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Gateway Health Medicare Assured Plans

Summary & Evidence of Coverage

Below you will find the appropriate Plan Summary and Evidence of Coverage documents for each Medicare Assured plan. These downloadable brochures provide information regarding eligibility and coverage for any Medicare Assured plan you are considering.

Plan Summaries

Pennsylvania Plan Choices

Ohio Plan Choices 

North Carolina Plan Choices 

Kentucky Plan Choices 

Evidence of Coverage

Diamond Plans

Ruby Plans

Select and Prime Plans

Forms require the Adobe Acrobat Reader installed on your system. Most computers have this program installed. If it is not installed on your computer, you can download it for free from Adobe.

Gateway Health offers HMO plans with a Medicare Contract. Some Gateway Health plans have a contract with Medicaid in the states where they are offered. Enrollment in these plans depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium – The State pays the Part B premium for full dual members. Please contact the plan for further details. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

Y0097_1104 Approved