|Part D Benefit:||Yes|
|Rx Gap Coverage:||N|
Gateway Health Medicare Assured Select is a Health Maintenance Organization (HMO) Medicare Advantage plan, by Gateway Health, available in Wake County, North Carolina. It offers all of the basic benefits of Original Medicare and may include additional coverage.
With an HMO plan, like this one from Gateway Health, your out-of-pocket costs are much lower than Original Medicare. That's the big advantage.
IMPORTANT: You must use providers in the Gateway Health network to avoid incurring additional costs. You are responsible for all costs incurred out of network. Referrals are generally required to see specialists.
This plan has a zero dollar premium!
The Gateway Health Medicare Assured Select premium is zero dollar, however, it is not free. You continue make your Medicare Part B premium payment and that covers the full cost. If your income is over $85,000 ($170,000 for married couples) a year, or you have a penalty due to late enrollment, you pay the standard Part B premium.
In addition to the premiums you also pay your share when you use healthcare services. Each time you see your doctor, or if you are admitted as an inpatient (hospitalized), you'll pay copayments. Your prescription drugs also have a cost sharing component.
Maximum Out-of-Pocket Limit
All 2018 Medicare Advantage plans have a $6,700 maximum out-of-pocket (MOOP) limit. That said, Medicare allows for a voluntary MOOP as low as $3,400.This plan's MOOP is $6,700. This figure is not inclusive of your monthly premium or the cost of your prescriptions (Medicare Part D Coverage).
This means that you will no longer pay copayment or coinsurance as soon as your copayments and coinsurance for doctor visits and hospital care reaches $6,700. This is your guarantee that an illness or accident will send you into bankruptcy. Consider the MOOP along with the premium and the copay.
If you're comparing this plan with Original Medicare, don't forget that you pay about 20% of all covered expenses, but there's no limit. You have a lot of risk with Original Medicare unless you buy a Medicare Supplement to cover your copayments and coinsurances.
Coverage, Copayments & Coinsurance
The Gateway Health Medicare Assured Select plan offers the same basic benefits as Original Medicare. The big difference is copayments and coinsurances. Below you will find (where available) what you will pay for common health care services.
Most plans have copayments when you see your primary care doctor or a specialist. Here's how this plan works:
|Primary Care Doctor:||$10 co-payment|
|Physician Specialist:||$45 co-payment|
|Occupational Therapist:||$40 co-payment|
|Physical Therapist:||$40 co-payment|
|Speech Terapist:||$40 co-payment|
If you are admitted to a hospital or clinic for treatment and stay overnight, you are an inpatient. Most plans have tiered costs for inpatient treatment. Here's how this plan covers you:
- Day 1 to 5: $350
- Day 6 to 90: $0
The following preventative healthcare services are covered at no cost:
- Abdominal aortic aneurysm screening
- Alcohol misuse counseling
- Bone mass measurement
- Breast cancer screening (mammogram)
- Cardiovascular disease (behavioral therapy)
- Cardiovascular screenings
- Cervical and vaginal cancer screening
- Colorectal cancer screenings
- Depression screening
- Diabetes screenings
- HIV screening
- Medical nutrition therapy services
- Obesity screening and counseling
- Prostate cancer screenings (PSA)
- Sexually transmitted infections screening and counseling
- Tobacco use cessation counseling
- Vaccines including Flu shots Hepatitis B shots Pneumococcal shots
- Welcome to Medicare preventive visit
- Yearly Wellness visit
Prescription Drug Coverage
This plan includes Medicare Part D coverage for your prescription medications. The table below outlines what you will pay (the copayment) at your pharmacy for medications at each tier level.
If you are entitled to Part D assistance, your premium will be adjusted based on your percentage.
The Part D deductible on plan is $200.00. This is the amount you will pay until the plan begins to pay its portion.
Medicare Plan Rating
Medicare gave the Gateway Health Medicare Assured Select plan an average rating of -1.0 out of 5 stars. This rating is , by Medicare's definition.
Medicare rates the quality of all Medicare Advantage plans. Ratings help shopper considering enrollment. Five stars represents the best quality. Plans rated less than 2.5 stars cannot be sold.
Compare Gateway Health Medicare Assured Select with these top rated plans available in Wake County:
- Humana Gold Plus H1036-233
- Blue Medicare PPO Enhanced
- Blue Medicare HMO Medical Only
- Blue Medicare HMO Essential
- Aetna Medicare Value Plan
Gateway Health Medicare Assured Select Availability
Gateway Health Medicare Assured Select is available in Apex, Wendell, Willow Spring, Garner, Raleigh, New Hill, Zebulon, Holly Springs, Fuquay Varina, Rolesville, Cary, Knightdale, Morrisville, Wake Forest, and all other areas of Wake County.
This page was last updated on 10/14/2017.
Plan data on Medicare-Plans.net comes from CMS.gov and is subject to change. The Centers for Medicare and Medicaid Services has neither reviewed nor endorsed the information on this site.
This page is a brief summary, not a complete description. Limitations, co-payments, and restrictions may apply. For more information contact the plan directly.
Medicare-Plans.net is available for educational purposes only. This website is not intended as a substitute for legal, health, or financial advice from a licensed professional. This page is intended to help consumers research and compare Medicare Advantage plans.
Medicare-Plans.net is an independent publisher. We are not affiliated with Medicare, Medicare plans, insurance carriers, or healthcare providers.