Member
The Enrollment/Disenrollment Process
Gateway Health Plan Medicare Assured® HMO is a Health Maintenance Organization (HMO) for people with Medicare Part A, Medicare Part B and Medicaid. Most Medicare plans have certain times of the year, called election or special election periods, when a person can apply or disenroll. Gateway Health Plan's Medicare Assured® HMO is a Special Needs Plan (SNP), which must allow the applicant to enroll or disenroll at any time during the year.
Members can enroll into our plan by:
- A paper enrollment form
- On-line forms through CMS’s website
- Gateway’s website at www.gatewayhealthplan.com
- By calling Gateway Health Plan® at 1-877-GATEWAY.
Members can disenroll from our plan by completing a paper disenrollment form, sending a letter/fax to Gateway Health Plan Medicare Assured® HMO, writing a letter to Social Security or Railroad Retirement Board or by calling 1-800-Medicare. Members may also disenroll from Gateway Health Plan Medicare Assured® HMO by simply enrolling in another HMO.
Members that enroll and disenroll are made effective the first day of the calendar month.
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Member ID Cards
Each Medicare Assured® HMO member will receive an ID card. Each card is issued once, unless cards are requested or reissued due to a change. ID Cards are good for as long as the person is a member of Gateway Health Plan Medicare Assured® HMO. (Sample ID cards below).
Members age 21 and over will need to use their Gateway Health Plan Medicare Assured® HMO ID card and keep their Medicaid Access card to use for services covered under Medical Assistance and to cover their Medicare deductibles and coinsurance, as long as the provider also participates with Medicaid.
Members under the age of 21 will use their Gateway Health Plan Medicare Assured® HMO ID card and their Gateway Health Plan® Medicaid card. These members will need to keep their Medicaid Access card for non-Medical assistance services, such as transportation through the Medical Assistance Transportation Program (MATP) or cash assistance.
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Determining Eligibility Through Gateway Health Plan Medicare Assured® HMO
Because of potential changes in a member’s eligibility, each participating practitioner is responsible to verify a member’s eligibility with Gateway Health Plan Medicare Assured® HMO BEFORE providing services. Verifying a member’s eligibility will ensure proper reimbursement for services. To verify a member’s eligibility, the following methods are available to all practitioners:
- Gateway Health Plan Medicare Assured® HMO Identification Card
- The card itself does NOT guarantee that a person is currently enrolled in Gateway Health Plan Medicare Assured® HMO. Members are NOT required to return their identification cards when they are no longer eligible for Gateway Health Plan Medicare Assured® HMO.
- Gateway Digital Voice Assistant (DIVA)
- The Gateway DIVA System (1-800-642-3515) is available 24 hours a day, 7 days a week. To verify member eligibility at each visit, practitioners follow a few simple steps, which are listed below:
Press 1 to verify eligibility
Member Identification Number?
Press 1 to verify eligibility using the patient’s social security number, when prompted enter the patient’s 9-digit social security number
Press 2 to verify eligibility using the patient’s Gateway member identification number, when prompted enter the patient’s 8-digit Gateway Health Plan Medicare Assured® HMO identification number
Press 3 to verify eligibility using the patient’s Medical Assistance recipient identification number, when prompted enter the patient’s Medical Assistance recipient number (Note: This option can not be used for Gateway Health Plan Medicare Assured® HMO members.)
Press 4 to verify eligibility using the patient’s Medicare Health Insurance Claim (HIC) number, when prompted enter the patient’s HIC number, followed by the # sign. (For letters press the corresponding key on your touch tone phone. For example: To enter an A, B, or C, press the 2 key. For Q, press the 7 key. For Z, press the 9 key.)
Press 0 to speak to a Provider Services Representative
Press 9 to repeat the menu
Verification of Date?
Press 1 to verify whether the patient is eligible TODAY
Press 2 to verify whether the patient is eligible on a specific date (enter date)
Press 9 to listen to the instructions again
Press 0 to speak to a Provider Services Representative
Additional Instructions:
Press 1 to receive additional information about the patient/member
Press 2 to receive the patient’s primary care practitioner name and telephone number
Press 3 to fax information regarding the patient whose eligibility is being verified
Press 4 to verify eligibility for another patient/member
Press 5 to exit
Press 0 to speak to a Provider Services Representative
Primary Care Practitioner’s Role in Determining Eligibility
Primary care practitioners verify eligibility by consulting their panel listing in order to confirm that the member is a part of the practitioner’s panel. The panel list is distributed on or about the first of every month. The primary care practitioner should check the panel list each time a member is seen in the office. If a member’s name is on the panel list, the member is eligible with Gateway for that month.
If members insist they are effective, but do not appear on the panel list, the practitioner should call the Gateway Health Plan Medicare Assured® HMO Provider Services Department for help in determining eligibility. (Refer to the Quick Reference section in this manual for phone number.)
Members’ Rights and Responsibilities
All Gateway members have rights and responsibilities. They are as follows:
Gateway Health Plan Medicare Assured® HMO
Members’ Rights and Responsibilities
Member Rights
- Your right to be treated with fairness and respect
- Your right to the privacy of your medical records and personal health information
- Your right to see plan providers and get covered services within a reasonable period of time
- Your right to know your treatment choices and participate in decisions about your health care
- Your right to use advance directives (such as a living will or a power of attorney)
- Your right to make complaints
- Your right to get information about your health care coverage and costs
- Your right to get information about Gateway Health Plan®, Gateway Health Plan Medicare Assured® HMO, and plan providers
Member Responsibilities
What are your responsibilities as a member of Gateway Health Plan Medicare Assured® HMO?
- To be familiar with your coverage and the rules you must follow to get care as a member. Please call Member Services if you have any questions.
- To give your doctor and other providers the information they need to care for you, and to follow the treatment plans and instructions that you and your doctors agree upon. Be sure to ask your doctors and other providers if you have any questions.
- To act in a way that supports the care given to other patients and helps the smooth running of your doctor’s office, hospitals, and other offices.
- To pay your plan premiums and any copayments you may owe for the covered services you get.
- To let us know if you have any questions, concerns, problems, or suggestions. If you do, please call Member Services.
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