2018 Medicare Advantage Gateway Health Medicare Assured Select (HMO)

Gateway Health Medicare Assured Select (HMO) H9190-019 is a 2018 Medicare Advantage or Medicare Part-C plan by Gateway Health Medicare Assured available to residents in Ohio. This plan includes additional Medicare prescription drug (Part-D) coverage. The Gateway Health Medicare Assured Select (HMO) has a monthly premium of $0.00 and has a in-network Maximum Out-of-Pocket limit of $6,700 (MOOP). This means that if you get sick or need a high cost procedure your co-pays are capped once you pay out of pocket $6,700 this can be a very nice safety net.

Gateway Health Medicare Assured Select (HMO) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you need special care for a physician specialist, your primary care physician will make the arrangements and tell you where you can go in the network. You will need your PCPs okay, called a referral. Without getting a referral or services received from out-of-network providers are not typically covered by the plan.

Gateway Health Medicare Assured works with Medicare to give you significant coverage beyond Part A and Part B benefits. If you decide to sign up for Gateway Health Medicare Assured Select (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Gateway Health Medicare Assured and not Original Medicare. With Medicare Advantage your always covered for urgently needed and emergency care and you receive all of the benefits of Original Medicare from Gateway Health Medicare Assured except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.

COMPARE AND SAVE ON MEDICARE INSURANCE

2018 Gateway Health Medicare Assured Medicare Advantage Plan Details

Plan Services

---

Health plan deductible

$0

---

Diagnostic procedures/lab services/imaging

Diagnostic tests and procedures		$0 copay
Lab services		$0 copay
Diagnostic radiology services (e.g., MRI)		$75 or 0-20%
Outpatient x-rays		$75

---

Hearing

Hearing exam		$50
Fitting/evaluation		$0 copay
Hearing aids		$0 copay

---

Preventive dental

Oral exam		$0 copay
Cleaning		$0 copay
Fluoride treatment		Not covered
Dental x-ray(s)		$0 copay

---

Comprehensive dental

Non-routine services		Not covered
Diagnostic services		Not covered
Restorative services		Not covered
Endodontics		Not covered
Periodontics		Not covered
Extractions		Not covered
Prosthodontics, other oral/maxillofacial surgery, other services		$0 copay

---

Vision

Routine eye exam		$0 copay
Other		Not covered
Contact lenses		$0 copay
Eyeglasses (frames and lenses)		$0 copay
Eyeglass frames		Not covered
Eyeglass lenses		Not covered
Upgrades		Not covered

---

Mental health services

$310 for days 1 through 5 $0 for days 6 through 90
Outpatient group therapy visit with a psychiatrist		$40
Outpatient individual therapy visit with a psychiatrist		$40
Outpatient group therapy visit		$40
Outpatient individual therapy visit		$40

---

Skilled Nursing Facility

$0 for days 1 through 20 $167.50 for days 21 through 100

---

Rehabilitation services

Occupational therapy visit		$40
Physical therapy and speech and language therapy visit		$40

---

Ambulance

$200

---

Transportation

Not covered

---

Other health plan deductibles?

	In-Network	No

---

Foot care (podiatry services)

Foot exams and treatment		$50
Routine foot care		$50

---

Medical equipment/supplies

Durable medical equipment (e.g., wheelchairs, oxygen)		15% per item
Prosthetics (e.g., braces, artificial limbs)		15% per item
Diabetes supplies		20% per item

---

Wellness programs (e.g., fitness, nursing hotline)

Covered

---

Medicare Part B drugs

Chemotherapy		20%
Other Part B drugs		20%

---

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$6,700 In-network

---

Optional supplemental benefits

No

---

Inpatient hospital coverage

$350 for days 1 through 5 $0 for days 6 through 90

---

Outpatient hospital coverage

$200-350 per visit

---

Doctor visits

Primary		$10 per visit
Specialist		$45 per visit

---

Preventive care

$0 copay

---

Emergency care/Urgent care

Emergency		$80 per visit (always covered)
Urgent care		$45 per visit (always covered)

Ratings for Gateway Health Medicare Assured Select (HMO) H9190

Member Experience with Health Plan

Member Complaints and Changes in Gateway Health Medicare Assured Select (HMO) Plans Performance

Health Plan Customer Service Rating for Gateway Health Medicare Assured Select (HMO)

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Ratings For Member Complaints and Changes in the Drug Plans Performance

Gateway Health Medicare Assured Select (HMO) Drug Plan Customer Service ratings

Part-C Premium

Gateway Health Medicare Assured plan charges a $0.00 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

Part-D Deductible and Premium

Gateway Health Medicare Assured Select (HMO) has a monthly drug premium of $0.00 and a $200.00 drug deductible. This Gateway Health Medicare Assured plan offers a $0.00 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by Gateway Health Medicare Assured above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0.00. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.

Premium Assistance

Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Gateway Health Medicare Assured Select (HMO) medicare insurance offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $0.00 for 75% low income subsidy $0.00 for 50% and $0.00 for 25%.

Gap Coverage

In 2018 once you and your plan provider have spent $3750 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 35% for brand-name drugs and 44% on generic drugs unless your plan offers additional coverage. This Gateway Health Medicare Assured plan does not offer additional coverage through the gap.

Coverage Area for Gateway Health Medicare Assured Select (HMO)

(Click county to compare all available Advantage plans)

Source: CMS.

Data as of September 2, 2017.

Star Rating as of September 6, 2017.

For More Information on Ratings Please See the CMS Tech Notes Here.

Notes: Data are subject to change as contracts are finalized. For 2018, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.

Includes 2018 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.