Our Products
Gateway Health Plan® offers two products in Pennsylvania:
- Medicaid HMO Plan
- Medicare Special Needs Plan
Unlike many health insurance companies, Gateway Health Plan® focuses entirely on serving the needs of the most vulnerable citizens - the poor, elderly and disabled.
Since its inception, Gateway has focused on providing the best possible healthcare to a growing number of Medicaid members. Gateway offers care for all kinds of health needs – everything from regular doctor visits to emergency care.
Gateway also offers a Medicare approved Special Needs Plan, called Medicare Assured®. This program is available to individuals who have both Medicare and Medicaid. As of January 2008, Gateway Health Plan Medicare Assured® is available to individuals in 27 counties in Pennsylvania making it one of the largest plans of its kind in the country.
Gateway offers the following benefits to members enrolled in Medicare Assured®:
- All the benefits of Original Medicare
- No monthly premiums
- Prescription drug coverage
- Hearing and vision benefits
- Health and wellness education, such as heart disease, diabetes and asthma programs, and smoking cessation
- Fitness Assured®, a fitness program to help members stay active
- Transportation
Membership/Network
Gateway Health Plan® serves more than 244,000 members. Gateway Health Plan Medicare Assured® has more than 24,000 members. Gateway’s provider network includes more than 8,000 health care providers, more than 100 hospitals, a network of pharmacies, home healthcare agencies and other related healthcare providers.
Quality Accomplishments
Gateway Health Plan® holds an ‘Excellent’ rating from the National Committee for Quality Assurance (NCQA), an independent agency that accredits and certifies managed care organizations, for its Medicaid HMO product. This rating is only awarded to those health plans that meet or exceed NCQA’s rigorous requirements for consumer protections and quality improvements. Gateway’s ‘Excellent’ rating indicates the strength of the health plan’s overall member focus, from efficient and timely claims processing to assisting its members in receiving the care they need. In 2000, Gateway became the first Medicaid health plan to receive NCQA’s ‘Excellent’ accreditation and was the first to repeat that level of accreditation in 2006.
Gateway Health Plan® is proud to be recognized with a five-star “Excellent” Member Quality Rating from the 2008 CAHPS® Survey. This rating is based on how Gateway members rated Gateway’s overall quality in the survey. This honor is the result of passion, a commitment to excellence, and the dedication of a compassionate staff. Our work is a reflection of our guiding principles and our mission to distinguish ourselves as the health plan with superior quality and service.
Continuing Quality Care
Healthcare is an ever-changing field and Gateway strives to stay on top of its members’ needs. Gateway is committed to continuous improvement and providing high standards of quality in every aspect of service. This commitment is led by Gateway’s 18-member Quality Improvement/Utilization Management committee, made up of experts in a wide variety of medical fields. The QI/UM Committee evaluates Gateway’s ongoing efforts as well as new protocols and clinical guidelines in order to improve services and care for its members.
Wellness & Disease Management
Gateway is committed to improving the life of its members and working to find new ways to promote wellness, illness prevention and health education as demonstrated by the following programs:
- Preventive health care guidelines
- Free quit tobacco program
- Pediatric and adult immunization reminders
- Cardiac disease prevention program
- Free personalized programs to assist patients with diabetes, asthma and depression
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