AmeriHealth Caritas
AmeriHealth Caritas is a Philadelphia-based managed care organization administering Medicaid, Medicare D-SNP, Marketplace, LTSS, and behavioral health plans for low-income and chronically ill populations across 13 states and the District of Columbia, majority-owned by Independence Health Group.
- Company typePrivate
- Founded1983
- HeadquartersPhiladelphia, United States
- Headcount5,001–10,000
- GTM typeB2B
- OfferingServices
What AmeriHealth Caritas does
AmeriHealth Caritas is a Philadelphia-based managed care organization founded in 1983 that administers government-sponsored and commercial health insurance products for low-income, chronically ill, and dual-eligible populations across 13 states and the District of Columbia. Its core product portfolio comprises Medicaid managed care plans (including Keystone First in Pennsylvania, Blue Cross Complete of Michigan, and First Choice in South Carolina), Medicare Dual-Eligible Special Needs Plans under the VIP Care brand, Health Insurance Marketplace plans under AmeriHealth Caritas Next, managed long-term services and supports (LTSS) including the Pennsylvania Community HealthChoices contract covering nearly 400,000 lives, behavioral health services through the PerformCare subsidiary, and (until end of 2026) pharmacy benefit management through PerformRx, with contracts transitioning to OptumRx. The company is 61.3% owned by Independence Health Group and operates with 5,001-10,000 employees.
The underlying technology stack integrates whole-person care coordination, value-based care contracting (PerformPlus suite including SPARC models for small and rural providers), proprietary PBM technology (PerformRx), specialty pharmacy operations (PerformSpecialty), and population health analytics. Revenue is generated primarily through capitation payments from state Medicaid agencies on a per-member-per-month basis, Medicare Advantage premiums for D-SNP enrollees, Marketplace premiums, and ancillary pharmacy and care management fees. The company pursues a multi-channel go-to-market combining state government RFP participation, broker/agent distribution for Marketplace products, provider network recruitment, and community-based outreach (Healthy Hoops, Bright Start, Mission GED, Pathways to Work) to address social determinants of health and differentiate on health equity outcomes. Strategic direction is heavily influenced by state-level contract cycles, with active expansion into Indiana and Idaho offset by the planned exit from the PBM vertical in 2026.
AmeriHealth Caritas firmographics
Firmographics- Name
- AmeriHealth Caritas
- Legal name
- AmeriHealth Caritas
- Website
- https://amerihealthcaritas.com
- Company type
- Private
- Founded year
- 1983
- Operating status
- Operating
- Headcount range
- 5,001–10,000 employees
- Short description
- AmeriHealth Caritas is a Philadelphia-based managed care organization administering Medicaid, Medicare D-SNP, Marketplace, LTSS, and behavioral health plans for low-income and chronically ill populations across 13 states and the District of Columbia, majority-owned by Independence Health Group.
- Ownership category
- akta.pro rank
AmeriHealth Caritas industry classification
Industry- Product category
- Managed Care / Health Insurance
- NAICS
- Direct Life, Health, and Medical Insurance Carriers (52411)
- SIC
- Hospital & Medical Service Plans (6324), Services-Health Services (8000)
- akta.pro primary industry
- Care Management & Population Health Program Administration (HLAEALAG)
- akta.pro secondary industries
- Medicare Advantage (MA) Plans (FSAIAGAA), MA-PD Plans (Medicare Advantage with Prescription Drug Coverage) (FSAIAGAG)
Keywords
Where AmeriHealth Caritas is headquartered
LocationHeadquarters
- HQ city
- Philadelphia
- HQ country
- United States
- HQ region
- North America
Offices2 records
Markets served
AmeriHealth Caritas business model
Business model- GTM type
- B2B
- Offering type
- Services
- Cost components
- Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure, Supply Chain
Revenue model
- Medicaid Managed Care Capitation: States pay a set amount per member per month (capitation) to AmeriHealth Caritas for administering Medicaid health benefits. The company arranges for provision of covered healthcare services to enrollees and bears responsibility for managing costs within the capitated amount.
- Medicare Advantage D-SNP Premiums: Revenue from Medicare Advantage Dual-Eligible Special Needs Plans for beneficiaries entitled to Medicare Part A, enrolled in Medicare Part B, and receiving Medical Assistance. Plans provide supplemental benefits beyond original Medicare.
- Health Insurance Marketplace Premiums: Revenue from individual and family health plans offered on and off the Health Insurance Marketplace through AmeriHealth Caritas Next brand. Plans cover 10 essential health benefits and are offered in gold, silver, and bronze tiers.
- Pharmacy Benefits Management (PerformRx): In-house PBM services providing formulary management, drug benefit structuring, prescription claims processing, pharmacy contracting, and cost control for Medicaid, Medicare, and commercial clients. Company announced closure of PerformRx PBM at end of 2026.
- Specialty Pharmacy (PerformSpecialty): URAC accredited specialty pharmacy providing high-cost medications for complex chronic conditions with customized care teams and patient management programs.
- Behavioral Health Managed Care (PerformCare): Full-service behavioral health managed care through PerformCare, serving Medicaid, Medicare, wellness, and specialty products including I/DD services, substance use treatment, and suicide prevention.
- Long-Term Services and Supports (LTSS): Managed LTSS programs for elderly, disabled, and those needing help with everyday activities. Includes non-rehabilitative nursing facility-level care and home-based support services.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Subscription | Monthly | Medicaid managed care plans with state-negotiated capitation rates |
| Subscription | Monthly | Medicare Advantage D-SNP plans with supplemental benefits |
| Subscription | Monthly | Individual and family health plans (gold, silver, bronze tiers) |
Go-to-market motion4 records
Distribution channels8 records
Marketing channels8 records
AmeriHealth Caritas product offering
Product offeringCore offering
AmeriHealth Caritas is a managed care organization that administers government-sponsored and commercial health plans for Medicaid, CHIP, Medicare Dual-Eligibles (D-SNPs), and Health Insurance Marketplace populations across 13 states and DC. It delivers care coordination, behavioral health, long-term services and supports, and in-house pharmacy benefits management through its subsidiaries PerformRx, PerformSpecialty, and PerformCare. Its core deliverable is whole-person managed care with capitated reimbursement from state agencies and premium-based individual plans.
Product overview
AmeriHealth Caritas operates as a managed care organization (MCO) offering a platform-plus-modules architecture. The core offerings include Medicaid managed care plans across 13 states and DC, Medicare Dual-Eligible Special Needs Plans (AmeriHealth Caritas VIP Care), Individual and Family Health Plans (AmeriHealth Caritas Next), Long-Term Services and Supports (LTSS), and Behavioral Health Care (PerformCare). The portfolio includes wholly-owned subsidiaries PerformRx (pharmacy benefits management) and PerformSpecialty (specialty pharmacy). Supporting modules include community health outreach programs (Bright Start maternal health, Healthy Hoops, Health Empowerment Tour), workforce development (Mission GED, Pathways to Work), value-based care programs (PerformPlus/SPARC), and social determinants interventions (Let Us Know program). Regional sub-brands include Keystone First (Pennsylvania) and Select Health of South Carolina/First Choice.
Differentiator
Problem solved
Functional benefit
Brands
- AmeriHealth Caritas VIP Care: Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP) for beneficiaries eligible for both Medicare and Medicaid
- AmeriHealth Caritas Next
- AmeriHealth Caritas VIP Care Choice
- First Choice Next
- First Choice VIP Care
- Keystone First VIP Choice
Products and services
- Medicaid Managed Care Comprehensive Medicaid managed care organization (MCO) services for low-income and chronically ill populations including Medicaid and CHIP beneficiaries across multiple states.
- AmeriHealth Caritas VIP Care (D-SNP) Medicare Dual-Eligible Special Needs Plans (D-SNPs) for individuals entitled to Medicare Part A, enrolled in Part B, and receiving Medical Assistance, including those with cognitive disabilities, physical impairments, or chronic conditions.
- AmeriHealth Caritas Next Individual and family health plans offered on and off the Health Insurance Marketplace with gold, silver, and bronze tier options covering 10 essential health benefits.
- Long-Term Services and Supports (LTSS) Comprehensive LTSS programs for elderly and disabled individuals requiring assistance with activities of daily living including bathing, dressing, eating, and medication management, including Pennsylvania Community HealthChoices covering nearly 400,000 people.
- PerformCare (Behavioral Health Managed Care) Full-service behavioral health managed care providing mental health services, intellectual and developmental disability (I/DD) services, substance use treatment, and suicide prevention programs.
- PerformRx (Pharmacy Benefits Management) URAC- and NCQA-accredited pharmacy benefits manager providing formulary management, drug benefit structuring, prescription claims processing, pharmacy contracting, and cost control. Contracts transferring to OptumRx effective January 1, 2027.
- PerformSpecialty (Specialty Pharmacy) URAC-accredited specialty pharmacy providing high-cost specialty pharmaceuticals for complex and chronic health conditions with personalized care teams and disease management programs.
- Community HealthChoices Pennsylvania-based managed LTSS program covering nearly 400,000 people, coordinating physical health and long-term services and supports under a $7 billion+ program.
- Keystone First AmeriHealth Caritas Pennsylvania Medicaid managed care plan serving Philadelphia and southeastern Pennsylvania, including CHIP and Community HealthChoices.
- Select Health of South Carolina (First Choice) South Carolina health plan offering Medicaid managed care, Health Insurance Marketplace plans (First Choice Next), and Dual-Eligible Special Needs Plans (First Choice VIP Care).
- PerformPlus with SPARC Value-Based Contracting Suite of value-based care programs including SPARC (Small Providers and Rural Communities) models for small and rural providers, episode-based solutions, and programs aggregating performance metrics across participating providers. Implemented in Louisiana and New Hampshire Medicaid plans.
Quantifiable outcome
- 45% reduction in inpatient admissions per member per year
- +11 more outcomes
Companies that use AmeriHealth Caritas
Customer profileNamed customers12 records
Segments7 records
Ideal customer profiles4 records
AmeriHealth Caritas technology and API
TechnologyTechnology focussed No
API detail
- Has API
- Yes
- API docs
- API detail
Core technology
AI maturity
App detail
Integration4 records
Feature12 records
AmeriHealth Caritas partnerships and signals
Strategic signalPartnerships
20 partnerships are on record, tiered core and minor.
- NC Community College SystemcorePartnership to address healthcare workforce shortage through $6 million Boost program expansion including Wake Technical Community College expansion and Bridge pilot program for short-term healthcare credentials.
- Wake Technical Community Collegecore$3 million expansion funding for students pursuing healthcare degrees as part of Boost program addressing statewide healthcare workforce shortfall.
- Nest HealthminorLaunch of Nest Origin in-home prenatal services program for Medicaid beneficiaries in New Orleans, Louisiana. Program reports 60% reduction in ED utilization and 2:1 ROI for AmeriHealth Caritas Louisiana. Outcomes to be studied by University of Pennsylvania researchers.
- Local Food Bank (Pennsylvania)coreValue-based program partnership in Pennsylvania where food bank is actively involved in members' care ensuring proper food and nutrition after medical encounters. Tracks outcomes as part of value-based care construct through Caring Communities virtual ACO.
- Louisiana State University (LSU) Health Sciences CenterminorPartnership for Population Health Clerkship offering fourth-year medical students and residents four-week remote rotation in Medicaid managed care, population health, strategy, quality improvement, cost reduction, and health equity. Also hosts AmeriHealth Caritas Health Policy Honors Program for LSU medical students.
- Metropolitan Area Neighborhood Nutrition Alliance (MANNA)minorPartnership for nutritious meal delivery to AmeriHealth Caritas members with qualifying health needs in Philadelphia area as part of social determinants of health initiatives.
- Mom's MealsminorNationwide partnership for nutritious meal delivery to members with qualifying health needs as part of emergency food and social determinants of health programs.
- YMCAminorCollaboration for diabetes management program using in-person educational sessions including personalized wellness coaching, tailored exercise plans, nutrition workshops, and cooking demonstrations to improve health of members with Type 2 diabetes.
- Cristo Rey Philadelphia High SchoolminorWork Study Program partnership providing high-school students from low-income backgrounds hands-on experience with mentoring, coaching, and cross-functional skill development.
- National Gay & Lesbian Chamber of CommerceminorLGBTQ+-owned business certification and diversity organization partnership supporting supplier diversity initiatives.
- National Minority Supplier Development Council (NMSDC)coreNational minority supplier development organization partnership. AmeriHealth Caritas is two-time NMSDC Corporation of the Year and 2022 Forefront 50 Company award recipient.
- Women's Business Enterprise CouncilminorWomen-owned business certification organization partnership supporting supplier diversity; named 2022 Partner of the Year.
- Urban LeagueminorCivil rights organization partnership supporting economic empowerment and diversity initiatives.
- Minority Business Development AgencyminorFederal agency partnership supporting minority-owned business development and supplier diversity.
- African American Chamber of CommerceminorRegional chamber partnership supporting African American business development and supplier diversity.
- Hispanic Chamber of CommerceminorRegional chamber partnership supporting Hispanic business development and supplier diversity.
- District of Columbia Department of Small and Local Business DevelopmentminorGovernment agency partnership supporting small and local business development in DC market.
- National Association of Community Health Centers (NACHC)coreFQHC National Advisory Board partnership with AmeriHealth Caritas to improve health and well-being of underserved communities through strategic guidance, advocacy, and leadership for FQHC leaders nationwide.
- OptumRx (UnitedHealth Group)coreTaking over PerformRx PBM contracts in 13 states on January 1 following AmeriHealth Caritas decision to close PerformRx PBM. Inheritance includes Independence Health Group contracts.
- National Committee for Quality Assurance (NCQA)minorParticipation in NCQA inaugural Measuring Patient Engagement Learning Collaborative to inform and develop best practices in digital wellness, condition management, and patient engagement strategies.
Scale indicators24 records
Recent moves7 records
Expansion highlights5 records
AmeriHealth Caritas competitors and assessment
Company assessmentDirect peers
- Centene Corporation: Centene is the largest Medicaid managed care organization in the US, serving complex populations through its WellCare and other subsidiaries. Directly comparable to AmeriHealth Caritas as a multi-state Medicaid MCO with a focus on government-sponsored healthcare programs.
- Molina Healthcare: Molina is a pure-play Medicaid and government-sponsored managed care company operating across multiple states. Closely comparable to AmeriHealth Caritas in business model (state Medicaid contracts, D-SNP, Marketplace) and target population (low-income, dual-eligible).
- CareSource: CareSource is a nonprofit managed care company specializing in Medicaid, Medicare, and Marketplace plans across multiple states. Comparable to AmeriHealth Caritas as a multi-state MCO with strong mission orientation toward underserved populations and similar product mix.
- Humana: Humana is the second-largest Medicare Advantage insurer with a sizable D-SNP franchise serving dual-eligibles. Highly comparable to AmeriHealth Caritas's D-SNP business, though Humana is much larger and broader in scope (also serves commercial, group, and specialty populations).
- Highmark Health: Highmark is a major Blue Cross Blue Shield licensee in Pennsylvania with Medicaid managed care and integrated delivery system. Directly comparable as a Pennsylvania-based Blues-affiliated MCO with overlapping markets and similar Medicaid/LTSS offerings.
Broad incumbents
- UnitedHealth Group (UnitedHealthcare): UnitedHealth Group operates the largest US health insurer and through Optum is taking over AmeriHealth Caritas's PerformRx PBM contracts. Direct competitor across Medicaid, D-SNP, and Marketplace lines and now a key vendor partner via OptumRx.
- Elevance Health (Anthem): Elevance Health operates Blue Cross Blue Shield plans across multiple states with significant Medicaid managed care presence through Anthem Blue plans. Comparable as a major multi-state MCO serving Medicaid, D-SNP, and commercial populations, though with broader portfolio and Blues brand advantage.
- CVS Health (Aetna): CVS Health owns Aetna, a major health insurer with Medicaid, Medicare Advantage, and D-SNP offerings, plus integrated PBM (Caremark) and retail health. Comparable in product mix and integrated payer-PBM-provider model that AmeriHealth Caritas is moving away from with PerformRx closure.
- HCSC (Health Care Service Corporation): HCSC operates Blue Cross Blue Shield plans in five states and has expanded into Medicaid and Medicare Advantage. Comparable as a multi-state, mission-driven MCO with growing government programs footprint similar to AmeriHealth Caritas's expansion trajectory.
Regional players
- Inland Empire Health Plan (IEHP): IEHP is a nonprofit Medicaid and Medicare-Medicaid Plan serving California's Inland Empire region. Comparable as a Medicaid-focused MCO serving complex populations; recently hired AmeriHealth Caritas's former VP of Medicaid Plans as CFO.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat6 records
Key risks6 records
Key highlights7 records
Customer concentration
AmeriHealth Caritas social profiles
Digital presenceAmeriHealth Caritas compliance and trust
Trust signalCompliance11 records
AmeriHealth Caritas financial estimates
Financial estimateRevenue estimate
Valuation estimate
AmeriHealth Caritas leadership team
Management profileNumber of profiles
Profiles24 records
AmeriHealth Caritas subsidiaries and ownership
Company hierarchySubsidiaries6 records
AmeriHealth Caritas funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
AmeriHealth Caritas M&A and investment
M&A and investmentM&A
Investments1 record
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about AmeriHealth Caritas
What does AmeriHealth Caritas do?
AmeriHealth Caritas is a managed care organization that administers government-sponsored and commercial health plans for Medicaid, CHIP, Medicare Dual-Eligibles (D-SNPs), and Health Insurance Marketplace populations across 13 states and DC. It delivers care coordination, behavioral health, long-term services and supports, and in-house pharmacy benefits management through its subsidiaries PerformRx, PerformSpecialty, and PerformCare. Its core deliverable is whole-person managed care with capitated reimbursement from state agencies and premium-based individual plans.
Is AmeriHealth Caritas a public or private company?
AmeriHealth Caritas is a private company. It is classified as corporate owned and is currently operating.
When was AmeriHealth Caritas founded?
AmeriHealth Caritas was founded in 1983. It employs 5,001 to 10,000 people.
Where is AmeriHealth Caritas based?
AmeriHealth Caritas is headquartered in Philadelphia, United States, in the North America region.
How does AmeriHealth Caritas make money?
Seven revenue lines are on record. Medicaid Managed Care Capitation is the primary driver. The others are medicare Advantage D-SNP Premiums, health Insurance Marketplace Premiums, pharmacy Benefits Management (PerformRx), specialty Pharmacy (PerformSpecialty), behavioral Health Managed Care (PerformCare) and long-Term Services and Supports (LTSS).
Who are AmeriHealth Caritas's main competitors?
Direct peers on record are Centene Corporation, Molina Healthcare, CareSource, Humana and Highmark Health. Broad incumbents are UnitedHealth Group (UnitedHealthcare), Elevance Health (Anthem), CVS Health (Aetna) and HCSC (Health Care Service Corporation). Inland Empire Health Plan (IEHP) is listed as a regional player.
Does AmeriHealth Caritas have an API?
Yes. Developer Portal available for external developers. Specific API endpoints, types (REST/GraphQL), authentication methods, and rate limits not disclosed in available source materials. Developer documentation is at developer.amerihealthcaritas.com.
What industry is AmeriHealth Caritas in?
AmeriHealth Caritas's product category is Managed Care / Health Insurance. Its primary akta.pro industry code is HLAEALAG, Care Management & Population Health Program Administration, with a secondary code of FSAIAGAA, Medicare Advantage (MA) Plans. Its NAICS code is 52411 and its SIC code is 6324.