Amerigroup was originally formed to serve people on public insurance programs. Now a subsidiary of Anthem, it maintains its focus on public programs including Medicare with the backing of a larger insurer. Amerigroup offers a lot of plan types in its relatively limited geographic footprint. Its plans earn just above 3.0 stars out of 5.0 from the Centers for Medicare and Medicaid Services—not bad but you might be able to find a higher-rated plan.
- Pros and Cons
- Key Takeaways
- Company Overview
Focus on public insurance programs
Several plan options
Backed by Anthem
Limited geographic coverage
Average quality ratings
- Amerigroup focuses on public insurance programs such as Medicare.
- It's a subsidiary of Anthem, one of the largest health insurers in the U.S.
- Amerigroup offers a wide assortment of Medicare insurance in a relatively small number of states.
Amerigroup is a managed care company that focuses on Medicare, Medicaid, and other public insurance programs. Based in Virginia Beach, Virginia, and founded in 1994 as AMERICAID Community Care, it’s now a subsidiary of Anthem. Amerigroup was acquired by WellPoint in 2012; WellPoint and Anthem had merged in 2004 and adopted Anthem as the corporate name in 2014. Anthem is the third-largest health insurer overall in the U.S.
Amerigroup offers Medicare plans in Arizona, Iowa, New Jersey, New Mexico, Tennessee, Texas, and Washington. Not all plan types are available in each of these states.
- Year Founded 1994
- Kinds of Plans Medicare Advantage HMO Plans, Special Needs Plans (Chronic Conditions Special Needs Plans, Dual-eligible Special Needs Plans, and Institutional Special Needs Plans), Medicare Prescription Drug Plans, Medicare Supplement (Medigap) Insurance
- Number of Plans 7
- Customer Service Telephone, online, in-person seminar
- Phone Number Prospective Members: 877-470-4131; Current Medicare Advantage and Medicare Supplement Insurance (Medigap) members: 866-805-4589; Medicare Prescription Drug Plan members call state-specific number.
- Official Website www.amerigroup.com
- Focus on public insurance programs: Amerigroup exclusively offers public health insurance, including Medicare, Medicaid, and other state-based insurance. The company’s focus on public programs gives it depth of experience and demonstrates the company’s commitment to people who qualify for public insurance.
- Several plan options: Amerigroup offers comprehensive Medicare Advantage plans, including several types of Special Needs Plans. It also offers supplemental coverage for members who don’t want comprehensive managed care coverage.
- Backed by Anthem: Amerigroup is a multi-state health plan but is backed by one of the nation’s largest health insurers, Anthem. This relationship gives Amerigroup even stronger financial footing, though on its own it also gets excellent financial strength ratings.
- Limited geographic coverage: Amerigroup offers some form of Medicare insurance in seven states, but only offers its Medigap plans in Arizona and Texas.
- Average quality ratings: Though it’s hard to get the top Star Ratings from CMS, Amerigroup plans average just above 3.0 out of 5.0, making it a squarely average plan in terms of quality.
Amerigroup offers several types of Medicare plans, including Medicare Advantage, Medicare Supplement Insurance (Medigap) Plans, and Stand-alone Prescription Drug Plans.
Medicare Advantage Plans
Amerigroup offers Medicare Advantage HMO plans which include all the benefits of Original Medicare combined with coverage for services excluded from Original Medicare. Many Amerigroup HMO plans include coverage for prescriptions as well as dental and vision services. These plans also cap the out-of-pocket costs members have to pay in a year, which Original Medicare does not. HMOs typically require members to choose a primary care doctor who acts as a gatekeeper to specialists you might need.
Special Needs Plans
Special Needs Plans (SNPs) are designed for people who have specific conditions and/or lower incomes and qualify for both Medicaid and Medicare. These plans cover Original Medicare components along with prescription drugs, dental, vision, and hearing. Amerigroup offers three types of SNPs, all of which count as Medicare Advantage HMO plans:
- Chronic Conditions Special Needs Plan (C-SNP): People with diabetes, cardiovascular disease, or chronic heart failure may qualify for a C-SNP. Amerigroup C-SNPs have no monthly premiums, no deductibles, and no copayments.
- Dual-eligible special needs plan (D-SNP): D-SNPs are for people who qualify for Medicaid based on their income along with Medicare. Amerigroup’s D-SNPs cover dental, vision, hearing, and prescription drug coverage along with Original Medicare services. These plans also include extra benefits such as transportation and meal deliveries.
- Institutional special needs plan (I-SNP): I-SNPs are for people who qualify for Medicare and live in a facility such as a nursing home or assisted living community. In addition to covering all the benefits of Original Medicare, Amerigroup’s I-SNPs offer prescription drug coverage and $0 deductibles though they do include low monthly premiums.
Medicare Supplement (Medigap) Insurance Plans
Medigap plans are supplemental plans that cover some of what Original Medicare doesn’t. Amerigroup offers Medigap plans in Arizona and Texas.
Stand-alone Prescription Drug Plans
Prescription Drug Plans cover drug costs, which Original Medicare does not. These plans complement Original Medicare or other supplemental coverage but are usually not compatible with Medicare Advantage plans because most Medicare Advantage plans include prescription coverage. Amerigroup contracts with a network of more than 66,000 pharmacies, including 24,000 preferred pharmacies which may offer better pricing for Amerigroup members. Premiums start at $20.50 per month and copayments can be as low as $1 for generic drugs. As always with health insurance plans, specific costs vary by plan and by state.
Many Amerigroup Medicare Advantage plans include extra dental, vision, and hearing coverage, membership in the SilverSneakers fitness program, and over-the-counter allowances.
For lower-income members, Amerigroup also offers special discounts, including low or zero-dollar premiums, copayments as low as $0, telehealth visits, and allowances for transportation, personal care helpers, and healthy food deliveries.
Prospective members can call 877-470-4131 between 8 a.m. and 8 p.m., seven days a week.
Medicare Advantage and Medigap
Current Medicare Advantage and Medicare Supplement Insurance (Medigap) members can call member services at 866-805-4589 between 8 a.m. and 8 p.m. seven days a week from October 1 through February 14, excluding Thanksgiving and Christmas. Between February 15 and September 30, member services are open Monday through Friday.
Prescription Drug Plans and Special Needs Plans
Medicare Prescription Drug Plan members in either HMO or Special Needs Plans call their local member services lines:
- Arizona: 888-816-2790
- New Jersey: 844-765-5160
- Tennessee: 877-411-0929
- Texas: 844-765-5165
- Washington: 844-812-2275
Medicare Prescription Drug Plan members in an HMO-POS or Chronic Special Needs Plan call their local member services line:
- New Jersey: 844-887-6350
- Texas: 877-269-5660
To track customer satisfaction with insurance companies, the National Association of Insurance Commissioners (NAIC) calculates a complaint index. This index reflects the number of complaints against an insurer relative to its market share. The lower the ratio, the better. A ratio greater than 1.0 indicates that the company had more than its share of complaints lodged against it.
Amerigroup has several subsidiary companies, each with different complaint index results. The Amerigroup plan in Arizona and Texas, for example, had a 2020 complaint index of 1.99—double what it should have given its size—though that reflected just one complaint. It had zero complaints against its Medigap plans. In 2019 and 2018, this plan had no complaints against it at all across all insurance lines of business according to NAIC.
Amerigroup New Jersey had no complaints in 2020, but it had seven in 2019 for a complaint index of 7.30. It had 18 complaints in 2018 for a complaint index of 17.88. These complaints could relate to the plan’s Medicaid business in New Jersey and/or to its Medicare plans, but there were no complaints against its Medigap plan in these three years.
Credit rating agency AM Best evaluates insurance companies on their financial strength. Not all Amerigroup plans are rated, but all those that are received a financial strength rating of A- (Excellent). In December 2020, AM Best affirmed this rating for Amerigroup as part of its overall assessment of Anthem and its subsidiaries. Anthem as a whole received an A (Excellent) rating, indicating the credit agency’s assessment that the insurer is well-positioned to meet its financial obligations.
Ratings from the National Committee for Quality Assurance (NCQA), a national health insurance accrediting body, reflect measures of customer satisfaction, members’ access to healthcare services, and the quality of care members receive. Though several of Amerigroup’s Medicaid plans are rated by NCQA, its Medicare plans did not participate in 2019-2020 ratings.
Amerigroup wasn’t specifically noted in J.D. Power’s 2020 U.S. Medicare Advantage Study, but its parent company, Anthem, tied for seventh place (with BlueCross BlueShield of Michigan) on the study’s overall customer satisfaction index ranking. Anthem scored 779 points out of 1,000, putting it just below the industry average of 800.
Medicare Star Ratings
Only four Amerigroup plans received Star Ratings from the Centers for Medicare and Medicaid Services (CMS), a standard way to assess a Medicare health plan’s quality. In the 2020 ratings, these plans received 3.0 and 3.5 stars out of 5.0, averaging 3.13. Several other Amerigroup plans were too new to be rated or did not have sufficient data available to be included.
While Amerigroup’s CMS Star Ratings are not bad, you may be able to find a plan with better ratings indicating higher quality.
Health plan costs include premiums, deductibles, copayments, and coinsurance, all capped by an out-of-pocket maximum that sets a limit for the most a member would have to pay in a year. The best way to find specific costs is to search by zip code, carrier, and plan type on Medicare.gov. To illustrate Amerigroup’s pricing, average pricing for its 2021 Medicare Advantage HMO plans in Tennessee include:
- Monthly Premiums: Premiums range from $0 to $30.20 and average $13.93.
- Annual Deductibles: These plans have either $0 or $445 annual drug deductibles.
- Out-of-pocket Maximums: Out-of-pocket cost caps range from $4,900 to $6,700, averaging $6,200.
Competition: Amerigroup vs. Aetna
Amerigroup competes with different dominant plans in different states, but Aetna is one of the largest plans in several states Amerigroup operates in, including Iowa, New Jersey, and Texas. Aetna covers a much wider geography, but on a head-to-head comparison where both plans operate, Aetna wins for quality. Its average Star Ratings are higher than Amerigroup’s and Aetna participated in the 2019-2020 NCQA Medicare ratings, which Amerigroup did not.
Aetna also edged out Amerigroup’s parent company, Anthem, in the J.D. Powers 2020 Medicare Advantage study. Amerigroup has more types of Special Needs Plans, so for people with special needs, it may be the better option. Costs vary so it’s important to compare specific plans in specific areas for a direct comparison. For quality, although Aetna’s not perfect and Amerigroup’s not bad, Aetna comes out on top.
|Number of States Available||7||46|
|Customer Service Options||Telephone, online, in-person seminar||Phone, request a call, email (through website)|
|AM Best Rating||A- (Excellent)||A (Excellent)|
|Average CMS Star Rating||3.13||3.74|
Amerigroup is a reasonable Medicare insurance option, especially if you’re looking for a Special Needs Plan in the areas where Amerigroup offers them. Backed by Anthem, Amerigroup has the depth of resources of an even bigger plan. It has a range of options and extra benefits, but in terms of quality ratings, you may be able to do better.
How We Reviewed Medicare Providers
Even Medicare health plans with a national presence can vary locally in their cost, quality, and customer satisfaction. To evaluate Medicare plans, we looked at health insurance industry ratings from the primary accrediting agency for health plans, NCQA, and the Medicare Star Ratings from CMS, the regulatory agency that oversees Medicare. We included the National Association of Insurance Commissioners’ complaint index, and AM Best’s financial stability ratings. We also considered information from the companies on their programs and strategies.
Center for Medicare & Medicaid Services. “Part C and D Performance Data, 2021 Star Ratings Data Table.” Accessed December 11, 2020.
Insurance Business America. “Top 10 health insurance companies in the US.” Accessed March 24, 2021.
AM Best. “Search results: Amerigroup credit ratings.” Accessed March 24, 2021.
National Association of Insurance Commissioners. “Amerigroup Ins Co National Complaint Index Report.”Accessed March 24, 2021.
National Association of Insurance Commissioners. “AMERIGROUP NJ Inc National Complaint Index Report.” Accessed March 24, 2021.
AM Best. “Search results: Amerigroup credit ratings.” Accessed March 24, 2021.
AM Best. “AM Best Affirms Credit Ratings of Anthem, Inc. and Its Subsidiaries.” Accessed March 24, 2021.
NCQA. “NCQA Health Insurance Plan Ratings 2019-2020 – Summary Report (Medicare).” Accessed March 24, 2021.
J.D. Power. “Medicare Advantage Plans Struggle to Communicate Effectively with Members, J.D. Power Finds.” Accessed March 5, 2021.
Centers for Medicare and Medicaid Services. “2021 MA Landscape Source Files.” Accessed January 19, 2021.
Becker’s Payer Issues. “The largest Medicare Advantage insurers in each state.“ Accessed March 24, 2021.
NCQA. “NCQA Health Insurance Plan Ratings 2019-2020 - Summary Report (Medicare).” Accessed December 9, 2020.