Gateway Health Medicare Advantage Products Pending CMS Approval
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- Charleen Henry
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1 Gateway Health Medicare Advantage Products 2016
2 2016 PLAN OFFERINGS
3 2016 PLAN OFFERINGS Product Plan Names States MedicareAdvantage Prescription Drug Plan (MAPD) ChronicCondition Special Needs Plans (C-SNP) Dual Eligible Special Needs Plan (D-SNP) Prime Select Platinum Gold Diamond Ruby Kentucky,North Carolina & Ohio Kentucky, North Carolina & Ohio Kentucky,North Carolina, Ohio, & Pennsylvania Kentucky,North Carolina, Ohio, & Pennsylvania Kentucky,North Carolina, Ohio & Pennsylvania Kentucky,North Carolina, Ohio & Pennsylvania
4 MAPD PLANS
5 Medicare Advantage Prescription Drug (MAPD) Eligibility Requirements MAPD Gateway Health SM Select Gateway Health SM Prime Enrollment Eligibility: Live in the County Service Area Entitled to Medicare Part A Enrolled in Medicare Part B
6 Deductible 2016 Benefit Snapshot MAPD KY, OH, NC Benefits SM Select SM Prime Deductible $225 Part C Deductible $360 Part D No Deductible MOOP $6,700 $6,700 Inpatient Hospital Days 1-5 $350 copay per day Days 1-5 $200 copay per day PCP/ SpecialistOffice Visits $10/ $50 Copay $0 / $25 Copay Chiropractor / Podiatry $20 / $50 Copay $20 / $25 Copay Home Health Care $0 $0 Rx Generic / Brand / Specialty $3/$16/$45/$95/25% $0/$20/$45/$95/27% Mail Order 2 x s Retail Copay except Tier 5 2 x s Retail Copay except Tier 5 Overthe Counter Items (OTC) (No cough/cold) Vision Dental $30 per Quarter $30 per Quarter $225 towards eye wearper year (1 eye exam per yr) $0 Co-pay Cleaning& Exam 6 mo $150 towards eye wear per yr (1 eye exam per yr) Cleaning& Exam 6 mo./ $1000 toward Comprehensive dental/ Dentures 5 yr Hearing Fitness Program $1,000 every 2 yrs $0 copaytesting, exams and fitting Health ClubMembership or at Home Workout Kit included $1,000 every 2 yrs $0 copaytesting, exams and fitting Health ClubMembership or at Home Workout Kit included
7 2016 MAPD Premiums State Select Prime Kentucky $0 $93.00 North Carolina $0 $93.00 Ohio $0 $93.00 Pennsylvania NA NA
8 CHRONIC CONDITION SPECIAL NEEDS PLANS
9 Chronic Special Needs Plan (C-SNP) Eligibility Requirements Gateway Health SM Gold Gateway Health SM Platinum For individuals with at least one of the following conditions: Diabetes Type 1 or Type 2 Congestive Heart Failure (CHF) Cardiovascular Disease (CVD) Cardiac Arrhythmias Coronary Artery Disease Peripheral Vascular Disorder Chronic Venous Thromboembolic Disorder There are no income limits or restrictions to enroll in either plan Enrollment Eligibility Live in Service Area Entitled to Medicare Part A Enrolled in Medicare Part B Not diagnosed with having End Stage Renal Disease
10 2016 Benefit Snapshot C-SNP All Service Areas Benefits Gold Platinum MOOP $6,700 $6,700 Inpatient Hospital Days 1-7 $275 copay per day Days 1-7 $275 copay per day PCP/ Specialist Office Visits $20/ $45 Copay $15/ $35 Copay Chiropractor / Podiatry $20 / $45 Copay $20 / $35 Copay Diabetic Monitoring Supplies $0 Co-pay $0 Co-pay Rx Generic / Brand / Specialty $4/$10/$45/$95/25% $4/$10/$45/$95/27% Tier 6 Chronic Condition Rx $11 $11 Over the Counter Items (OTC) $25 per Quarter $25 per Quarter Vision Dental Hearing Fitness Program $100 towards eye wear every 2 years (1 eye exams per yr) Cleaning& Exam 6 mo./ $0 Copay $0 copay exams / hearing aid NOT covered Health ClubMembership or at Home Workout Kit included $150 towards eye wear every year (4 eye exams per yr) Cleaning& Exam 6 mow $0 Copay/ $500 toward Comprehensive dental/ Dentures 5 yr $1,000 every 2 yrs $0 copaytesting, exams and fitting Health ClubMembership or at Home Workout Kit included
11 2016 C-SNP Premiums State Gold Platinum Kentucky $64.00 $97.00 North Carolina $64.00 $97.00 Ohio $59.00 $97.00 Pennsylvania $64.00 $97.00
12 DUAL ELIGIBLE SPECIAL NEEDS PLANS
13 Dual Special Needs Plan (D-SNP) Eligibility Requirements Gateway Health SM Diamond Gateway Health 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
14 2016 Benefit Snapshot D-SNP All service Areas MOOP Benefits Diamond $3400 $6700 Ruby Inpatient Hospital Days 1-90 $0 Days 1-7 $250 PCP/ SpecialistOffice Visits $0 /$0 Copay $0 /$35 Copay Chiropractor / Podiatry $0 Copay $20/$30 Copay Rx Generic / All Other $0-$2.95 / $0-$7.40 $0-$2.95 / $0-$7.40 Overthe Counter Items (OTC) no cough/cold $50 per Quarter $50 per Quarter Vision Dental Hearing $100 towards eye wear per yr (4 eye exams per yr) $0 copay Cleaning& Exam 6 mo./ $500 toward Comprehensive dental/ Dentures 5 yrs $1,000 every 2 yrs $0 copaytesting, exams and fitting $100 towards eye wear per yr (4 eye exams per yr) Cleaning& Exam 6 mo./ $0 Copay $1,000 every 2 yrs $0 copaytesting, exams and fitting Transportation Yes, Up to24 one way trips per year Yes, Up to24 one way trips per year Fitness Program Health ClubMembership or at Home Workout Kit included Health ClubMembership or at Home Workout Kit included
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