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.
2018 Gateway Health Medicare Assured Medicare Advantage Plan Details
Name: | Gateway Health Medicare Assured Select (HMO) |
ID: | H9190-019 |
Provider: | Gateway Health Medicare Assured |
Year: | 2018 |
Type: | Local HMO |
Monthly Premium C+D: | $0.00 |
MOOP: | $6,700 |
Plan Services
Health plan deductible
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
Transportation
Other health plan deductibles?
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)
Medicare Part B drugs
Chemotherapy |
|
20% |
Other Part B drugs |
|
20% |
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
Optional supplemental benefits
Inpatient hospital coverage
$350 for days 1 through 5 $0 for days 6 through 90 |
|
|
Outpatient hospital coverage
Doctor visits
Primary |
|
$10 per visit |
Specialist |
|
$45 per visit |
Preventive care
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
2018 Overall Rating | | |
Part C Summary Rating | | |
Part D Summary Rating | | |
Staying Healthy: Screenings, Tests, Vaccines | | |
Managing Chronic (Long Term) Conditions | | |
Member Experience with Health Plan | | |
Complaints and Changes in Plans Performance | | |
Health Plan Customer Service | | |
Drug Plan Customer Service | | |
Complaints and Changes in the Drug Plan | | |
Member Experience with the Drug Plan | | |
Drug Safety and Accuracy of Drug Pricing | | |
Member Experience with Health Plan
Total Experience Rating | | |
Getting Needed Care | | |
Timely Care and Appointments | | |
Customer Service | | |
Health Care Quality | | |
Rating of Health Plan | | |
Care Coordination | | |
Member Complaints and Changes in Gateway Health Medicare Assured Select (HMO) Plans Performance
Total Rating | | |
Members Leaving the Plan | | |
Complaints about Health Plan | | |
Beneficiary Access | | |
Health Plan Quality Improvement | | |
Health Plan Customer Service Rating for Gateway Health Medicare Assured Select (HMO)
Total Customer Service Rating | | |
Timely Decisions About Appeals | | |
Reviewing Appeals Decisions | | |
Call Center, TTY, Foreign Language | | |
Staying Healthy, Screening, Testing, & Vaccines
Total Preventative Rating | | |
Breast Cancer Screening | | |
Colorectal Cancer Screening | | |
Annual Flu Vaccine | | |
Improving Physical | | |
Improving Mental Health | | |
Monitoring Physical Activity | | |
Adult BMI Assessment | | |
Managing Chronic And Long Term Care for Older Adults
Total Rating | | |
SNP Care Management | | |
Medication Review | | |
Functional Status Assessment | | |
Pain Screening | | |
Osteoporosis Management | | |
Diabetes Care - Eye Exam | | |
Diabetes Care - Kidney Disease | | |
Diabetes Care - Blood Sugar | | |
Controlling Blood Pressure | | |
Rheumatoid Arthritis | | |
Improving Bladder Control | | |
Reducing Risk of Falling | | |
Plan - Cause Readmissions | | |
Member Experience with the Drug Plan
Total Rating | | |
Rating of Drug Plan | | |
Getting Needed Prescription Drugs | | |
Drug Safety and Accuracy of Drug Pricing
Total Rating | | |
MPF Price Accuracy | | |
Drug Adherence for Diabetes Medications | | |
Drug Adherence for Hypertension (RAS antagonists) | | |
Drug Adherence for Cholesterol (Statins) | | |
MTM Program Completion Rate for CMR | | |
Ratings For Member Complaints and Changes in the Drug Plans Performance
Total Rating | | |
Complaints about the Drug Plan | | |
Members Choosing to Leave the Plan | | |
Beneficiary Access | | |
Drug Plan Quality Improvement | | |
Gateway Health Medicare Assured Select (HMO) Drug Plan Customer Service ratings
Total Rating | | |
Appeals Auto Forward | | |
Appeals Upheld | | |
Call Center, TTY, Foreign Language | | |
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%.
Part C Premium: | $0.00 |
Part D (Drug) Premium: | $0.00 |
Part D Supplemental Premium | $0.00 |
Total Part D Premium: | $0.00 |
Drug Deductible: | $200.00 |
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Tiers with No Deductible: | 1 |
Benchmark: | not below the regional benchmark |
Type of Medicare Health: | Enhanced Alternative |
Drug Benefit Type: | Enhanced |
Full LIS Premium: | $0.00 |
75% LIS Premium: | $0.00 |
50% LIS Premium: | $0.00 |
25% LIS Premium: | $0.00 |
Initial Coverage Limit: | $3750 |
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Gap Coverage: | No |
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)
State: |
Ohio
County: | Adams, Allen, Ashtabula, Auglaize, Brown, Butler, Carroll, Champaign, Clark, Clermont, Clinton, Columbiana, Crawford, Cuyahoga, Darke, Fayette, Fulton, Gallia, Geauga, Greene, Hamilton, Hardin, Harrison, Henry, Highland, Hocking, Holmes, Jackson, Jefferson, Lake, Lawrence, Licking, Logan, Lorain, Lucas, Madison, Mahoning, Medina, Mercer, Miami, Monroe, Montgomery, Morrow, Noble, Ottawa, Paulding, Perry, Pickaway, Pike, Portage, Preble, Putnam, Shelby, Stark, Summit, Trumbull, Van Wert, Vinton, Warren,
|
|
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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.