Gateway Health Medicare AssuredSM
Gateway Health Medicare AssuredSM offers all the benefits of Original Medicare, plus so much more. For 20 years, Gateway HealthSM has operated as a Managed Care Organization (MCO) that has provided access to more than 300,000 members eligible for Medicaid (Medical Assistance) in Pennsylvania. In 2006, Gateway added Medicare coverage, creating the Gateway Health Medicare Assured line of business, now serving more than 40,000 members.
Learn more about Gateway’s Medicare products:
Medicare Assured serves people who are dual eligible, have both Medicare and Medicaid or people who have Medicare and one of the following chronic conditions: diabetes, cardiovascular disorder or chronic heart failure.
Gateway’s Dual Eligible Special Needs Plans (D-SNP):
Medicare Assured DiamondSM (HMO SNP) – serves those who have both Medicare (Parts A and B) and full Medical Assistance. This plan has a $0 monthly premium, although you must pay your Medicare Part B premium, unless the State pays it for you.
Medicare Assured RubySM (HMO SNP) – serves those who have both Medicare (Parts A and B) and get some assistance from the State. The monthly premium for this plan ranges from $0-$32.70 depending on your level of assistance. Just like Medicare Assured Diamond, you must continue to pay your Medicare Part B premium, unless the State pays it for you.
The benefits of being a dual eligible mean that you can enroll in a new plan at any time throughout the year, not just during the Medicare Annual Enrollment Period.
Chronic Condition Special Needs Plans (C-SNP):
Medicare Assured GoldSM (HMO SNP) and Medicare Assured PlatinumSM (HMO SNP) – serves those who have both Medicare (Parts A and B) and at least one of the following chronic conditions: diabetes, cardiovascular disorder or chronic heart failure.
The Medicare Assured Gold plan has a $0 to low monthly premium. Copayments for select benefits apply and you must continue to pay your Plan B premium, unless the State pays it for you.
The Medicare Assured Platinum plan offers a low plan premium. The monthly plan premium is up to or no more than $56.40 and includes a robust benefit package, including benefits not covered by Original Medicare. This includes, but is not limited to bathroom safety products, hearing, vision and dental care, as well as fitness membership services.
Gateway Health also offers an extensive network of more than 11,000 providers and 110 + hospitals throughout 32 counties in Pennsylvania.
Those eligible for the C-SNP plans can enroll during the Medicare Annual Enrollment Period (October 15 – December 7), when diagnosed with a qualifying condition or if previously disenrolled from a plan due to no proof of illness. There are no income requirements for the C-SNP plans. For more information, call 1-888-905-3415 or visit MedicareAssured.com
Can I choose my doctors? Medicare Assured products have a network of doctors, specialists and hospitals. You can only use doctors who are part of the Medicare Assured network. The health providers in the Medicare Asured network can change at any time. You can ask for a current provider directory. For an updated list, visit MedicareAssured.com.
Where can I get my prescriptions if I join these plans? Medicare Assured products have a network of pharmacies. You must use a network pharmacy to receive plan benefits. Medicare Assured may not pay for your prescriptions if you use an out-of-network pharmacy. The pharmacies in the Medicare Assured network can change at any time. You can ask for a pharmacy directory or visit MedicareAssured.com. Medicare Assured products cover both Medicare Part B prescription drugs and Medicare Part D prescription drugs.
Gateway Health Philosophy
Research shows that with resources and support, people with chronic conditions can improve their health and well-being. In an effort to meet our members’ unique needs, to address the challenges faced by members in accessing medical and social support services, Gateway Health developed an enhanced healthcare management model called Prospective Care Management (PCM®). This model is a proactive, holistic approach that addresses the Behavioral, Environmental, Economic, Medical, Social and Spiritual (BEEMSSSM) issues a member faces that may be barriers to care. Using state of the art techniques, the PCM® model of care helps design a plan to ensure the member receives the individualized services needed. Some of our no-cost programs include smoking cessation and managing chronic conditions, such as asthma, depression, diabetes and heart disease.
Gateway Health has been approved by the National Committee for Quality Assurance (NCQA®), a non-profit organization dedicated to improving healthcare quality.
Prospective Members may call:
1-888-905-3415 (TTY: 711)