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AmeriHealth Caritas Pennsylvania

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(TTY: 1-855-235-5112)

To see a list of services covered by all plans, go to Physical and behavioral health benefits and Long-term services and supports.


People with Medicare pay the co-pays below except prescription drug co-pays. People with both Medicare and Medicaid get most prescriptions through Medicare Part D. They pay Part D co-pays, not the prescription co-pays listed here.

Ambulance - Per trip $0

Dental care - $0

Inpatient hospital
Per day - $0
Maximum with limits - $0

Medical centers
Ambulatory surgical center - $0
Federal Qualified Health Center or Regional Health Center - $0
Independent medical/surgical center - $0
Short procedure unit - $0

Medical equipment
Purchase - Sliding scale
Rental - $0

Medical visits
Certified nurse practitioner - $0
Chiropractor - $0
Doctor - $0
Optometrist - $0
Podiatrist - $0

Outpatient hospital
Per visit – Outpatient surgical, except maternity - $0
Per visit – Non-surgical or diagnostic - $0

Generic - $0
Brand name - $2

X-rays - Per service $0

Adult dental
  • Beyond Medicaid coverage of dental services, qualified participants will get an oral hygiene kit
Adult vision
  • Beyond Medicaid covered vision services, no extra services
Phone services
  • Free Smartphone with 350 minutes of talk and unlimited texts for participants who qualify
Wellness programs
  • Home provider visits, lab draws and testing for qualified participants
  • Video visits with care manager
  • Bright Start® maternity program
Other benefits
  • In-home supports and services to help participants not approved for LTSS avoid nursing home stay
  • Welcome Home Benefit helps qualified participants with LTSS move from nursing facility to home, with up to $6000 for rental assistance ($2000 more than the $4000 state limit)
  • For those not approved for LTSS, caregiver programs offer education, respite services and supports

*There are no co-pays for persons living in a nursing, personal care or domiciliary home. Pregnant women, new mothers and terminally ill participants getting hospice care
have no co-pays. Some services, items and drugs have no co-pays. For co-pay updates, go to ow.ly/WGQM30hern9.