2018 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | Gateway Health Medicare Assured Prime (HMO) | ||||
Location: | Hardin, Ohio Click to see other locations | ||||
Plan ID: | H9190 - 006 - 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 Prime (HMO) benefit details
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— Medicare Plan Features — | |||||
Monthly Premium: | $107.00 (see Plan Premium Details below) | ||||
Annual Deductible: | $250 (Tier 1 and 2 excluded from the Deductible.) | ||||
Annual Initial Coverage Limit (ICL): | $3,750 | ||||
Health Plan Type: | Local HMO | ||||
Maximum Out-of-Pocket Limit for Parts A & B (MOOP): | $6,700 | ||||
Additional Gap Coverage? | No additional gap coverage, only the Donut Hole Discount | ||||
Total Number of Formulary Drugs: | 3,295 drugs | Browse the Gateway Health Medicare Assured Prime (HMO) Formulary | |||
This plan has 5 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: | $0.00 | $20.00 | $45.00 | $95.00 | 28% |
• Number of Drugs per Tier: | 627 | 1577 | 406 | 213 | 472 |
Plan's Pharmacy Search: | http://www.MedicareAssured.com | ||||
Plan Offers Mail Order? | No | ||||
Number of Members enrolled in this plan in Hardin, Ohio: | less than 10 members | ||||
Number of Members enrolled in this plan in (H9190 - 006): | 83 members | ||||
Plan’s Summary Star Rating: | 2.5 out of 5 Stars. | ||||
• Customer Service Rating: | 5 out of 5 Stars. | ||||
• Member Experience Rating: | 3 out of 5 Stars. | ||||
• Drug Cost Accuracy Rating: | 2 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 | |
$107.00 | $73.50 | $33.50 | $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: | $1.50 | $9.50 | $17.50 | $25.50 | |
Total Monthly Premium with LIS (Parts C & D): | $75.00 | $83.00 | $91.00 | $99.00 |
— Plan Health Benefits — |