Amerigroup Benefits & Health Insurance | Real Solutions
Unlocking Comprehensive Amerigroup Benefits: A Deep Dive into Amerigroup Health Insurance and Real Solutions
In the complex landscape of American healthcare, navigating insurance options, particularly for government-sponsored programs, can be a formidable challenge. For millions of individuals and families, Amerigroup has emerged as a pivotal name, dedicated to providing access to quality care and support. As a prominent subsidiary of Elevance Health, Amerigroup specializes in designing and delivering health plans for those enrolled in state and federal programs like Medicaid and Medicare. This in-depth exploration will illuminate the core facets of the company, from its foundational history to the tangible Amerigroup benefits that impact members’ daily lives. We will examine the operational scale, the variety of Amerigroup health insurance products, and the innovative Amerigroup real solutions aimed at addressing the holistic well-being of its diverse membership. Whether you are a potential member, a healthcare provider, or an industry observer, this comprehensive overview serves as a definitive guide to the world of Amerigroup.
Amerigroup Basic Company Overview
Amerigroup stands as a leading manager of publicly funded health programs in the United States. Its fundamental mission is to improve health and well-being for its members, who are often among the nation’s most vulnerable populations. The company operates as a crucial component of Elevance Health’s Government Business Segment, leveraging the resources and stability of one of the largest health companies in the country to deliver localized, person-centric care.
The core operational model of Amerigroup is built on a partnership with state governments. It contracts with these states to administer their Medicaid programs, including the Children’s Health Insurance Program (CHIP), as well as specialized programs for aged, blind, and disabled (ABD) populations and those requiring long-term services and supports (LTSS). Additionally, Amerigroup offers a suite of Medicare products, primarily Medicare Advantage plans, which often include dual-eligible plans for individuals who qualify for both Medicare and Medicaid.
The philosophy guiding the company is the delivery of Amerigroup real solutions—a concept that extends beyond traditional medical claims processing. This approach emphasizes whole-person health, recognizing that factors outside the doctor’s office, known as social determinants of health (SDoH), profoundly influence health outcomes. These factors can include access to stable housing, nutritious food, reliable transportation, and community support. By integrating services that address these needs, Amerigroup aims to provide more effective, comprehensive, and compassionate care. This model is not only beneficial for members but also provides value to its state partners by improving health outcomes and managing costs more effectively. While Amerigroup’s direct offerings are in the government sector, the expertise it develops in managing complex health needs and costs provides valuable insights that inform the strategies of its parent company’s commercial offerings, including the employer group health plan market.
Amerigroup Company History
The story of Amerigroup is one of focused growth, strategic vision, and adaptation within the dynamic managed care industry. Its journey from a small, private startup to a cornerstone of a Fortune 50 healthcare giant reflects the evolving role of private companies in public healthcare.
Founding and Early Years
Amerigroup was founded in 1994 by Jeffrey L. McWaters in Virginia Beach, Virginia. McWaters, who had previous experience in the healthcare industry, saw a significant opportunity in the burgeoning field of Medicaid managed care. At the time, states were increasingly looking for ways to control spiraling Medicaid costs while improving the quality of care and access for beneficiaries. The managed care model, which involves a private company receiving a fixed per-member, per-month payment (capitation) from the state to manage a person’s healthcare, was seen as a promising solution.
The company’s initial vision was to focus exclusively on this niche, building expertise in serving the unique needs of the Medicaid population. This singular focus allowed Amerigroup to develop programs tailored to low-income families, pregnant women, and children, establishing a reputation for being a dedicated and knowledgeable partner for state governments.
Amerigroup Growth, IPO, and Expansion
The company grew rapidly through the late 1990s, winning contracts in new states and steadily increasing its enrollment. This success culminated in a major milestone in November 2001, when Amerigroup Corporation launched its initial public offering (IPO) on the New York Stock Exchange under the ticker symbol AGP. The capital raised from the IPO fueled further expansion, allowing Amerigroup to enter larger, more complex markets like Texas, Florida, and New York.
During this period, Amerigroup honed its care management programs, developing disease management initiatives for chronic conditions like asthma and diabetes, and creating outreach programs to ensure members, particularly new mothers and infants, received necessary preventative care. This hands-on approach was a key differentiator and a core component of its value proposition to state partners.
The Landmark Acquisition by WellPoint, Inc.
The most transformative event in Amerigroup’s history occurred on July 9, 2012, when WellPoint, Inc. (which would later rebrand as Anthem, Inc., and subsequently as Elevance Health) announced its agreement to acquire Amerigroup for approximately $4.9 billion. The acquisition was a strategic masterstroke for WellPoint, a company whose business was predominantly centered on commercial and employer group health plan insurance.
The rationale behind the acquisition was clear:
Market Diversification: The Affordable Care Act (ACA) was set to expand Medicaid eligibility significantly, creating a massive growth opportunity in the government-sponsored health sector. Acquiring Amerigroup instantly positioned WellPoint as a national leader in this market.
Expertise and Capabilities: Amerigroup brought deep, specialized expertise in managing the complex clinical and social needs of Medicaid and Medicare dual-eligible populations. This was a skillset that WellPoint, with its commercial focus, had not fully developed.
Geographic Synergy: While there was some overlap, Amerigroup’s footprint complemented WellPoint’s existing operations, giving the combined entity a powerful presence in key states.
The acquisition was completed in December 2012, and Amerigroup became a wholly-owned subsidiary of WellPoint. While it was integrated into the larger corporate structure, the Amerigroup brand and its specialized operational model were largely preserved, becoming the foundation of WellPoint’s Government Business Division. This event marked the end of Amerigroup as an independent, publicly traded company but heralded a new era of growth and resource allocation as part of a national healthcare leader. The subsequent rebranding of its parent company to Elevance Health in 2022 further underscored a strategic shift towards a “whole health” approach, a philosophy Amerigroup had championed for years.
Amerigroup Major Acquisitions and Expansions
Following its integration into the WellPoint/Anthem/Elevance Health family, Amerigroup’s growth trajectory accelerated, driven by both organic contract wins and strategic acquisitions made by its parent company to bolster the Government Business Segment.
Organic Expansion Through State Contract Wins
The primary method of expansion for Amerigroup has always been winning competitive bids for state Medicaid contracts. Over the years, Amerigroup and its affiliated brands have successfully entered numerous state markets or expanded their services within existing ones. This process is intensely competitive, requiring companies to demonstrate superior care management capabilities, robust provider networks, technological innovation, and cost-effectiveness. Key organic expansions have included:
Iowa (2019): After a previous exit, Anthem’s affiliate, Iowa Total Care, re-entered the state’s Medicaid managed care market, leveraging the expertise of the Amerigroup model.
North Carolina (2021): The launch of North Carolina’s Medicaid managed care program was a significant event, and Wellpoint (operating as Healthy Blue, a collaboration with Blue Cross NC) was selected as one of the primary statewide health plans, marking a major expansion in the Southeast.
New State Contracts: Throughout the 2010s and into the 2020s, Amerigroup consistently competed for and won new contracts and renewed existing ones in states like Georgia, Texas, New Jersey, and Tennessee, solidifying its market leadership.
Amerigroup Key Metrics
To understand the scale and impact of Amerigroup, it’s essential to examine the key metrics that define its operations. As Amerigroup is a part of Elevance Health’s Government Business Segment, these figures often reflect the performance of the entire segment, of which Amerigroup is the principal component.
Amerigroup Number of Members/Enrollees
The number of members served is the most direct measure of a health plan’s reach. As of the end of fiscal year 2023, Elevance Health’s Government Business Segment served approximately 13.5 million members. This figure is broken down into several categories:
Medicaid Members: This is the largest group, comprising over 10.6 million individuals. These members are enrolled in state-sponsored programs managed by Amerigroup and its affiliated brands. This includes low-income adults, children (through CHIP), pregnant women, and individuals with disabilities.
Medicare Members: The segment serves approximately 2.9 million Medicare members. This includes those in Medicare Advantage plans, Medicare Supplement plans, and standalone Part D prescription drug plans. A significant and vital portion of this group consists of dual-eligibles—individuals enrolled in both Medicare and Medicaid, who are served by Amerigroup’s specialized D-SNP plans.
This massive membership base makes Elevance Health one of the largest Medicaid and Medicare managed care providers in the nation.
Amerigroup Annual Revenue
The financial scale of the operation is staggering. Revenue is primarily generated from the capitated payments received from state and federal governments. For the fiscal year ending December 31, 2023, Elevance Health’s Government Business Segment reported operating revenue of approximately $99.8 billion.
To illustrate the growth trend, here is a look at the segment’s revenue over the past several years:
FY 2023: $99.8 billion
FY 2022: $90.2 billion
FY 2021: $76.9 billion
FY 2020: $62.6 billion
FY 2019: $40.5 billion
This dramatic growth can be attributed to several factors: organic growth in membership, the acquisitions of MMM and WellCare assets, and premium rate adjustments from state partners to account for medical cost trends and expanded benefits.
Amerigroup Coverage States
The Amerigroup brand and its direct affiliates (such as Healthy Blue and Wellpoint) operate government-sponsored health plans in a wide range of states across the country. As of 2024-2025, the primary states of operation include, but are not limited to:
Arizona (as Wellpoint)
Florida (as Simply Healthcare Plans)
Georgia (as Amerigroup Community Care of Georgia)
Iowa (as Iowa Total Care)
Kansas (as Wellpoint)
Louisiana
Maryland
Nevada
New Jersey
New Mexico
New York (as Wellpoint, HealthPlus)
Tennessee
Texas
Washington
West Virginia (as Wellpoint)
Puerto Rico (as MMM)
It’s important to note that brand names can vary by state and are subject to change. For example, Elevance Health has been actively rebranding many of its Amerigroup and Legato plans under the single “Wellpoint” brand name to create a more unified identity in the government sector.
Amerigroup Number of Employees
Pinpointing the exact number of employees working solely on Amerigroup business is difficult, as they are part of the larger Elevance Health corporate structure. As of early 2024, Elevance Health employs approximately 100,000 associates globally. A significant portion of this workforce is dedicated to the Government Business Segment, encompassing roles in clinical care management, provider relations, member services, claims processing, data analytics, compliance, and community outreach. These employees are the engine that delivers the Amerigroup benefits and services to millions of members every day.
Amerigroup Product & Services
The core of Amerigroup’s mission is delivered through its diverse portfolio of Amerigroup health insurance products and member-centric services. These are designed not just to pay for medical bills but to actively manage and improve the health of members through coordinated care, preventative services, and innovative digital tools.
Amerigroup Plan Types Offered
Amerigroup’s offerings are tailored to the specific needs of government program beneficiaries.
Medicaid Plans: This is Amerigroup’s foundational product. They manage state Medicaid programs for a variety of populations:
TANF/Families and Children: Serving low-income families and children, providing essential health coverage for doctor visits, immunizations, and preventative care. This includes the Children’s Health Insurance Program (CHIP), which covers children in families with incomes too high to qualify for traditional Medicaid but too low to afford private insurance.
Aged, Blind, and Disabled (ABD): Offering specialized care for individuals with long-term disabilities, focusing on managing complex medical needs and coordinating care across multiple specialists.
Long-Term Services and Supports (LTSS): A critical service line that provides assistance with activities of daily living (like bathing, dressing, and eating) for individuals with chronic illness or disability. The goal of LTSS is to help members remain in their homes and communities, avoiding more costly institutional care. This is a cornerstone of the Amerigroup real solutions approach.
Medicare Plans: Amerigroup offers several types of Medicare Advantage (Part C) plans, which are an alternative to Original Medicare (Parts A and B) and often include prescription drug coverage (Part D) and extra benefits.
Dual-Eligible Special Needs Plans (D-SNPs): This is a key area of expertise for Amerigroup. D-SNPs are designed for people who have both Medicare and Medicaid (“dual eligibles”). These plans are powerful because they coordinate the benefits of both programs seamlessly. A member in a D-SNP has one plan, one ID card, and one point of contact for all their Medicare and Medicaid services. This often includes extra benefits not covered by either program alone, such as dental, vision, hearing, and transportation benefits.
Chronic Condition Special Needs Plans (C-SNPs): These plans are tailored for individuals with specific severe or disabling chronic conditions, such as diabetes, cardiovascular disease, or chronic heart failure. C-SNPs provide targeted care management, specialized provider networks, and drug formularies designed to manage the specific condition effectively.
Medicare-Medicaid Plans (MMPs): In some states, Amerigroup participates in demonstration projects to fully integrate care for dual eligibles under a single financing and delivery model. These MMPs are designed to be the ultimate solution for coordinating care for this high-need population.
Amerigroup Provider Network Information
Access to care is meaningless without a strong network of doctors, hospitals, and other healthcare professionals. Amerigroup builds and maintains extensive provider networks in each state it serves. These networks are designed to be comprehensive and accessible, including:
Primary Care Physicians (PCPs)
Specialists (Cardiologists, Oncologists, etc.)
Hospitals and Medical Centers
Urgent Care Centers
Behavioral Health Providers (Therapists, Psychiatrists)
Dentists and Vision Centers
Pharmacies
Durable Medical Equipment (DME) Suppliers
Amerigroup works closely with its network providers, often engaging them in value-based care arrangements. Unlike traditional fee-for-service models where providers are paid for each service they perform, value-based care models reward providers for achieving positive health outcomes and managing costs effectively. This aligns the incentives of the health plan and the provider to focus on keeping members healthy.
Market Sectors and Project Expertise
Amerigroup’s success is rooted in its deep expertise within a highly specialized market sector: government-sponsored healthcare. This is not a market for generalists; it requires a profound understanding of complex regulations, diverse populations with acute needs, and the intricacies of public-private partnerships.
Core Market Sector: Government-Sponsored Healthcare
Amerigroup operates exclusively in the government programs sector. Its clients are not individuals or employers, but state and federal government agencies. This B2G (Business-to-Government) model requires a distinct set of competencies:
Regulatory Compliance: The company must navigate a labyrinth of federal (CMS) and state-level regulations that govern every aspect of its operations, from marketing and enrollment to claims payment and provider network adequacy.
Policy Acumen: Amerigroup must stay ahead of shifts in healthcare policy, such as changes to Medicaid eligibility, new mandates for benefits, or the introduction of new care models.
Public-Private Partnership Management: Success depends on building strong, collaborative relationships with state Medicaid directors and their staff, acting as a trusted partner in achieving the state’s public health goals.
Project Expertise: Managing Complex and High-Need Populations
Where Amerigroup truly excels is in its project-level expertise in designing and implementing programs for populations with complex health and social needs. This is the essence of Amerigroup real solutions.
Dual-Eligible Integration: As mentioned, managing the “dual eligible” population is a hallmark of Amerigroup’s expertise. These individuals often have multiple chronic conditions, behavioral health issues, and significant social barriers to care. Amerigroup’s D-SNP products are designed to break down the silos between Medicare and Medicaid, providing a single, coordinated plan that manages the member’s total health, from doctor visits and hospital stays to long-term care and prescription drugs.
Behavioral Health Integration: Amerigroup was an early adopter of the integrated care model, which recognizes that physical and mental health are inextricably linked. The company works to integrate behavioral healthcare into the primary care setting, screening for conditions like depression and substance use disorder and connecting members with therapists, psychiatrists, and community mental health resources. This approach improves outcomes and reduces the total cost of care, as untreated mental health issues often exacerbate physical conditions.
Addressing Social Determinants of Health (SDoH): This is perhaps the most innovative area of Amerigroup’s expertise. The company understands that a prescription for medication is of little use if the member doesn’t have transportation to the pharmacy or a stable home in which to recover. Amerigroup has developed numerous programs to address SDoH, including:
Food Security Programs: Partnering with food banks, offering benefits for healthy groceries, and providing medically tailored meals to members after a hospital stay.
Housing Support: Connecting members facing homelessness with community resources and housing navigators.
Transportation Services: Providing non-emergency medical transportation (NEMT) to ensure members can get to their doctor’s appointments, physical therapy, and other essential health services.
Value-Based Care Implementation: Amerigroup is a leader in shifting provider payments away from the outdated fee-for-service model. By implementing sophisticated value-based care arrangements, Amerigroup pays providers based on their ability to deliver high-quality, efficient care. This requires advanced data analytics to measure quality, robust care coordination to manage at-risk patients, and strong partnerships with provider groups willing to share in the financial risk and reward of improving population health.
Amerigroup Benefits: A Focus on Whole-Person Health
When examining Amerigroup health insurance, the true value lies in the comprehensive suite of Amerigroup benefits available to members. These benefits are structured to go far beyond the basic requirements, reflecting a commitment to whole-person health and providing tangible support that can improve quality of life.
Core Medical Amerigroup Benefits
At its foundation, every Amerigroup plan covers the essential medical services members need to stay healthy and get care when they are sick. These core benefits typically include:
Doctor Visits: Coverage for visits to a primary care physician (PCP) and specialists with no or very low co-pays.
Hospital Care: Coverage for inpatient hospital stays, surgeries, and related services.
Emergency Services: Coverage for emergency room visits and ambulance services, available 24/7.
Prescription Drugs: A comprehensive formulary (list of covered drugs) that includes generic and brand-name medications. Many plans offer low-cost or $0 co-pay options for generic drugs.
Maternity and Newborn Care: Complete coverage for prenatal visits, delivery, and postpartum care for mothers, as well as well-baby checkups and immunizations for newborns.
Preventive Care: Coverage for annual checkups, flu shots, cancer screenings (like mammograms and colonoscopies), and other services designed to prevent illness before it starts. This is a crucial benefit for long-term health.
Lab Work and X-rays: Coverage for diagnostic tests and imaging ordered by a doctor.
Expanded Amerigroup Benefits for Whole Health
This is where the Amerigroup real solutions philosophy becomes most apparent. Recognizing that health is more than just the absence of disease, Amerigroup plans often include a rich package of value-added benefits that address daily life needs. These expanded Amerigroup benefits can make a significant difference for members.
Dental Coverage: Most plans include routine dental care, covering cleanings, exams, and X-rays. Many plans, especially D-SNPs, offer more extensive benefits covering fillings, extractions, and even dentures.
Vision Coverage: Plans typically cover an annual eye exam and provide an allowance towards the cost of eyeglasses or contact lenses.
Hearing Services: Many Medicare Advantage plans include coverage for hearing exams and provide an allowance for hearing aids, a critical but often expensive need for seniors.
Over-the-Counter (OTC) Allowance: This popular benefit provides members with a quarterly or monthly allowance to spend on common health and wellness products at participating retailers. Members can buy items like pain relievers, vitamins, cold medicine, bandages, and toothpaste without having to pay out-of-pocket.
Fitness Programs: For Medicare members, many plans include a membership to the SilverSneakers® fitness program (or a similar program), which provides free access to thousands of gyms and fitness classes nationwide.
Healthy Meals: Some plans, particularly for members with chronic conditions or those recently discharged from the hospital, provide home-delivered meals to support proper nutrition during recovery.
Transportation: As mentioned, non-emergency medical transportation is a vital benefit, ensuring that a lack of a car or access to public transit does not prevent a member from receiving care.
Amerigroup Benefits for Care Management and Support
Beyond covered services, a key Amerigroup benefit is the human support system provided to members, especially those with complex needs.
Care Coordinators: Members with multiple health issues are often assigned a dedicated Care Coordinator or Case Manager. This person acts as a single point of contact, helping the member navigate the healthcare system, schedule appointments, understand their treatment plan, and connect with community resources.
Disease Management Programs: Members with chronic conditions like diabetes, COPD, or heart disease can enroll in specialized programs that provide education, coaching, and tools to help them better manage their condition and avoid complications.
24/7 NurseLine and Behavioral Health Support: Access to immediate clinical advice and mental health resources provides peace of mind and ensures members can get help whenever they need it.
Amerigroup Benefits and the Employer Group Health Plan Market
While Amerigroup does not directly offer an employer group health plan, the expertise and innovations developed within its government programs have a significant and beneficial influence on the commercial plans offered by its parent company, Elevance Health. The lessons learned in managing the highest-cost, most complex populations in the country are invaluable. For instance, the successful strategies used in Amerigroup’s integrated behavioral health programs can be adapted for employer plans to better support employee mental wellness. Similarly, the data-driven approach to addressing social determinants of health and implementing value-based care within Amerigroup provides a proven blueprint that can help employers control costs and improve the health of their workforce. In this way, the Amerigroup benefits model serves as an innovation lab, developing best practices that ultimately benefit a much broader spectrum of the insured population.
Partnerships
Amerigroup’s model is inherently collaborative. It cannot achieve its goals alone. Its success is built on a foundation of strong partnerships with a wide range of stakeholders.
State and Federal Governments: The most fundamental partnership is with the state agencies that administer Medicaid and the federal Centers for Medicare & Medicaid Services (CMS). These are not vendor-client relationships but true partnerships aimed at meeting shared public health objectives.
Community-Based Organizations (CBOs): To deliver on the promise of addressing social determinants of health, Amerigroup actively partners with local non-profits and CBOs. This includes forging relationships with food banks, housing authorities, Area Agencies on Aging, and local charities that provide the on-the-ground support members need.
Provider Groups: Amerigroup fosters deep, collaborative relationships with hospital systems, large physician practices, and Federally Qualified Health Centers (FQHCs). These partnerships are essential for implementing value-based care models, sharing data to improve care coordination, and ensuring members have access to high-quality providers.
Technology and Analytics Companies: To power its digital tools, telehealth services, and sophisticated population health analytics, Amerigroup and Elevance Health partner with leading technology firms. These partnerships enable the innovation that makes care more accessible and personalized.
Awards and Recognitions
While awards are often given at the parent company level, they reflect the quality and values embedded in all of its business units, including Amerigroup. Elevance Health has received numerous accolades that speak to its corporate culture and operational excellence:
Fortune 500: Consistently ranked among the top companies in the nation by revenue.
DiversityInc: Frequently named one of the “Top 50 Companies for Diversity,” recognizing its commitment to an inclusive workplace and diverse supplier network.
Military Friendly® Employer: Often designated as a top employer for veterans and military spouses, highlighting its commitment to hiring and supporting the military community.
NCQA Accreditation: Many of Amerigroup’s individual health plans across the country have earned accreditation from the National Committee for Quality Assurance (NCQA). NCQA accreditation is a widely recognized symbol of quality, demonstrating that a health plan meets rigorous standards for patient care, quality improvement, and member satisfaction.
Licensing & Regulatory Information
Amerigroup maintains state insurance licenses across its service states. For example:
Amerigroup New Jersey, Inc. is licensed as an HMO in NJ (NAIC code 95373, Group code 0671).
Amerigroup Maryland, Inc. (NAIC code 14073) licensed since 1999; Amerigroup Tennessee, Inc. (NAIC 16574) licensed since 2007; Amerigroup Iowa, Inc. (NAIC 14078); Amerigroup Texas, Inc. (NAIC 10767); Amerigroup PA, OK, OH, NM, WA, GA also licensed with respective NAIC codes.
NAIC Group code for Amerigroup/Elevance is 0671.
CMS star ratings: Amerigroup participates in Medicare Advantage plans under Elevance Health—star ratings vary by state and year; parent uses star ratings metrics to assess quality and performance
Amerigroup represents a focused and highly specialized force within the American healthcare system. Through its comprehensive Amerigroup health insurance products, a commitment to providing Amerigroup real solutions for complex life challenges, and an ever-improving array of tangible Amerigroup benefits, the company plays a vital role in the lives of millions. As a key part of Elevance Health, it is backed by the resources of a national leader while maintaining its specialized expertise, continuing its foundational mission to improve health and change lives.
Profile Structure
Name: Amerigroup (an Elevance Health company)
Industry: Healthcare / Managed Care
Founded: 1994
HQ: 4425 Corporation Lane, Suite 400, Virginia Beach, Virginia 23462, USA
Employees: Approx. 100,000 (at parent company, Elevance Health)
Annual Revenue: Approx. $99.8 billion (for Government Business Segment, FY 2023)
Coverage: Operates in states including AZ, FL, GA, IA, KS, LA, MD, NV, NJ, NM, NY, TN, TX, WA, WV, and Puerto Rico.
Plan Types: Medicaid (including CHIP & LTSS), Medicare Advantage (D-SNPs, C-SNPs), Medicare-Medicaid Plans (MMPs).
Key Differentiator: Focus on whole-person health by addressing Social Determinants of Health (SDoH); deep expertise in managing complex populations, especially dual-eligibles.
Website: amerigroup.com
LinkedIn: linkedin.com/company/amerigroup-corporation
Amerigroup Leadership & Teams
Ricardo Fraga – Chief Operations Officer
Roland Valle – Vice President Provider Relations
Maria Hernandez – Director Medicaid Plan Marketing
Lavonda Exum Adkins – Associate Vice President, Reimbursement Policy
Michael James – Vice President Sales, Marketing, Operations
Yvette Harris – Planning and Performance Director, Chief of Staff