Amerihealth
AmeriHealth is a privately held regional health insurance company founded in 1994, serving 265,000+ members in New Jersey and Pennsylvania with HMO, PPO, Medicare Advantage, Medigap, and self-funded employer plans through wholly-owned subsidiaries and broker channels.
- Company typePrivate
- Founded1988
- HeadquartersPhiladelphia, United States
- Headcount501–1,000
- GTM typeB2B and B2C
- OfferingServices
What Amerihealth does
AmeriHealth is a privately held regional health insurance company founded in 1994 and headquartered in Cranbury, New Jersey (with a Philadelphia mailing address), serving more than 265,000 members across New Jersey and Pennsylvania. The company offers a comprehensive portfolio including commercial HMO and PPO plans for individuals, families, and employers; Medicare Advantage PPO plans (Core Rx, Secure Rx, Ultimate Rx, Enhanced Rx variants) available in seven New Jersey counties; Medicare Supplement (Medigap) plans; self-funded third-party administration through its AmeriHealth Administrators subsidiary; and Medicaid and community-based coverage through AmeriHealth Caritas. Its product surface is augmented by supplemental benefit partnerships spanning dental (Dominion Dental), vision (Davis Vision), hearing (TruHearing), fitness (One Pass), transportation (Roundtrip), telemedicine (Teladoc Health), oncology support (Thyme Care), in-home health assessments (ComplexCare Solutions), and rewards program management (New Ocean Health Solutions).
AmeriHealth's underlying technology stack is a standard carrier platform: a member portal and mobile app (iOS/Android), provider finder, prescription drug lookup, CMS ONC Patient Access API for Medicare PPO members enabling third-party app data sharing, and machine readable files published on Google Cloud Storage and FM Formulary Navigator for plan, provider, pharmacy, and formulary data. Utilization management — precertification for radiology, cardiology, sleep, musculoskeletal, oncology, genetic testing, and home-care services — is handled by external partners Carelon Medical Benefits Management, eviCore Healthcare, and Tango Health rather than in-house automation.
The business model centers on recurring health insurance premiums across commercial, Medicare Advantage, Medigap, and Medicaid lines, supplemented by managed services revenue from AmeriHealth Administrators' TPA business and professional services fees. Distribution combines direct website enrollment, employer direct sales across small business/large business/public sector/self-funded segments, a dedicated Medicare broker resource center with Litmos-powered training and certification, and self-service member portals. Pricing varies by plan type and is not publicly disclosed for commercial plans; Medicare plan premiums shown include $0 entries (Core Rx, Ultimate Rx) and a $36 monthly premium for the Enhanced Rx plan, with Extra Help/Low Income Subsidy reducing premiums to $0 for qualifying beneficiaries. The company has been recognized as one of NJBIZ's Best Places to Work in New Jersey for 14 consecutive years as of 2025.
Amerihealth firmographics
Firmographics- Name
- Amerihealth
- Legal name
- AmeriHealth
- Website
- https://www.amerihealth.com
- Company type
- Private
- Founded year
- 1988
- Operating status
- Operating
- Headcount range
- 501–1,000 employees
- Short description
- AmeriHealth is a privately held regional health insurance company founded in 1994, serving 265,000+ members in New Jersey and Pennsylvania with HMO, PPO, Medicare Advantage, Medigap, and self-funded employer plans through wholly-owned subsidiaries and broker channels.
- Ownership category
- akta.pro rank
Amerihealth industry classification
Industry- Product category
- Health Insurance
- NAICS
- Direct Health and Medical Insurance Carriers (524114)
- SIC
- Hospital & Medical Service Plans (6324)
- akta.pro primary industry
- MA PPO Plans (Local/Regional PPO) (HLAEACAB)
Keywords
Where Amerihealth is headquartered
LocationHeadquarters
- HQ city
- Philadelphia
- HQ country
- United States
- HQ region
- North America
Offices2 records
Markets served
Amerihealth business model
Business model- GTM type
- B2B and B2C
- Offering type
- Services
- Cost components
- Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure, Supply Chain
Revenue model
- Health Insurance Premiums: AmeriHealth generates primary revenue through health insurance premiums paid by individuals, families, and employers for medical coverage including HMO and PPO plans.
- Medicare Advantage Plans: Revenue from Medicare Advantage PPO plans offered to Medicare beneficiaries, including prescription drug coverage (Part D) and supplemental benefits.
- Self-Funded Plan Administration: Administrative services for employers choosing self-funded health plans, providing flexibility and potential cost savings for larger organizations.
- Third-Party Administration (TPA): AmeriHealth Administrators provides TPA services to help employers manage self-funded employee health benefit plans.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Subscription | Monthly | AmeriHealth Medicare Enhanced Rx PPO - Standard premium |
| Subscription | Monthly | AmeriHealth Medicare Core Rx PPO |
| Subscription | Monthly | AmeriHealth Medicare Ultimate Rx PPO |
| Usage-based | Pay-as-you-go | Medicare Part D Out-of-Pocket Cap 2026 |
| Unit Pricing | Monthly | Insulin Cost-Sharing Cap |
Go-to-market motion3 records
Distribution channels5 records
Marketing channels7 records
Amerihealth product offering
Product offeringCore offering
AmeriHealth is a health insurance company that sells HMO and PPO plans to individuals, families, and employers in New Jersey and Pennsylvania, including Medicare Advantage PPO plans, Medicare Supplement (Medigap) coverage, and third-party administration (TPA) services for self-funded employer plans through its AmeriHealth Administrators subsidiary.
Product overview
AmeriHealth is a health insurance company established in 1994 offering a comprehensive portfolio of health plans and wellness programs for individuals, families, and employers in New Jersey (and formerly Pennsylvania). The company represents more than 265,000 members nationwide. The product architecture consists of core health insurance plans (HMO and PPO options for individuals/employers) supplemented by Medicare Advantage offerings including AmeriHealth Medicare PPO plans with various prescription drug tiers (Core Rx, Secure Rx, Ultimate Rx, Enhanced Rx), Medigap Supplement plans, and third-party administered benefits (dental via Dominion Dental, vision via Davis Vision, hearing via TruHearing, fitness via One Pass, transportation via Roundtrip). Wellness programs include Baby FootSteps maternity program, Embrace Well-being Program, Registered Nurse Health Coaches, and behavioral health services. The company provides member portals, mobile apps (iOS/Android), and machine readable files for data access. Subsidiaries include AmeriHealth Administrators (TPA services), AmeriHealth Caritas (Medicaid), and AmeriHealth Medicare. Third-party partnerships with Carelon, eviCore, and Tango Health handle utilization management while New Ocean Health Solutions manages rewards programs.
Differentiator
Problem solved
Functional benefit
Brands
- Embrace Well-being Program: A well-being program offering members support to reach their health goals, including wellness resources and rewards.
- Baby FootSteps Maternity Program
- AmeriHealth Medicare PPO
- AmeriHealth Core Rx PPO
- AmeriHealth Secure Rx PPO
- AmeriHealth Ultimate Rx PPO
- AmeriHealth Medicare Enhanced Rx PPO
- AmeriHealth Medigap
Products and services
- NJ Health Insurance Plans Health insurance coverage for individuals, families, and employers in New Jersey, including HMO and PPO plan options with varying network sizes, premiums, deductibles, and coverage levels.
- Medicare Advantage PPO Plans Medicare Advantage PPO plans offered by AmeriHealth Insurance Company of New Jersey for New Jersey residents, including Medicare Part C coverage, Part D prescription drug coverage, dental, vision, and hearing benefits. Available across Core Rx, Secure Rx, Ultimate Rx, and Enhanced Rx tiers in Atlantic, Burlington, Camden, Gloucester, Mercer, Middlesex, and Ocean counties.
Quantifiable outcome
- Over 265,000 members served nationwide
- +1 more outcomes
Companies that use Amerihealth
Customer profileSegments5 records
Ideal customer profiles4 records
Amerihealth technology and API
TechnologyTechnology focussed No
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Integration17 records
Feature6 records
Amerihealth partnerships and signals
Strategic signalPartnerships
Twelve partnerships are on record, tiered core, supporting and minor.
- Davis VisioncoreDavis Vision provides vision benefits administration for AmeriHealth members, including access to the Davis Vision provider network for eye exams and eyewear.
- Thyme CaresupportingThyme Care provides a Cancer Support Team for AmeriHealth members, offering dedicated support and resources for members dealing with cancer diagnoses.
- RoundtripsupportingRoundtrip provides transportation benefits for AmeriHealth Medicare members, helping with non-emergency medical transportation needs.
- One PasssupportingOne Pass provides a voluntary fitness membership program for eligible AmeriHealth Medicare Advantage beneficiaries, offering gym and wellness club access.
- Teladoc HealthsupportingTeladoc Health provides telemedicine services accessible through AmeriHealth plans, enabling virtual doctor visits for members.
- ComplexCare SolutionssupportingComplexCare Solutions (an affiliate of Inovalon, Inc.) performs personal health visits for AmeriHealth members to help identify and address care gaps.
- New Ocean Health SolutionssupportingNew Ocean Health Solutions manages the AmeriHealth rewards program for members, including coordination of health care activity rewards.
- Tango Card, Inc.minorTango Card, Inc. manages the gift card service related to the AmeriHealth rewards program for eligible Medicare Advantage beneficiaries.
- TruHearingsupportingTruHearing provides hearing aid benefits and access to TruHearing providers for AmeriHealth Medicare members.
- Dominion DentalsupportingDominion Dental provides dental provider network access and finder tools for AmeriHealth Medicare plan members.
- AmeriHealth CaritascoreAmeriHealth Caritas is a subsidiary company of AmeriHealth focused on Medicaid and community-based health plan offerings.
- AmeriHealth AdministratorscoreAmeriHealth Administrators provides third-party administration (TPA) services for self-funded employer health benefit plans.
Scale indicators3 records
Recent moves6 records
Expansion highlights5 records
Amerihealth competitors and assessment
Company assessmentRegional players
- CDPHP: Physician-founded regional health plan in upstate New York offering commercial HMO/POS, Medicare, and Medicaid products. Comparable as a regional nonprofit-style payer with HMO emphasis; differs geographically but analogous in scale and regulatory exposure.
Broad incumbents
- Elevance Health (Anthem Blue Cross Blue Shield): Multi-state BCBS-licensed carrier offering commercial, MA, and Medicaid plans across the Northeast including NJ/PA. Overlaps with AmeriHealth's product portfolio via Anthem Blue Cross Blue Shield plans and aggressive MA growth strategy.
- UnitedHealthcare: Largest US health insurer, offering national commercial, MA, and Medicaid products. Competes across every AmeriHealth segment, particularly through its Optum-backed MA-PD plans in NJ, and via extensive broker relationships.
- Cigna: National health services company offering employer-sponsored, individual, and Medicare Advantage plans. Comparable to AmeriHealth on commercial group/individual core products, even though Cigna's MA mix is smaller.
- Aetna (CVS Health): Major national health insurer with HMO, PPO, MA, and Medicare Supplement plans and vertically integrated PBM and retail-clinic assets. Directly comparable to AmeriHealth across all commercial and MA lines, including Medigap.
- Humana: One of the largest US Medicare Advantage carriers, competing head-on with AmeriHealth's MA PPO SKUs in NJ and nationally. Highly comparable on MA product design (PPO/HMO with Part D) and broker distribution, but at vastly greater scale.
Direct peers
- Capital Blue Cross: Pennsylvania-based BCBS regional carrier offering commercial and Medicare Advantage plans. Closely matches AmeriHealth's residual PA presence and its HMO/POS plan architecture for employer groups.
- Independence Blue Cross: Philadelphia-based commercial and MA carrier historically tied to the AmeriHealth organization. Operates HMO/PPO plans across PA with overlapping product architecture (individual, employer, MA PPO) and broker channel distribution.
- Highmark Blue Cross Blue Shield: BCBS-licensed payer across PA, WV, and DE with commercial, MA, and third-party-administration products. Compares directly to AmeriHealth on product mix and Northeast regional focus, including PPO Medicare Advantage offerings.
- Horizon Blue Cross Blue Shield of New Jersey: Dominant NJ commercial and MA carrier, the most direct in-state competitor to AmeriHealth on HMO, PPO, and Medicare Advantage products. Highly comparable because both are NJ-domestic HMO/PPO health insurers serving employer, individual, and MA segments.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat5 records
Key risks6 records
Key highlights7 records
Customer concentration
Amerihealth social profiles
Digital presenceAmerihealth financial estimates
Financial estimateRevenue estimate
Valuation estimate
Amerihealth leadership team
Management profileNumber of profiles
Amerihealth subsidiaries and ownership
Company hierarchySubsidiaries3 records
Amerihealth funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Amerihealth M&A and investment
M&A and investmentM&A
Investments5 records
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Amerihealth
What does Amerihealth do?
AmeriHealth is a health insurance company that sells HMO and PPO plans to individuals, families, and employers in New Jersey and Pennsylvania, including Medicare Advantage PPO plans, Medicare Supplement (Medigap) coverage, and third-party administration (TPA) services for self-funded employer plans through its AmeriHealth Administrators subsidiary.
Is Amerihealth a public or private company?
Amerihealth is a private company. It is classified as unknown and is currently operating.
When was Amerihealth founded?
Amerihealth was founded in 1988. It employs 501 to 1,000 people.
Where is Amerihealth based?
Amerihealth is headquartered in Philadelphia, United States, in the North America region.
How does Amerihealth make money?
Four revenue lines are on record. Health Insurance Premiums are the primary driver. The others are medicare Advantage Plans, self-Funded Plan Administration and third-Party Administration (TPA).
Who are Amerihealth's main competitors?
CDPHP is listed as a regional player. Broad incumbents are Elevance Health (Anthem Blue Cross Blue Shield), UnitedHealthcare, Cigna, Aetna (CVS Health) and Humana. Direct peers are Capital Blue Cross, Independence Blue Cross, Highmark Blue Cross Blue Shield and Horizon Blue Cross Blue Shield of New Jersey.
Does Amerihealth have an API?
No public API is recorded for Amerihealth.
What industry is Amerihealth in?
Amerihealth's product category is Health Insurance. Its primary akta.pro industry code is HLAEACAB, MA PPO Plans (Local/Regional PPO). Its NAICS code is 524114 and its SIC code is 6324.