What is Gateway Health Medicare Assured Diamond (Local HMO D-SNP)?
Gateway Health Medicare Assured Diamond is a 2021 D-SNP Medicare Special Needs Plan, from Gateway Health, available in Berks County, Pennsylvania.
- It's a Local HMO health plan.
- It includes prescription drug coverage (Medicare Part D).
- It offers the same health insurance benefits as Original Medicare.
- It offers extras that Medicare does not cover.
- Most of the costs of joining this Medicare Special Needs Plan will be covered for you.
How to Qualify to Enroll in Gateway Health Medicare Assured Diamond
If you qualify and enroll, this Local HMO plan replaces your Original Medicare coverage. To qualify, you must meet the following criteria:
- You have Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance).
- You live in the plan's service area.
- You have both Medicare and Medicaid.
If you're not sure if you qualify for both Medicare and Medicaid, contact your local Medicaid office.
IMPORTANT: If you qualify for this plan based on your dual eligibility status, but you also have one or more chronic conditions, you should also investigate C-SNP plans in your areas, as they may offer a care manager to help coordinate your healthcare needs.
If you don't qualify to join this plan, you might want to compare Medicare Advantage plans in Berks County, Pennsylvania. Another popular option is to add a Pennsylvania Medicare supplement plan and a stand-alone Pennsylvania Medicare prescription drug plan.
Before Joining Gateway Health Medicare Assured Diamond, Consider These Questions:
- Does the plan coordinate my Medicare and Medicaid benefits to make them easily accessible?
- What costs should I expect for my coverage (premiums, deductibles, copayments)?
- Is there an annual limit on my out-of-pocket expenses?
- Will I be able to use my doctors? Are they in the plan's network?
- Are the plan's in-network providers and facilities in convenient locations?
- Does the plan provide coverage for services I receive from out-of-network providers?
- Do I need a referral to see a specialist?
- Are my medications on the plan's formulary?
- What special accommodations does the plan make for persons with disabilities?
- What special language and cultural accommodations does the plan make?
How Much Does Gateway Health Medicare Assured Diamond Cost?
The premium on this plan is $37.50 per month. That includes your prescription drugs, as well. Plus, you must continue to pay your monthly Medicare Part B premium. Co-payments and/or co-insurances also apply with most healthcare services, except preventive care mandated by CMS (see H5932-001 Summary of Benefits below).
Although the health plan itself does not have a deductible, the prescription drug plan does. It's $445.00 per year. That means you pay 100% of your prescription costs until you've spent $445.00, then the plan will begin paying it's share.
Medicare 5-Star Ratings
In this section we show you the quality rating for this Gateway Health plan. Each year CMS rates health plans (Part C) in five broad categories and drug plans (Part D) in four broad categories. We do not recommend joining a plan with an overall rating less than 3.0. The following marks will give you an idea of the level of care you will receive if you join this health plan.
Gateway Health Medicare Assured Diamond Medicare Part D Co-Pays
This SNP plan includes prescription drug coverage (Medicare Part D). If you have regular prescriptions, it's critical that you evaluate your costs using the plan's formulary.
In addition to the monthly premium and Part D deductible, the drug plan has copayments (fixed dollar amount) and/or coinsurances (percentage) that you must pay when you pickup your medications. Here's the drug coverage schedule for this plan:
|1 (Preferred Generic)||$0.00 copay|
|2 (Generic)||$20.00 copay|
|3 (Preferred Brand)||$47.00 copay|
|4 (Non-Preferred Drug)||$100.00 copay|
|5 (Specialty Tier)||25%|
Contact Gateway Health
For more information about this plan, and other plans on this site, call 1-855-266-4865. You may also contact the plan:
For assistance 24 hours a day, call 800-633-4227. TTY users should call 877-486-2048. If you qualify for Medicare but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov. To learn more about this plan, visit the Gateway Health Medicare website.
Compare Plan Options
The average Pennsylvania senior compares three or more plan options before making an enrollment decision.
Gateway Health Medicare Assured Diamond is available to beneficiaries living in Hereford, Bally, Barto, Bechtelsville, Bernville, Bethel, Birdsboro, Blandon, Bowers, Boyertown, Centerport, Douglassville, Earlville, Fleetwood, Geigertown, Hamburg, Kempton, Kutztown, Leesport, Lenhartsville, Limekiln, Lyon Station, Maxatawny, Mertztown, Mohnton, Mohrsville, Monocacy Station, Morgantown, Mount Aetna, New Berlinville, Oley, Pine Forge, Rehrersburg, Robesonia, Shartlesville, Shoemakersville, Strausstown, Temple, Topton, Virginville, Wernersville, Womelsdorf, Reading, and all other areas of Berks County, Pennsylvania; Medicare plans are the same throughout the County.