2.Initial Coverage: (ICL) After you reach the plans deductible but before the Initial Coverage limit of $3310 1 National Imaging Associates, Inc. is a subsidiary of Magellan Healthcare, Inc. *A separate authorization number is required for each procedure ordered. Gateway Health Medicare Assured providers in Pennsylvania or 1-800-424-1732 for those providers in Ohio, Kentucky, and North Carolina. Premium: A monthly flat fee that varies by plan. 4.Catastrophic: Anything over $4850 you will receive a significant increase in coverage. Medicare Assured Diamond. Gateway Health Medicare Assured SM Diamond Gateway Health Medicare Assured SM Ruby • Enrollment Eligibility: Live in the Service Area Entitled to Medicare Part A Enrolled in Medicare Part B Not diagnosed with End Stage Renal Disease (ESRD) Enrolled in state Medicaid program –Pending CMS Approval Gateway Health Medicare Assured Diamond is a 2021 D-SNP Medicare Special Needs Plan, from Gateway Health, available in Lancaster County, Pennsylvania. Source:CMS Formulary Data Oct. 2015 Gateway Health's Medicare Assured Diamond (HMO SNP) is created for Medicare beneficiaries on a fixed income and who are eligible for full Medicaid benefits. 2016 Medicare Advantage Plan Benefits explained in plain text. Below is the Formulary, or drug list, for Gateway Health Medicare Assured Diamond (HMO SNP) from Gateway Health Plan Of Ohio, Inc. See More on Gateway Health Medicare Assured Diamond (HMO SNP), (Mouse over for Tips) In 2016 if you have spent $4700 in expenditures you enter the Catastrophic Phase. If you still cannot locate your drugs, your plan may not offer coverage. You can see if this plan covers your drugs in the Catastrophic Phase by clicking the "Catastrophic" link on the left above the chart. The Gateway Health Medicare Assured Diamond (HMO D-SNP) plan has a monthly drug premium of $35.60 and a $435.00 drug deductible. (combined amount plus your deductible) You will enter the coverage gap. Welcome to the Gateway Health Medicare Assured Diamond/Ruby formulary. As a Percent of the total drug cost or a flat rate. This Gateway Health Medicare Assured plan offers a $35.60 Part D Basic Premium that is not below the regional benchmark. The Coverage Gap, which is also known as the Donut (Doughnut) Hole is the phase of your Medicare Part D plan where you are responsible for 100% of your medication costs. Both plans include $0 copay options. This plan is available in PA. If this is not an option, you can request an exception to have the plan review its coverage decision based on your individual circumstances. As a Percent of the total drug cost or a flat rate. This formulary is a list of prescription medications that are covered under Gateway Health Plan Of Ohio, Inc.'s Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of Gateway Health Medicare Assured Diamond (HMO SNP) This booklet gives you the details about your Medicare health care and prescription drug coverage from January 1 – December 31, 2021. (Click the Drug Name to Compare every Plans Price). Premiums, deductibles, co-pays, drug coverage, and more for Gateway Health Medicare Assured Diamond (HMO), a 2021 Medicare Advantage Plan for beneficiaries in Jefferson County, PA | 2021-H5932-001-0 The formulary may change at any time. ... View Document The Gateway Health Medicare Assured Diamond (HMO SNP) plan has a $360 drug deductible. Details Drug Coverage for the Gateway Health Medicare Assured Gateway Health Medicare Assured Diamond H5932-001 (HMO D-SNP) in Pennsylvania. Cost Non Pref: Your Cost for the Prescription Drug at a Non-Prefered Pharmacy. Gateway Health Medicare Assured Diamond is created for Medicare beneficiaries who are on a fixed income and eligible for full Medicaid benefits. You will receive notice when necessary. Gateway medicare assured formulary keyword after analyzing the system lists the list of keywords related and the list of websites with related content, in addition you can see which keywords most interested customers on the this website. Welcome to the Gateway Health Medicare Assured Diamond/Ruby formulary. Or, contact the owner Gateway Health LLC of the GATEWAY HEALTH MEDICARE ASSURED DIAMOND … **We make every attempt to keep our information accurate. Write a review about a product or service associated with this GATEWAY HEALTH MEDICARE ASSURED DIAMOND trademark. Will be allowed to maintain customer base. You can search the formulary alphabetically by selecting the first letter of the drug you are looking for, OR by either the Brand or Generic name of a drug by entering the name of the drug or the first few letters if the full name or correct spelling is not … If you dont get approval, the plan may not cover the drug. This is a 4-star Medicare Advantage plan. Please check the formulary for different brand and generic names. Gateway Health is committed to offering a variety of comprehensive, cost-effective health plan options to support the whole person. You can search the formulary in several ways. This is a brand page for the GATEWAY HEALTH MEDICARE ASSURED DIAMOND trademark by Gateway Health LLC in PITTSBURGH, PA, 15222. Gateway Health Medicare Assured providers in Pennsylvania, Ohio, Kentucky, and North Carolina should check claims status via NaviNet or by calling our Provider Services Department at 1-800-685-5209, press 2, Who should a provider contact if they want to appeal a prior Gateway Health Medicare Assured Diamond is an Ohio Registered Trade Name filed on March 3, 2014. This is a 4-star Medicare Advantage plan. The exception is the $0 Deductible Plans. Health Details: Gateway Health Medicare Assured Diamond and Gateway Health Medicare Assured Ruby will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Gateway Health Medicare Assured Diamond or Gateway Health Medicare Assured … Some plans have a $0 Deductible. But please check with the plan providers to verify all information. Call 1-800-401-2740 (TTY: 711) for more information. Healthgolds.com 2021 Comprehensive Formulary. You or your prescriber have the right to request a coverage determination or exception for drugs that require prior approval or for exceptions to Gateway’s formulary. Gateway Health Medicare Formulary. Most plans have 4 levels of coverage. 2017 Medicare SNP Plans For NC - NCDOI - Home Page Medicare SNP Plans for NC *** Indicates sanctioned by CMS. This plan is available in PA. 2017 Medicare 5 Tier Formulary Gateway Health Medicare Assured PrimeSM (HMO) Gateway Health Medicare Assured SelectSM (HMO) PLEASE READ: This document contains information about the drugs we cover in these plans. Get the Gateway health plan medicare assured hmo snp drug exception form Step Therapy: Means you must first try one drug to treat your medical condition before the plan will cover another drug for the same condition. If your prescribing doctor feels it is necessary to exceed the set limit, he or she must get prior approval before the higher quantity will be covered. ... Formulary Medications - Gateway Health. It explains how to get coverage for the health care services Some plans offer select Pre-deductible drug Coverage Since 1992, Gateway Health has focused on serving the members of our community who are eligible for Medical Assistance. This formulary is a list of prescription medications that are covered under Gateway Health Plan Of Ohio, Inc.'s 2016 Medicare Advantage Plan. You can search the formulary alphabetically by selecting the first letter of the drug you are looking for, OR by either the Brand or Generic name of a drug by entering the name of the drug or the first few letters if the full name or correct spelling is not known. Usually just an additional form. Click here to browse the Gateway Health Medicare Assured Diamond (HMO D-SNP) Formulary. Lower costs for a gateway medicare phone or receive remuneration from communicare advantage plans this humana plan may not covered under a provider services. Disclaimer | Contacts Copyright © 2021 Medicare Help, Gateway Health Medicare Assured Diamond (HMO SNP), State Health Insurance Assistance Programs SHIP, See More on Gateway Health Medicare Assured Diamond (HMO SNP), 12 Vial, Glass In 1 Carton > 10 Ml In 1 Vial, Glass. The max in 2016 is $320. Learn more about plan monthly cost,premimum deductibles,prescription drug … Learn more about plan monthly cost,premimum deductibles,prescription drug … Cost Mail: Your Cost for Prescription Drugs through a Mail Order Pharmacy. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1GROUP LLC and National Insurance Markets, Inc It includes prescription drug coverage (Medicare Part D). Deductible: The amount you must pay each year for your prescriptions before your plan begins to pay its share of your covered drugs. The Initial Coverage Limit (ICL) for this plan is $3310. Cost Prefered: Your Cost for the Drug at the Providers In Network Prefered Pharmacy. Drugs in each tier have a different cost. Once you and your plan provider have spent $3310 on covered drugs. The company's filing status is listed as Active and its File Number is 2274429. Gateway Health Medicare Assured Diamond (HMO SNP) Gateway Health Medicare Assured Ruby (HMO SNP) This is a summary of drug and health benefits for January 1, 2020 – December 31, 2020 The benefit information provided is a summary of what we cover and what you pay. Does the Deduct Apply: Some drugs do not require that the deductible is met before you receive coverage. Having the benefits of a Gateway Health Medicaid membership allows you access to better health plan solutions. You can see if this plan offers coverage in the "donut hole" be clicking the "Coverage Gap" link on the left above the chart. drug, you will see the page number where you can find coverage information. Get 2019 Medicare Advantage information on Gateway Health Medicare Assured Diamond (HMO SNP) from Gateway Health Plan. Medicare Assured Diamond and Gateway Health Medicare Assured Ruby will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Gateway Health Medicare Assured Diamond or Gateway Health Medicare Assured Ruby network pharmacy, and other plan rules are followed. This Information is not a complete description of benefits. For more information on how to submit a request, visit our website at https://www.gatewayhealthplan.com/medicare/member-tools/medication-benefits/formulary-medication/formulary-exceptions. Health Details: 1—Gateway Health Medicare Assured – Prior Authorization Checklist To expedite the process, please have the following information ready before logging on to Magellan Healthcare’s 1 Web site or calling the Magellan Healthcare Utilization gateway prior authorization form › Verified 4 days ago 3.Coverage Gap: (AKA Donut Hole) After you reach the plans ICL but before the Catastrophic of $4850 in 2016. Below is the Formulary, or drug list, for Gateway Health Medicare Assured Diamond (HMO SNP) from Gateway Health Plan Of Ohio, Inc. Gateway Health, which earned a four-star quality rating from the Centers for Medicare and Medicaid Services (CMS), offers supplemental benefits through its Medicare Assured Diamond Plan and Medicare Assured Ruby Plan. Gateway Health Medicare Assured Ruby Medicare Part D Co-Pays This SNP plan includes prescription drug coverage (Medicare Part D) . Healthcare Reform mandates that the insurance carrier pay 75% of your generic drug prescription costs in the donut hole … Prior Authorization: Certain Drugs require you or your doctor to get prior authorization in order to be covered. Premiums, deductibles, co-pays, drug coverage, and more for Gateway Health Medicare Assured Diamond (HMO), a 2021 Medicare Advantage Plan for beneficiaries in Lebanon County, PA | 2021-H5932-001-0 All Rights Reserved, https://www.gatewayhealthplan.com/medicare/member-tools/medication-benefits/formulary-medication/formulary-exceptions, Blood Formation, Coagulation, And Thrombosis, Eye, Ear, Nose, And Throat (Eent) Preparations. The Registered Agent on file for this company is Gateway Health Plan Of Ohio, Inc. and is located at Four Gateway Center, 444 Liberty Avenue Suite 2100, Pittsburgh, PA 15222. 1.Pre-Deductable: Before you reach the plans deductible of $360. These plans include significant $0 copay options to ensure that health plan members can access the care you need when you need it. During the Catastrophic Period you will begin to receive significant coverage. The Initial Coverage Period is the period after the Deductible has been met but before the Coverage Gap phase. Gateway Health Medicare Assured Diamond (HMO SNP) will begin paying approximately 95% of your covered medication expenses. 2016 Medicare Advantage Plan. It's a Local HMO health plan. You can see if the deductible is required below in the "Does the Deductible Apply" column. Talk to your doctor first about changing your prescription to a drug on your plans formulary. (AKA "donut hole") Once you reach the coverage gap you will be required to pay 45% of the plan's cost for covered brand-name prescription drugs unless your plan offers additional coverage. PRIOR AUTHORIZATION INFORMATION - RADMD. health medicare assured number can only need your request will receive coverage to your condition. ©1997-2021 Managed Markets Insight and Technology, LLC. A drug in a lower tier will generally cost you less. If you have already tried other drugs or your doctor thinks they are not right for you, you and your doctor can ask the plan to cover this drug. You can also search the formulary by Therapeutic Class of the drug if the exact drug name is not known. This deductible is the amount of expenses that must be paid out of pocket before the Initial Coverage period begins. Quantity Limit Amount/Days: Certain drugs have a Quantity Limit. You can search the formulary in several ways. Details Drug Coverage for the Gateway Health Medicare Assured Gateway Health Medicare Assured Ruby H5932-009 (HMO D-SNP) in Pennsylvania. Freedom Health, Inc. is an HMO with a Medicare contract and a contract with the state of Florida Medicaid program. Enrollment in Freedom Health, Inc. depends on contract renewal. If you have regular prescriptions, it's critical that you evaluate your costs using the plan's formulary. Gateway Health Medicare Assured Diamond and Gateway Health Medicare Assured Ruby will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Gateway Health Medicare Assured Diamond or Gateway Health Medicare Assured Ruby network pharmacy, and other plan rules are followed. As a Percent of the total drug cost or a flat rate. That means the plan will only cover the drug up to a designated quantity or amount. The Gateway Health Medicare Assured Diamond (HMO SNP) plan has a $360 drug deductible. Tier Level: Medicare drug plans place drugs into different "tiers" on their formularies. Source:NDC Directory by FDA.gov Medicare Assured Diamond Plan However some drugs do not require that the deductible is met before you receive coverage. 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