Gateway Health Plan Medicare Assured®
Gateway Health Plan® Adds Three New Medicare Assured® Products to its Portfolio
Gateway Health Plan Medicare Assured® offers all the benefits of Original Medicare, plus so much more. For 20 years, Gateway Health Plan® has operated as a Managed Care Organization (MCO) that has provided access to more than 255,000 members eligible for Medical Assistance (Medicaid) in Pennsylvania. In 2006, Gateway added Medicare coverage, creating the Gateway Health Plan Medicare Assured® line of business, now serving more than 30,000 members.
Now, beginning Jan. 1, 2013, Gateway will offer even more health coverage to those with Medicare who also have at least one of the following chronic conditions: diabetes, cardiovascular disorder or chronic heart failure. Our specific products include:
Medicaid – Serves members eligible for Medical Assistance
Medicare Assured® - Serves members eligible for BOTH Medicare and Medical Assistance. Gateway’s Medicare Assured® portfolio of products includes two Dual Eligible Special Needs Plans (D-SNPs) and two Chronic Condition Special Needs Plans
Gateway’s Dual Eligible Special Needs Plans (D-SNP):
You have choices in your healthcare. No matter what you decide, you are still in the Medicare Program. All Medicare Advantage plans agree to stay in the program for a full calendar year at a time. Plan benefits and cost sharing may change from calendar year to calendar year.
Medicare Assured®(HMO SNP) – serves those who have BOTH Medicare (Parts A and B) and full Medical Assistance or Qualified Medicare Beneficiary (QMB/QMB Plus) or SLMB Plus. 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® 3 (HMO SNP) – serves those who have Both Medicare (Parts A and B) and get assistance from the State or are SLMB, QDWI, QI. The monthly premium for this plan ranges from $0-$36.50 depending on your level of assistance. Just like Medicare Assured®, 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 open enrollment season.
Chronic Condition Special Needs Plans (C-SNP):
Medicare Assured® Select (HMO SNP) and Medicare Assured® Select Plus (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® Select plan has a $0 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® Select Plus plan offers a lower plan premium than other Medicare supplement plans. The monthly plan premium is up to or no more than $44.50 and includes a robust benefit package, not offered by Original Medicare. This includes, but is not limited to bathroom safety products, hearing, vision and dental care, as well as fitness membership services through the *Forever Fit Wellness Program.
Gateway Health Plan® also offers an extensive network of more than 10,000 providers and 100 + hospitals throughout 32 counties in Pennsylvania. In 2013, Gateway Health Plan Medicare Assured® will extend our service area to include Bucks, Chester, Delaware and Montgomery Counties.
Those eligible for these two C-SNP plans can enroll during Open Enrollment
(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 these plans. Visit us at MedicareAssured.com, or call us.
Can I choose my doctors? Gateway Health Plan Medicare Assured® products have formed a network of doctors, specialists and hospitals. You can only use doctors who are part of our network. The health providers in our network can change at any time. You can ask for a current provider directory. For an updated list, visit us at MedicareAssured.com
Where can I get my prescriptions if I join these plans?
Gateway Health Plan Medicare Assured® products have formed a network of pharmacies. You must use a network pharmacy to receive plan benefits. We may not pay for your prescriptions if you use an out-of-network pharmacy. The pharmacies in our network can change at any time. You can ask for a pharmacy directory or visit us at MedicareAssured.com. Gateway Health Plan Medicare Assured® products do cover both Medicare Part B prescription drugs and Medicare Part D prescription drugs.
Gateway Health Plan® 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 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 Plan® has been approved by the National Committee for Quality Assurance (NCQA®), a non-profit organization dedicated to improving healthcare quality until December 31, 2015.
*Forever Fit is only available for Medicare Assured® and Medicare Assured® Select Plus members.
Prospective Members may call:
1-877-GATEWAY (1-877-428-3929) TTY: 711