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
$360.00

What To Know About This Plan

  • This plan has health and drug coverage

Why We Like This Plan

  • has both Health and Drug Coverage
  • has a copay of $0 for Tier 1 preferred generic drugs (30 day supply, preferred retail pharmacies)

All cost-sharing assumes in-network healthcare providers.

Plan Details

Costs and Other Important Information

Plan Year:
2016
Optional Supplemental Benefits?
No
Choice of Doctors?
Plan Doctors for Most Services
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$3,400 In-network
Other Health Plan Deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$0.00
Monthly Health Plan Premium
$0.00

Benefits

Service
Cost
Ambulance
You pay nothing
Doctor's office visits
Primary Physician
You pay nothing
Specialist
You pay nothing
Durable medical equipment (wheelchairs, oxygen, etc.)
You pay nothing
Emergency care
You pay nothing
Home health care
You pay nothing
Mental health care
You pay nothing
Outpatient hospital
You pay nothing
Renal dialysis
You pay nothing
Inpatient hospital care
You pay nothing
Skilled Nursing Facility (SNF)
You pay nothing

Cost Sharing Information

Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$0 copay$0 copayNot 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 Generic$0 copay$0 copayNot 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
Colorectal cancer screening
Annual flu vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Adult BMI assessment

Managing Chronic Conditions

Special needs plan care management
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
Controlling blood pressure
Rheumatoid arthritis management
Reducing the risk of falling
Plan all-cause readmissions

Member Experience with Health Plan

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

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Members choosing to leave the health plan
Beneficiary access and performance problems
Health plan quality improvement

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability - Medical

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - Drugs
Appeals auto-forward
Appeals upheld

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Members choosing to leave the drug plan
Beneficiary access and performance problems
Drug plan quality improvement

Member Experience with Drug Plan

Rating of drug plan
Getting needed prescription drugs

Drug Pricing and Patient Safety

MPF Price Accuracy
High risk medication
Part D medication adherence for diabetes
Part D medication adherence for hypertension
Part D medication adherence for cholesterol
Medication Therapy Management program completion rate

Physician Finder

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

/
GOLDSTEIN, SCOTT
5501 OLD YORK RD
PHILADELPHIA, PA 19141
OGUREK, DAVID
3322 N BROAD ST
PHILADELPHIA, PA 19140
SAMDANI, AMER
3551 N BROAD ST
PHILADELPHIA, PA 19140
ALBURGER, PHILIP
3551 N BROAD ST
PHILADELPHIA, PA 19140
CAROLINE, DINA
3401 N BROAD ST
PHILADELPHIA, PA 19140
DESIMONE, SALVATORE
5001 FRANKFORD AVE
PHILADELPHIA, PA 19124
SZATKOWSKI, MICHAEL
ERIE AVE AT FRONT ST
PHILADELPHIA, PA 19134
KND DEVELOPMENT 59 LLC
6129 PALMETTO ST
PHILADELPHIA, PA 19111
PLIMACK, ELIZABETH
333 COTTMAN AVE
PHILADELPHIA, PA 19111
FREDERICK, JOHN
1650 HUNTINGDON PIKE
MEADOWBROOK, PA 19046
Details
SCOTT GOLDSTEIN, D.O.
Phone Number
(215) 456-6679
Office Locations
5501 OLD YORK RD
PHILADELPHIA, PA 19141
5501 OLD YORK RD PHILADELPHIA PA, 19141

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