid is run by your state — but AmeriHealth Caritas is one of the companies your state may contract with to manage Medicaid benefits on its behalf. If your state uses AmeriHealth Caritas, you may be enrolled in one of their plans when you become Medicaid-may be able to access, or you may have the option to choose them.

Whether AmeriHealth Caritas serves your area depends entirely on where you live. The company operates in multiple states but not all of them, and coverage varies by state program. Some states use AmeriHealth Caritas for standard Medicaid; others use it only for specific populations like children, pregnant people, or people with disabilities. You can find out whether AmeriHealth Caritas is available in your state by contacting your state Medicaid office or checking your state's Medicaid website.

Key Takeaways

  • AmeriHealth Caritas is a managed care company contracted by states to deliver Medicaid benefits, not a government agency.
  • Your state decides which insurance companies manage its Medicaid program, so AmeriHealth Caritas may or may not serve your area.
  • If you live in a state where AmeriHealth Caritas operates, you may be automatically enrolled in their plan or given a choice of plans.
  • Your state Medicaid office can tell you which companies manage Medicaid in your region and how to contact them.

How AmeriHealth Caritas fits into the Medicaid system

Medicaid is a joint federal and state program, but each state runs its own version. Most states contract with private insurance companies called managed care organizations (MCOs) to handle the day-to-day work of Medicaid. AmeriHealth Caritas is one of these MCOs. When you enroll in Medicaid through AmeriHealth Caritas, the state pays AmeriHealth Caritas a monthly fee to cover your care, and AmeriHealth Caritas then manages your benefits — deciding which doctors and hospitals you can see, which medications are covered, and how claims are processed.

This arrangement does not change your Medicaid status or your rights. You are still a Medicaid member, and your coverage is still funded by the state and federal government. AmeriHealth Caritas simply handles the administration. The state remains responsible for making sure the plan meets Medicaid rules and that you receive the services you are may have access to to.

Which states and programs use AmeriHealth Caritas

AmeriHealth Caritas operates in multiple states, but the list changes and varies by program type. As of recent years, the company has managed Medicaid plans in states including Pennsylvania, New Jersey, Delaware, Florida, and others, but you should not assume it serves your state without checking. Some states may use AmeriHealth Caritas only for certain Medicaid categories — for example, for children and families but not for seniors or people with disabilities — or only in certain counties.

The best way to find out whether AmeriHealth Caritas serves your area is to contact your state Medicaid office directly. You can also visit your state's Medicaid website, which usually lists all the managed care plans available in your region. If AmeriHealth Caritas does operate where you live, the state website will show you how to enroll or switch plans during open enrollment periods.

How to contact AmeriHealth Caritas if you are enrolled

If you are already enrolled in an AmeriHealth Caritas Medicaid plan, your member ID card should have a customer service phone number on the back. You can call that number to ask questions about your coverage, find in-network doctors, request prior authorization for a service, or report a problem with a claim. AmeriHealth Caritas also maintains a website where you can log into your account, view your benefits, and search for providers.

Keep your member ID card with you at all times. When you see a doctor or fill a prescription, you will need to show it to confirm you have coverage. If you lose your card, call the number on your last statement or contact your state Medicaid office to request a replacement.

What to do if you are unsure whether you have AmeriHealth Caritas coverage

If you are enrolled in Medicaid but do not know which company manages your plan, check any paperwork you received when you enrolled. Your Medicaid member ID card should list the plan name and company. You can also call your state Medicaid office and give them your name and date of birth; they can tell you which plan you are in and provide contact information.

If you received a notice saying you were enrolled in AmeriHealth Caritas but you did not choose it, you may have been automatically assigned. Most states allow you to switch plans during open enrollment, which usually happens once a year. Your state Medicaid office can tell you when open enrollment is and how to request a different plan if you want to change.

Your rights as an AmeriHealth Caritas Medicaid member

Being enrolled in an AmeriHealth Caritas plan does not reduce your Medicaid rights. You have the right to receive all services your state's Medicaid program covers, to see a doctor of your choice within the network, to appeal a denied claim or service, and to file a complaint if you believe the plan is not following the rules. If AmeriHealth Caritas denies you a service you believe you need, you can request an appeal through the plan and, if necessary, through your state Medicaid office.

You also have the right to leave the plan if you are unhappy with it. During open enrollment, you can switch to a different managed care plan in your state, or you may be able to disenroll and receive Medicaid through a fee-for-service arrangement (where you see any Medicaid-accepting provider without choosing a specific plan). Your state Medicaid office can explain your options.

Frequently Asked Questions

Do I have to use AmeriHealth Caritas if my state offers it?

It depends on your state's rules. Some states automatically enroll you in a plan if you do not choose one; others let you stay unenrolled. If you are automatically enrolled in AmeriHealth Caritas and want a different plan, you can usually switch during open enrollment or if you have a may have access to life event like a move or job loss. Contact your state Medicaid office to learn your options.

Is AmeriHealth Caritas the same as regular Medicaid?

No. AmeriHealth Caritas is a company that manages Medicaid benefits on behalf of your state. You are still a Medicaid member with the same coverage and rights, but AmeriHealth Caritas handles the day-to-day administration like processing claims and managing your provider network. Your state Medicaid office remains the ultimate authority over your coverage.

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

Your Medicaid coverage will end in your old state when you move. You will need to apply for Medicaid in your new state, and you may be enrolled in a different managed care plan or in fee-for-service Medicaid, depending on what your new state offers. Contact your new state's Medicaid office as soon as you move to start the process.

Can I see any doctor I want with AmeriHealth Caritas Medicaid?

You can see any doctor who is in the AmeriHealth Caritas network and accepts Medicaid. If you see an out-of-network doctor, you may have to pay out of pocket or the claim may be denied. Your member ID card or the AmeriHealth Caritas website has a provider directory so you can check whether your doctor is in the network before you schedule an appointment.

How do I know if a service is covered by my AmeriHealth Caritas plan?

Call the customer service number on your member ID card or log into your account on the AmeriHealth Caritas website. You can also ask your doctor's office to check your coverage before you receive a service. If you are unsure whether something is covered, ask for a written explanation before you proceed so you know whether you will have to pay.