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About Us

Gateway HealthSM delivers quality and affordable healthcare for its members. With more than 20 years of service to the community, Gateway strongly believes in doing things “A better way.”  We don’t believe in just fulfilling members’ health insurance needs. At Gateway, we also assist our members in many aspects of their daily lives that affect their health and well-being.  Gateway understands that overall health is more than a factor of genetics and lifestyle – and that where one lives shouldn’t matter about the quality of care received. That’s why Gateway offers a variety of health plan options for beneficiaries eligible for Medicaid or Medicare. Our large network provides access to top-notch physicians, hospitals and health providers to make sure our members have access to the care they deserve. When communities are healthier, everybody wins. 

Gateway delivers service to members whether young and Growing Up With GatewaySM or older and living with chronic conditions. From regular doctor visits to emergency care, the Gateway team works hard for each member.

Philosophy

Research shows that with resources and support, people with chronic conditions can improve their health and well-being. In an effort to meet our members’ unique needs, to address the challenges faced by members in accessing medical and social support services, Gateway developed an enhanced healthcare management model called Prospective Care Management (PCM®®). This model is a proactive, holistic approach that addresses the Behavioral, Environmental, Economic, Medical, Social and Spiritual (BEEMSSM) issues a member faces that may be barriers to care. Using state of the art techniques, the PCM® model of care helps design a plan to ensure the member receives the individualized services needed. Some of our no-cost programs include smoking cessation and managing chronic conditions, such as asthma, depression, diabetes and heart disease.

History

In 1992, Gateway Health Plan® was established as an alternative to Pennsylvania’s Department of Public Welfare’s Medical Assistance Program. For nearly two decades, members have benefitted from services such as disease management, health and wellness programs and preventive care. Today, Gateway Health is a top-ranked managed care organization that serves more than 300,000 members. Gateway Health is a NCQA® accredited health plan. NCQA is an independent, not-for-profit organization dedicated to assessing and improving health care quality.

Corporate Citizenship and Responsibility

Gateway Health focuses on improving the health of its members and the community by responding to a growing recognition that health is not just the result of genes, lifestyle and access to healthcare. It is also determined by social, economic and environmental conditions that impact the health and vitality of all communities. Gateway demonstrates a strong commitment to corporate citizenship through its many programs and initiatives to promote health and wellness within the community.

Products

 

Medicaid HMO Plan:  Serves those who are eligible for Medical Assistance living in Pennsylvania.

 

Medicare Advantage Plans: Gateway Health's Medicare Advantages plans are now available in Pennsylvania and Ohio.  

 

Dual Eligible Special Needs Plans: For Medicare beneficiaries who also qualify for Medicaid or receive assistance from the State.

• Medicare Assured DiamondSM (HMO SNP)

• Medicare Assured RubySM (HMO SNP)

 

Chronic Special Needs Plans: For Medicare beneficiaries living with diabetes, cardiovascular disorder or chronic heart failure. There are no income requirements for these plans.

• Medicare Assured GoldSM (HMO SNP)

• Medicare Assured PlatinumSM (HMO SNP)

 

Medicare Advantage Prescription Drug (MAPD) Plans: For Medicare beneficiaries living in Ohio.

• Medicare Assured ChoiceSM (HMO)

• Medicare Assured PrimeSM (HMO) 

 

Medicare AssuredSM Special Needs Plans* offer the following benefits in addition to all the benefits of Original Medicare including:

• $0 to low monthly premiums

• Prescription drug coverage

• Transportation  

• Hearing and vision care

• Health and wellness education, such as heart disease,diabetes and asthma programs • Health club membership

* Benefit coverage depends on plan eligibility.