PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
Gateway Health Plan
CMS Rating
Plan Type
HMO SNP
Annual Deductible
$310.00

What To Know About This Plan

  • This plan has health and drug coverage

Plan Details

Costs and Other Important Information

Plan Year:
2014
Optional Supplemental Benefits?
No
Choice of Doctors?
Plan Doctors Only
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$3,400 In-Network
Other Deductibles?
In Network: No. Out of Network: No
Health Plan Deductible
$0 In-Network
Monthly Drug Plan Premium
$0.00
Monthly Health Plan Premium
$0.00

Benefits

Service
In Network
Out of Network
Doctor Office Visits
$0
Not Applicable
Specialist Office Visit
$0
Not Applicable
Outpatient Services
$0
Not Applicable
Emergency Care
$0
Not Applicable
Ambulance Services
$0
Not Applicable
Kidney Disease and Conditions
$0
Not Applicable
Home Health Care
$0
Not Applicable
Durable Medical Equipment
$0
Not Applicable
Inpatient Hospital Care
$0
Not Applicable
Skilled Nursing Facility (SNF)
$0
Not Applicable
Inpatient Mental Health Care
$0
Not Applicable

Cost Sharing Information

Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offeredsNot offeredNot offered
Tier 2: Non-Preferred Generic
Tier 3: Preferred Brand Name
Tier 4: Non-Preferred Brand Name
Tier 5: Specialty Tier
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offeredNot offeredNot offered
Tier 2: Non-Preferred Generic
Tier 3: Preferred Brand Name
Tier 4: Non-Preferred Brand Name
Tier 5: Specialty Tier

CMS Ratings

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Not Rated
Colorectal cancer screening
Cholesterol screening for patients with heart disease
Glaucoma testing
Annual flu vaccine
Pneumonia vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Access to primary care doctor visits
Adult BMI assessment

Managing Chronic Conditions

Care for older adults – medication review
Care for older adults – functional status assessment
Care for older adults – Pain screening
Osteoporosis management in women who had a fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Diabetes care – cholesterol controlled
Controlling blood pressure
Rheumatoid arthritis management
Improving bladder control
Not Rated
Reducing the risk of falling
Plan all-cause readmissions

Ratings of Plan Responsiveness and Care

Getting needed care
Getting appointments and care quickly
Customer service
Overall rating of health care quality
Overall rating of plan

Member Complaints, Problems Getting Services, and Choosing to Leave the Plan

Complaints about the health plan
Beneficiary access and performance problems
Members choosing to leave the plan
Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability

Physician Finder

Physicians that accept Gateway Health Medicare Assured Diamond (HMO SNP) for Pennsylvania

/
WALSH, BRIAN
4702 N 5TH ST
PHILADELPHIA, PA 19120
GOLDSTEIN, SCOTT
5501 OLD YORK RD
PHILADELPHIA, PA 19141
ALBURGER, PHILIP
3551 N BROAD ST
PHILADELPHIA, PA 19140
CAROLINE, DINA
3401 N BROAD ST
PHILADELPHIA, PA 19140
SAMDANI, AMER
3551 N BROAD ST
PHILADELPHIA, PA 19140
AKINYEMI, TOLULOPE
25 MONUMENT RD
YORK, PA 17403
DESIMONE, SALVATORE
5001 FRANKFORD AVE
PHILADELPHIA, PA 19124
SZATKOWSKI, MICHAEL
ERIE AVE AT FRONT ST
PHILADELPHIA, PA 19134
HONG, SEUNG HEE
2301 E ALLEGHENY AVE
PHILADELPHIA, PA 19134
ZWILLENBERG, DAVID
3601 A STREET
PHILADELPHIA, PA 19134
PLIMACK, ELIZABETH
333 COTTMAN AVE
PHILADELPHIA, PA 19111
PREWITT, JOSEPH
4943 GERMANTOWN AVE
PHILADELPHIA, PA 19144
ORTIZ, NATALIA
100 E LEHIGH AVE
PHILADELPHIA, PA 19125
FEASTER, CYDNI
3000 N 22ND ST
PHILADELPHIA, PA 19132
LONG, CHARLES
1250 GREENWOOD AVE
JENKINTOWN, PA 19046
SHAH, MEERA
500 OLD YORK RD
JENKINTOWN, PA 19046
Details
BRIAN WALSH, D.O.
Phone Number
(215) 329-4888
Office Locations
4702 N 5TH ST
PHILADELPHIA, PA 19120
4702 N 5TH ST PHILADELPHIA PA, 19120

Community Q&A

Do you have questions about this plan?

Get answers from the HealthPocket community.

Similar Plans

PremiumPlan NameCMS Rating
$0.00
Today's Options Premier 700 (PFFS)
Select
$0.00
Humana Gold Choice H8145-055 (PFFS)
Select
$0.00
Geisinger Gold Reserve (MSA)
Select
$0.00
UPMC for Life (HMO)
Select
$0.00
SeniorBlue - Option 3 (HMO)
Select

Related Articles

Related Searches