2017 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | Gateway Health Medicare Assured Ruby (HMO SNP) | ||||
Location: | Adams, Ohio Click to see other locations | ||||
Plan ID: | H9190 - 002 - 0 Click to see other plans | ||||
Member Services: | 1-888-447-4505 TTY users 711 | ||||
— This plan information is for research purposes only. — Click here to see plans for the current plan year | |||||
Medicare Contact Information: | Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options. TTY users 1-877-486-2048 or contact your local SHIP for assistance |
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Email a copy of the Gateway Health Medicare Assured Ruby (HMO SNP) benefit details
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— Medicare Plan Features — | |||||
Monthly Premium: | $0.00 for people who qualify for both Medicare and Medicaid. (see Plan Premium Details below) | ||||
Annual Deductible: | $0 for people who qualify for both Medicare and Medicaid. | ||||
Annual Initial Coverage Limit (ICL): | $3,700 | ||||
Health Plan Type: | Local HMO | ||||
Special Needs Plan (SNP) Eligibility Requirement: | Dual-Eligible | ||||
Additional Gap Coverage? | No additional gap coverage, only the Donut Hole Discount | ||||
Total Number of Formulary Drugs: | 3,233 drugs | Browse the Gateway Health Medicare Assured Ruby (HMO SNP) Formulary | |||
This plan has drug tiers.
See cost-sharing for all pharmacies and tiers.
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Formulary Drug Details: | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
• Preferred Pharmacy Cost-Sharing during initial coverage phase: | cost-sharing data not available. | ||||
• Number of Drugs per Tier: | |||||
Plan's Pharmacy Search: | http://www.MedicareAssured.com | ||||
Plan Offers Mail Order? | Yes | ||||
Number of Members enrolled in this plan in (H9190 - 002): | 283 members | ||||
Plan’s Summary Star Rating: | 2.5 out of 5 Stars. | ||||
• Customer Service Rating: | 4 out of 5 Stars. | ||||
• Member Experience Rating: | 3 out of 5 Stars. | ||||
• Drug Cost Accuracy Rating: | 3 out of 5 Stars. | ||||
— Plan Premium Details — | |||||
The Monthly Premium is Split as Follows: ❔ | Total Premium | Part C Premium | Part D Base Premium | Part D Supplemental Premium | |
$32.30 | $0.00 | $32.30 | $0.00 | ||
Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔ | 100% Subsidy | 75% Subsidy | 50% Subsidy | 25% Subsidy | |
Monthly Part D Premium with LIS: | $0.00 | $0.00 | $0.00 | $0.00 | |
Total Monthly Premium with LIS (Parts C & D): | $0.00 | $0.00 | $0.00 | $0.00 | |
— Plan Health Benefits — | |||||
** General Plan Information ** | |||||
Choice of Doctors?: Plan Doctors for Most Services | |||||
** Cost ** | |||||
Monthly Health Plan Premium: $0.00 | |||||
Monthly Drug Plan Premium: $32.30 | |||||
Health Plan Deductible: $0 | |||||
Other Health Plan Deductibles?: No | |||||
Maximum Out-of-Pocket Enrollee Responsibility (does not include prescription drugs) : $6,700 In-network | |||||
** Extra Benefits ** | |||||
Prescription Drugs Covered?: Yes | |||||
Optional Supplemental Benefits?: No | |||||
** Outpatient Care and Services ** | |||||
Ambulance: $0 or $200 | |||||
Doctor's office visits:
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Durable medical equipment (wheelchairs, oxygen, etc.): 0% or 20% per item | |||||
Emergency care: $0 or $75 per visit (always covered) | |||||
Home health care: You pay nothing | |||||
Mental health care:
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Outpatient hospital: $0 or $200-275 per visit | |||||
Renal dialysis: 0% or 20% per visit | |||||
** Inpatient Care ** | |||||
Inpatient hospital care:
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Optional Supplemental Benefits?: No | |||||
Skilled Nursing Facility (SNF):
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Prescription Drugs Covered?: Yes | |||||
** Additional Benefits ** | |||||
Optional Supplemental Benefits?: No |