2017 Evidence Of Coverage

Transcription

1 2017 Evidence Of Cverage January 1 December 31, 2017 Yur Medicare Health Benefits and Services and Prescriptin Drug Cverage as a Member f Gateway Health Medicare Assured Ruby SM (HMO SNP) This plan, Gateway Health Medicare Assured Ruby SM, is ffered by Gateway Health Plan, Inc. and Gateway Health Plan f Ohi, Inc. (When this Evidence f Cverage says we, us, r ur, it means Gateway Health Plan, Inc. and Gateway Health Plan f Ohi, Inc. When it says plan r ur plan, it means Gateway Health Medicare Assured Ruby SM.) Gateway Health Medicare Assured Ruby SM (HMO SNP) is an HMO plan with a Medicare cntract and a cntract with Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) and Kentucky Medicaid. Enrllment in this plan depends n cntract renewal. Member Services has free language interpreter services available fr nn-english speakers (phne numbers are printed n the back cver f this bklet). This infrmatin is als available in languages ther than English, in Braille, in large print r ther alternate frmats, etc. Benefits, premium, deductible, and/r cpayments/ cinsurance may change n January 1, The frmulary, pharmacy netwrk, and/r prvider netwrk may change at any time. Yu will receive ntice when necessary. This bklet gives yu the details abut yur Medicare health care and prescriptin drug cverage frm January 1 - December 31, It explains hw t get cverage fr the health care services and prescriptin drugs yu need. This is an imprtant legal dcument. Please keep it in a safe place. Y0097_771 Accepted Frm CMS ANOC/EOC (Apprved 03/2014) OMB Apprval

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3 2017 Evidence f Cverage fr Gateway Health Medicare Assured Table f Cntents Evidence f Cverage Table f Cntents This list f chapters and page numbers is yur starting pint. Fr mre help in finding infrmatin yu need, g t the first page f a chapter. Yu will find a detailed list f tpics at the beginning f each chapter. Chapter 1. Getting started as a member... 4 Explains what it means t be in a Medicare health plan and hw t use this bklet. Tells abut materials we will send yu, yur plan premium, yur plan membership card, and keeping yur membership recrd up t date. Chapter 2. Chapter 3. Imprtant phne numbers and resurces Tells yu hw t get in tuch with ur plan (Gateway Health Medicare Assured) and with ther rganizatins including Medicare, the State Health Insurance Assistance Prgram (SHIP), the Quality Imprvement Organizatin, Scial Security, Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) and Kentucky Medicaid (the state health insurance prgram fr peple with lw incmes), prgrams that help peple pay fr their prescriptin drugs, and the Railrad Retirement Bard. Using the plan s cverage fr yur medical and ther cvered services Explains imprtant things yu need t knw abut getting yur medical care as a member f ur plan. Tpics include using the prviders in the plan s netwrk and hw t get care when yu have an emergency. EVIDENCE OF COVERAGE Chapter 4. Chapter 5. Chapter 6. Benefits Chart (what is cvered and what yu pay)...52 Gives the details abut which types f medical care are cvered and nt cvered fr yu as a member f ur plan. Explains hw much yu will pay as yur share f the cst fr yur cvered medical care. Using the plan s cverage fr yur Part D prescriptin drugs Explains rules yu need t fllw when yu get yur Part D drugs. Tells hw t use the plan s List f Cvered Drugs (Frmulary) t find ut which drugs are cvered. Tells which kinds f drugs are nt cvered. Explains several kinds f restrictins that apply t cverage fr certain drugs. Explains where t get yur prescriptins filled. Tells abut the plan s prgrams fr drug safety and managing medicatins. What yu pay fr yur Part D prescriptin drugs Tells abut the 3 stages f drug cverage (Deductible Stage, Initial Cverage Stage, Catastrphic Cverage Stage) and hw these stages affect what yu pay fr yur drugs. Tells abut the late enrllment penalty.

4 2017 Evidence f Cverage fr Gateway Health Medicare Assured Table f Cntents 2 Chapter 7. Asking us t pay ur share f a bill yu have received fr cvered medical services r drugs Explains when and hw t send a bill t us when yu want t ask us t pay yu back fr ur share f the cst fr yur cvered services r drugs. Chapter 8. Yur rights and respnsibilities Explains the rights and respnsibilities yu have as a member f ur plan. Tells what yu can d if yu think yur rights are nt being respected. Chapter 9. What t d if yu have a prblem r cmplaint (cverage decisins, appeals, cmplaints) Tells yu step-by-step what t d if yu are having prblems r cncerns as a member f ur plan. Explains hw t ask fr cverage decisins and make appeals if yu are having truble getting the medical care r prescriptin drugs yu think are cvered by ur plan. This includes asking us t make exceptins t the rules r extra restrictins n yur cverage fr prescriptin drugs, and asking us t keep cvering hspital care and certain types f medical services if yu think yur cverage is ending t sn. Explains hw t make cmplaints abut quality f care, waiting times, custmer service, and ther cncerns. Chapter 10. Ending yur membership in the plan Explains when and hw yu can end yur membership in the plan. Explains situatins in which ur plan is required t end yur membership. Chapter 11. Legal ntices Includes ntices abut gverning law and abut nndiscriminatin. Chapter 12. Definitins f imprtant wrds Explains key terms used in this bklet.

5 CHAPTER 1 Getting started as a member EVIDENCE OF COVERAGE

6 2017 Evidence f Cverage fr Gateway Health Medicare Assured Chapter 1. Getting started as a member 4 Chapter 1. Getting started as a member SECTION 1 Sectin 1.1 Sectin 1.2 Sectin 1.3 SECTION 2 Sectin 2.1 Sectin 2.2 Sectin 2.3 Sectin 2.4 Sectin 2.5 SECTION 3 Sectin 3.1 Sectin 3.2 Sectin 3.3 Sectin 3.4 SECTION 4 Sectin 4.1 Sectin 4.2 Sectin 4.3 SECTION 5 Sectin 5.1 SECTION 6 Sectin 6.1 SECTION 7 Sectin 7.1 Intrductin...5 Yu are enrlled in Gateway Health Medicare Assured, which is a specialized Medicare Advantage Plan (Special Needs Plan)... 5 What is the Evidence f Cverage bklet abut?... 6 Legal infrmatin abut the Evidence f Cverage... 6 What makes yu eligible t be a plan member?...6 Yur eligibility requirements... 6 What are Medicare Part A and Medicare Part B?... 7 What is Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) and Kentucky Medicaid?... 7 Here is the plan service area fr Gateway Health Medicare Assured... 8 U.S. Citizen r Lawful Presence... 9 What ther materials will yu get frm us?...9 Yur plan membership card Use it t get all cvered care and prescriptin drugs... 9 The Prvider & Pharmacy Directry: Yur guide t all prviders and pharmacies in the plan s netwrk The plan s List f Cvered Drugs (Frmulary) The Part D Explanatin f Benefits (the Part D EOB ): Reprts with a summary f payments made fr yur Part D prescriptin drugs Yur mnthly premium fr Gateway Health Medicare Assured...12 Hw much is yur plan premium? There are several ways yu can pay yur plan premium Can we change yur mnthly plan premium during the year? Please keep yur plan membership recrd up t date...15 Hw t help make sure that we have accurate infrmatin abut yu We prtect the privacy f yur persnal health infrmatin We make sure that yur health infrmatin is prtected Hw ther insurance wrks with ur plan...16 Which plan pays first when yu have ther insurance?... 16

7 2017 Evidence f Cverage fr Gateway Health Medicare Assured 5 Chapter 1. Getting started as a member SECTION 1 Sectin 1.1 Intrductin Yu are enrlled in Gateway Health Medicare Assured, which is a specialized Medicare Advantage Plan (Special Needs Plan) Yu are cvered by bth Medicare and Medicaid: Medicare is the Federal health insurance prgram fr peple 65 years f age r lder, sme peple under age 65 with certain disabilities, and peple with end-stage renal disease (kidney failure). Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) and Kentucky Medicaid are jint Federal and state gvernment prgrams that help with medical csts fr certain peple with limited incmes and resurces. Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) and Kentucky Medicaid cverage varies depending n the state and the type f Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) r Kentucky Medicaid yu have. Sme peple with Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) r Kentucky Medicaid get help paying fr their Medicare premiums and ther csts. Other peple als get cverage fr additinal services and drugs that are nt cvered by Medicare. Yu have chsen t get yur Medicare health care and yur prescriptin drug cverage thrugh ur plan, Gateway Health Medicare Assured. There are different types f Medicare health plans. Gateway Health Medicare Assured is a specialized Medicare Advantage Plan (a Medicare Special Needs Plan ), which means its benefits are designed fr peple with special health care needs. Gateway Health Medicare Assured is designed specifically fr peple wh have Medicare and wh are als entitled t assistance frm Medicaid. EVIDENCE OF COVERAGE Because yu get assistance frm Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) r Kentucky Medicaid, yu will pay less fr sme f yur Medicare health care services. Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) r Kentucky Medicaid may als prvide ther benefits t yu by cvering health care services nt usually cvered under Medicare. Yu may als receive Extra Help frm Medicare t pay fr the csts f yur Medicare prescriptin drugs. Gateway Health Medicare Assured will help manage all f these benefits fr yu, s that yu get the health care services and payment assistance that yu are entitled t. Gateway Health Medicare Assured is run by a private cmpany. Like all Medicare Advantage Plans, this Medicare Special Needs Plan is apprved by Medicare. The plan als has a cntract with the Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) and Kentucky Medicaid prgram t crdinate yur Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) r Kentucky Medicaid benefits. We are pleased t be prviding yur Medicare health care cverage, including yur prescriptin drug cverage.

8 2017 Evidence f Cverage fr Gateway Health Medicare Assured 6 Chapter 1. Getting started as a member Sectin 1.2 What is the Evidence f Cverage bklet abut? This Evidence f Cverage bklet tells yu hw t get yur Medicare medical care and prescriptin drugs cvered thrugh ur plan. This bklet explains yur rights and respnsibilities, what is cvered, and what yu pay as a member f the plan. The wrd cverage and cvered services refers t the medical care and services and the prescriptin drugs available t yu as a member f Gateway Health Medicare Assured. It s imprtant fr yu t learn what the plan s rules are and what services are available t yu. We encurage yu t set aside sme time t lk thrugh this Evidence f Cverage bklet. If yu are cnfused r cncerned r just have a questin, please cntact ur plan s Member Services (phne numbers are printed n the back cver f this bklet). Sectin 1.3 Legal infrmatin abut the Evidence f Cverage It s part f ur cntract with yu This Evidence f Cverage is part f ur cntract with yu abut hw Gateway Health Medicare Assured cvers yur care. Other parts f this cntract include yur enrllment frm, the List f Cvered Drugs (Frmulary), and any ntices yu receive frm us abut changes t yur cverage r cnditins that affect yur cverage. These ntices are smetimes called riders r amendments. The cntract is in effect fr mnths in which yu are enrlled in Gateway Health Medicare Assured between January 1, 2017 and December 31, Each calendar year, Medicare allws us t make changes t the plans that we ffer. This means we can change the csts and benefits f Gateway Health Medicare Assured after December 31, We can als chse t stp ffering the plan, r t ffer it in a different service area, after December 31, Medicare must apprve ur plan each year Medicare (the Centers fr Medicare & Medicaid Services) must apprve Gateway Health Medicare Assured each year. Yu can cntinue t get Medicare cverage as a member f ur plan as lng as we chse t cntinue t ffer the plan and Medicare renews its apprval f the plan. SECTION 2 Sectin 2.1 What makes yu eligible t be a plan member? Yur eligibility requirements Yu are eligible fr membership in ur plan as lng as: Yu have bth Medicare Part A and Medicare Part B (sectin 2.2 tells yu abut Medicare Part A and Medicare Part B) -- and -- Yu live in ur gegraphic service area (sectin 2.4 belw describes ur service area)

9 2017 Evidence f Cverage fr Gateway Health Medicare Assured 7 Chapter 1. Getting started as a member -- and -- yu are a United States citizen r are lawfully present in the United States -- and -- Yu d nt have End-Stage Renal Disease (ESRD), with limited exceptins, such as if yu develp ESRD when yu are already a member f a plan that we ffer, r yu were a member f a different plan that was terminated. -- and -- Yu meet the special eligibility requirements described belw. Special eligibility requirements fr ur plan Our plan is designed t meet the needs f peple wh receive certain Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) r Kentucky Medicaid benefits. (Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) r Kentucky Medicaid is a jint Federal and state gvernment prgram that helps with medical csts fr certain peple with limited incmes and resurces.) T be eligible fr ur plan yu must be eligible fr bth Medicare and Specified Lw-Incme Medicare Beneficiary (SLMB), Qualifying Individual (QI) r Qualified Disabled and Wrking Individual (QDWI) under Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) r Kentucky Medicaid. Please nte: If yu lse yur Medicaid eligibility but can reasnably be expected t regain eligibility within three mnths, then yu are still eligible fr membership in ur plan (chapter 4, sectin 2.1 tells yu abut cverage during a perid f deemed cntinued eligibility). Sectin 2.2 What are Medicare Part A and Medicare Part B? When yu first signed up fr Medicare, yu received infrmatin abut what services are cvered under Medicare Part A and Medicare Part B. Remember: Medicare Part A generally helps cver services prvided by hspitals (fr inpatient services, skilled nursing facilities, r hme health agencies). Medicare Part B is fr mst ther medical services (such as physician s services and ther utpatient services) and certain items (such as durable medical equipment and supplies). EVIDENCE OF COVERAGE Sectin 2.3 What is Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) and Kentucky Medicaid? Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) and Kentucky Medicaid are jint Federal and state gvernment prgrams that help with medical and lng-term care csts fr certain peple wh have limited incmes and resurces. Each state decides what cunts as incme and resurces, wh is eligible, what services are cvered, and the cst fr services. States als can decide hw t run their prgram as lng as they fllw the Federal guidelines. In additin, there are prgrams ffered thrugh Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) r Kentucky Medicaid that help peple with Medicare pay their Medicare csts, such as their Medicare premiums. These Medicare Savings Prgrams help peple with limited incme and resurces save mney each year:

10 2017 Evidence f Cverage fr Gateway Health Medicare Assured 8 Chapter 1. Getting started as a member Specified Lw-Incme Medicare Beneficiary (SLMB): Helps pay Part B premiums. Qualifying Individual (QI): Helps pay Part B premiums. Qualified Disabled & Wrking Individuals (QDWI): Helps pay Part A premiums. Sectin 2.4 Here is the plan service area fr Gateway Health Medicare Assured Althugh Medicare is a Federal prgram, Gateway Health Medicare Assured is available nly t individuals wh live in ur plan service area. T remain a member f ur plan, yu must cntinue t reside in the plan service area. The service area is described belw. Our service area includes these cunties in Pennsylvania: Adams, Allegheny, Armstrng, Beaver, Bedfrd, Berks, Blair, Bucks, Butler, Cambria, Chester, Clarin, Crawfrd, Cumberland, Dauphin, Delaware, Erie, Fayette, Frest, Greene, Huntingdn, Indiana, Lackawanna, Lancaster, Lawrence, Lebann, Lehigh, Mercer, Mntgmery, Nrthamptn, Nrthumberland, Perry, Philadelphia, Schuylkill, Smerset, Venang, Washingtn, Westmreland, and Yrk Our service area includes these cunties in Ohi: Adams, Allen, Ashtabula, Auglaize, Brwn, Butler, Carrll, Champaign, Clark, Clermnt, Clintn, Clumbiana, Crawfrd, Cuyahga, Darke, Fayette, Fultn, Gallia, Geauga, Greene, Hamiltn, Hardin, Harrisn, Henry, Highland, Hcking, Hlmes, Jacksn, Jeffersn, Lake, Lawrence, Licking, Lgan, Lrain, Lucas, Madisn, Mahning, Medina, Mercer, Miami, Mnre, Mntgmery, Mrrw, Nble, Ottawa, Paulding, Perry, Pickaway, Pike, Prtage, Preble, Putnam, Shelby, Stark, Summit, Trumbull, Van Wert, Vintn, and Warren Our service area includes these cunties in Nrth Carlina: Alexander, Alleghany, Avery, Beaufrt, Bertie, Bladen, Caswell, Catawba, Chatham, Chwan, Cumberland, Davie, Duplin, Durham, Greene, Halifax, Hertfrd, Hyde, Jacksn, Jhnstn, Jnes, Lincln, Madisn, Martin, McDwell, Mitchell, Nrthamptn, Orange, Pamlic, Pender, Pitt, Plk, Sampsn, Swain, Transylvania, Vance, Wake, Warren, Wayne, Wilkes, and Yancey Our service area includes these cunties in Kentucky: Andersn, Bath, Bne, Burbn, Byd, Byle, Bracken, Bullitt, Butler, Caldwell, Campbell, Carrll, Carter, Clark, Clay, Crittenden, Estill, Fayette, Franklin, Gallatin, Garrard, Grant, Greenup, Harrisn, Hendersn, Henry, Hpkins, Jacksn, Jeffersn, Jessamine, Kentn, Knx, Larue, Lawrence, Lee, Leslie, Lewis, Lincln, Lyn, Madisn, McCreary, McLean, Meade, Menifee, Mercer, Mntgmery, Muhlenberg, Nelsn, Nichlas, Ohi, Oldham, Owen, Owsley, Pendletn, Pwell, Pulaski, Rbertsn, Rckcastle, Sctt, Shelby, Spencer, Tdd, Trigg, Trimble, Unin, Washingtn, Wayne, Webster, Wlfe, and Wdfrd If yu plan t mve ut f the service area, please cntact Member Services (phne numbers are printed n the back cver f this bklet). When yu mve, yu will have a Special Enrllment Perid that will allw yu t switch t Original Medicare r enrll in a Medicare health r drug plan that is available in yur new lcatin. It is als imprtant that yu call Scial Security if yu mve r change yur mailing address. Yu can find phne numbers and cntact infrmatin fr Scial Security in Chapter 2, Sectin 5.

11 2017 Evidence f Cverage fr Gateway Health Medicare Assured 9 Chapter 1. Getting started as a member Sectin 2.5 U.S. Citizen r Lawful Presence A member f a Medicare health plan must be a U.S. citizen r lawfully present in the United States. Medicare (the Centers fr Medicare & Medicaid Services) will ntify Gateway Health Medicare Assured if yu are nt eligible t remain a member n this basis. Gateway Health Medicare Assured must disenrll yu if yu d nt meet this requirement. SECTION 3 Sectin 3.1 What ther materials will yu get frm us? Yur plan membership card Use it t get all cvered care and prescriptin drugs While yu are a member f ur plan, yu must use yur membership card fr ur plan and yur Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) r Kentucky Medicaid card whenever yu get any services cvered by this plan and fr prescriptin drugs yu get at netwrk pharmacies. Here s a sample membership card t shw yu what yurs will lk like: EVIDENCE OF COVERAGE As lng as yu are a member f ur plan yu must nt use yur red, white, and blue Medicare card t get cvered medical services (with the exceptin f rutine clinical research studies and hspice services). Keep yur red, white, and blue Medicare card in a safe place in case yu need it later. Here s why this is s imprtant: If yu get cvered services using yur red, white, and blue Medicare card instead f using yur Gateway Health Medicare Assured membership card while yu are a plan member, yu may have t pay the full cst yurself. If yur plan membership card is damaged, lst, r stlen, call Member Services right away and we will send yu a new card. (Phne numbers fr Member Services are printed n the back cver f this bklet.)

12 2017 Evidence f Cverage fr Gateway Health Medicare Assured 10 Chapter 1. Getting started as a member Sectin 3.2 The Prvider & Pharmacy Directry: Yur guide t all prviders and pharmacies in the plan s netwrk The Prvider & Pharmacy Directry lists ur netwrk prviders, pharmacies, durable medical equipment suppliers and participating Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) r Kentucky Medicaid prviders. What are netwrk prviders and netwrk pharmacies? Netwrk prviders are the dctrs and ther health care prfessinals, medical grups, durable medical equipment suppliers, hspitals, and ther health care facilities that have an agreement with us t accept ur payment and any plan cst-sharing as payment in full. We have arranged fr these prviders t deliver cvered services t members in ur plan. Netwrk pharmacies are all f the pharmacies that have agreed t fill cvered prescriptins fr ur plan members. Why d yu need t knw which prviders and pharmacies are part f ur netwrk? It is imprtant t knw which prviders are part f ur netwrk because, with limited exceptins, while yu are a member f ur plan yu must use netwrk prviders t get yur medical care and services. The nly exceptins are emergencies, urgently needed services when the netwrk is nt available (generally, when yu are ut f the area), ut-f-area dialysis services, and cases in which Gateway Health Medicare Assured authrizes use f ut-f-netwrk prviders. See Chapter 3 (Using the plan s cverage fr yur medical services) fr mre specific infrmatin abut emergency, ut-f-netwrk, and ut-f-area cverage. Mst Gateway Health Medicare Assured prviders als accept Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) r Kentucky Medicaid. In the Prvider & Pharmacy Directry, the prviders that accept Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) r Kentucky Medicaid are marked with an asterisk (*). Fr services cvered by Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) r Kentucky Medicaid but nt cvered by Gateway Health Medicare Assured, yu must see a Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) r Kentucky Medicaid prvider. Yu can use the Prvider & Pharmacy Directry t find the netwrk pharmacy yu want t use. This is imprtant because, with few exceptins, yu must get yur prescriptins filled at a netwrk pharmacy if yu want ur plan t cver (help yu pay) fr them. Our netwrk has changed mre than usual fr An updated Pharmacy Directry is lcated n ur website at Yu may als call Member Services fr updated prvider infrmatin r t ask us t mail yu a Pharmacy Directry. We strngly suggest that yu review ur current Pharmacy Directry t see if yur pharmacy is still in ur netwrk. This is imprtant because, with few exceptins, yu must get yur prescriptins filled at a netwrk pharmacy if yu want ur plan t cver (help yu pay fr) them.

13 2017 Evidence f Cverage fr Gateway Health Medicare Assured 11 Chapter 1. Getting started as a member If yu dn t have the Prvider & Pharmacy Directry, yu can get a cpy frm Member Services (phne numbers are printed n the back cver f this bklet). Yu may ask Member Services fr mre infrmatin abut ur netwrk prviders, including their qualificatins. At any time, yu can call Member Services t get up-t-date infrmatin abut changes in the pharmacy netwrk. Yu can als see the Prvider & Pharmacy Directry at r dwnlad it frm this website. Bth Member Services and the website can give yu the mst up-t-date infrmatin abut changes in ur netwrk prviders and pharmacies. Sectin 3.3 The plan s List f Cvered Drugs (Frmulary) The plan has a List f Cvered Drugs (Frmulary). We call it the Drug List fr shrt. It tells which Part D prescriptin drugs are cvered under the Part D benefit included in Gateway Health Medicare Assured. The drugs n this list are selected by the plan with the help f a team f dctrs and pharmacists. The list must meet requirements set by Medicare. Medicare has apprved the Gateway Health Medicare Assured Drug List. In additin t the drugs cvered by Part D, sme prescriptin drugs are cvered fr yu under yur Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) r Kentucky Medicaid benefits. The Drug List tells yu hw t find ut which drugs are cvered under Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) r Kentucky Medicaid. The Drug List als tells yu if there are any rules that restrict cverage fr yur drugs. We will send yu a cpy f the Drug List. T get the mst cmplete and current infrmatin abut which drugs are cvered, yu can visit the plan s website ( r call Member Services (phne numbers are printed n the back cver f this bklet). Sectin 3.4 The Part D Explanatin f Benefits (the Part D EOB ): Reprts with a summary f payments made fr yur Part D prescriptin drugs EVIDENCE OF COVERAGE When yu use yur Part D prescriptin drug benefits, we will send yu a summary reprt t help yu understand and keep track f payments fr yur Part D prescriptin drugs. This summary reprt is called the Part D Explanatin f Benefits (r the Part D EOB ). The Part D Explanatin f Benefits tells yu the ttal amunt yu, r thers n yur behalf, have spent n yur Part D prescriptin drugs and the ttal amunt we have paid fr each f yur Part D prescriptin drugs during the mnth. Chapter 6 (What yu pay fr yur Part D prescriptin drugs) gives mre infrmatin abut the Explanatin f Benefits and hw it can help yu keep track f yur drug cverage. A Part D Explanatin f Benefits summary is als available upn request. T get a cpy, please cntact Member Services (phne numbers are printed n the back cver f this bklet).

14 2017 Evidence f Cverage fr Gateway Health Medicare Assured 12 Chapter 1. Getting started as a member SECTION 4 Sectin 4.1 Yur mnthly premium fr Gateway Health Medicare Assured Hw much is yur plan premium? As a member f ur plan, yu pay a mnthly plan premium. The table belw shws the mnthly plan premium amunt fr each plan we are ffering in the service area. In additin, yu must cntinue t pay yur Medicare Part B premium (unless yur Part B premium is paid fr yu by Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) r Kentucky Medicaid r anther third party). If yu receive Extra Help frm Medicare t pay fr yur prescriptin drugs, yur premium may be less. Service Area Premium Kentucky $32.00 Nrth Carlina $31.30 Ohi $32.30 Pennsylvania $39.40 In sme situatins, yur plan premium culd be mre In sme situatins, yur plan premium culd be mre than the amunt listed abve in Sectin 4.1. This situatin is described belw. Sme members are required t pay a late enrllment penalty because they did nt jin a Medicare drug plan when they first became eligible r because they had a cntinuus perid f 63 days r mre when they didn t have creditable prescriptin drug cverage. ( Creditable means the drug cverage is expected t pay, n average, at least as much as Medicare s standard prescriptin drug cverage.) Fr these members, the late enrllment penalty is added t the plan s mnthly premium. Their premium amunt will be the mnthly plan premium plus the amunt f their late enrllment penalty. If yu receive Extra Help frm Medicare t pay fr yur prescriptin drugs, yu will nt pay a late enrllment penalty. If yu ever lse yur lw incme subsidy ("Extra Help"), yu must maintain yur Part D cverage r yu culd be subject t a late enrllment penalty if yu ever chse t enrll in Part D in the future If yu are required t pay the late enrllment penalty, the amunt f yur penalty depends n hw many mnths yu were withut drug cverage after yu became eligible. Chapter 6, Sectin 9 explains the late enrllment penalty. Sme members are required t pay ther Medicare premiums In additin t paying the mnthly plan premium, sme members are required t pay ther Medicare premiums. As explained in Sectin 2 abve, in rder t be eligible fr ur plan, yu must maintain yur eligibility fr Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) r Kentucky Medicaid as well as be entitled t Medicare Part A and enrlled in

15 2017 Evidence f Cverage fr Gateway Health Medicare Assured 13 Chapter 1. Getting started as a member Medicare Part B. Fr mst Gateway Health Medicare Assured members, Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) r Kentucky Medicaid pays fr yur Part A premium (if yu dn t qualify fr it autmatically) and fr yur Part B premium. If Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) r Kentucky Medicaid is nt paying yur Medicare premiums fr yu, yu must cntinue t pay yur Medicare premiums t remain a member f the plan. Sme peple pay an extra amunt fr Part D because f their yearly incme; this is knwn as Incme Related Mnthly Adjustment Amunts, als knwn as IRMAA. If yur incme is greater than $85,000 fr an individual (r married individuals filing separately) r greater than $170,000 fr married cuples, yu must pay an extra amunt directly t the gvernment (nt the Medicare plan) fr yur Medicare Part D cverage. If yu have t pay an extra amunt, Scial Security, nt yur Medicare plan, will send yu a letter telling yu what that extra amunt will be. If yu had a life-changing event that caused yur incme t g dwn, yu can ask Scial Security t recnsider their decisin. If yu are required t pay the extra amunt and yu d nt pay it, yu will be disenrlled frm the plan. Fr mre infrmatin abut Part D premiums based n incme, g t Chapter 6, Sectin 10 f this bklet. Yu can als visit n the Web r call MEDICARE ( ), 24 hurs a day, 7 days a week. TTY users shuld call Or yu may call Scial Security at TTY users shuld call Yur cpy f Medicare & Yu 2017 gives infrmatin abut these premiums in the sectin called 2017 Medicare Csts. Everyne with Medicare receives a cpy f Medicare & Yu each year in the fall. Thse new t Medicare receive it within a mnth after first signing up. Yu can als dwnlad a cpy f Medicare & Yu 2017 frm the Medicare website ( Or, yu can rder a printed cpy by phne at MEDICARE ( ), 24 hurs a day, 7 days a week. TTY users call EVIDENCE OF COVERAGE Sectin 4.2 There are several ways yu can pay yur plan premium There are 4 ways yu can pay yur plan premium. Yu can have it autmatically deducted frm yur Scial Security r Railrad Retirement Bard check; yu can pay each mnth by check; r yu can pay each mnth by mney rder. If yu pay by check r mney rder, we will send yu a statement. If yu are new t the plan, yu can indicate yur preferred payment methd n yur enrllment frm, r yu may cntact Member Services. If yu are already a plan member and want t change yur payment methd, yu may cntact Member Services (phne numbers are printed n the back cver f this bklet). If yu decide t change the way yu pay yur premium, it can take up t three mnths fr yur new payment methd t take effect. While we are prcessing yur request fr a new payment methd, yu are respnsible fr making sure that yur plan premium is paid n time.

16 2017 Evidence f Cverage fr Gateway Health Medicare Assured 14 Chapter 1. Getting started as a member Optin 1: Yu can pay by check Yu can pay yur plan premium by check. Each mnth we will send yu a statement telling yu hw much yu we. Yu must either mail yur check t the address listed n the reply envelpe prvided (Gateway Health, PO Bx 99787, Pittsburgh, PA ) r -- fr expedited (FexEx, UPS, etc.) payments, send yur check t the address n the statement (Gateway Health, Finance Department, Fur Gateway Center, 444 Liberty Ave, Suite 2100, Pittsburgh, PA ) -- by the date due, nrmally the last day f the mnth. Checks must be made payable t Gateway Health Plan, nt Medicare, CMS r HHS. Optin 2: Yu can pay by mney rder Yu can pay yur plan premium by mney rder. Each mnth we will send yu a statement telling yu hw much yu we. Yu must send yur mney rder t the address listed n the reply envelpe prvided (Gateway Health, PO Bx 99787, Pittsburgh, PA ) r -- fr expedited (FexEx, UPS, etc.) payments, send yur mney rder t the address n the statement (Gateway Health, Finance Department, Fur Gateway Center, 444 Liberty Ave, Suite 2100, Pittsburgh, PA ) -- by the date due, nrmally the last day f the mnth. Mney rders must be made payable t Gateway Health Plan, nt Medicare, CMS r HHS. Optin 3: Yu can have the plan premium taken ut f yur mnthly Scial Security check Yu can have the plan premium taken ut f yur mnthly Scial Security check. Cntact Member Services fr mre infrmatin n hw t pay yur mnthly plan premium this way. We will be happy t help yu set this up. (Phne numbers fr Member Services are printed n the back cver f this bklet.) Optin 4: Yu can have the plan premium taken ut f yur mnthly Railrad Retirement Bard check If yu receive Railrad Retirement Bard benefits, yu can have the plan premium taken ut f yur mnthly Railrad Retirement Bard check. Cntact Member Services fr mre infrmatin n hw t pay yur mnthly plan premium this way. We will be happy t help yu set this up. (Phne numbers fr Member Services are printed n the back cver f this bklet.) What t d if yu are having truble paying yur plan premium/late enrllment penalty Yur plan premium/late enrllment penalty is due in ur ffice by the last day f the mnth. If we have nt received yur premium/penalty by the due date listed n the statement typically the last day f the mnth we will send yu a ntice telling yu that yur payment is late. If yu are required t pay a late enrllment penalty, yu must pay the penalty t keep yur prescriptin drug cverage. If yu are having truble paying yur premium/late enrllment penalty n time, please cntact Member Services t see if we can direct yu t prgrams that will help with yur plan premium/penalty. (Phne numbers fr Member Services are printed n the back cver f this bklet.)

17 2017 Evidence f Cverage fr Gateway Health Medicare Assured 15 Chapter 1. Getting started as a member Sectin 4.3 Can we change yur mnthly plan premium during the year? N. We are nt allwed t change the amunt we charge fr the plan s mnthly plan premium during the year. If the mnthly plan premium changes fr next year we will tell yu in September and the change will take effect n January 1. Hwever, in sme cases the part f the premium that yu have t pay can change during the year. This happens if yu becme eligible fr the Extra Help prgram r if yu lse yur eligibility fr the Extra Help prgram during the year. If a member qualifies fr Extra Help with their prescriptin drug csts, the Extra Help prgram will pay all r part f the member s mnthly plan premium. If Medicare pays nly a prtin f this premium, we will bill yu fr the amunt Medicare desn t cver. A member wh lses their eligibility during the year will need t start paying their full mnthly premium. Yu can find ut mre abut the Extra Help prgram in Chapter 2, Sectin 7. SECTION 5 Please keep yur plan membership recrd up t date Sectin 5.1 Hw t help make sure that we have accurate infrmatin abut yu Yur membership recrd has infrmatin frm yur enrllment frm, including yur address and telephne number. It shws yur specific plan cverage including yur Primary Care Prvider. The dctrs, hspitals, pharmacists, and ther prviders in the plan s netwrk need t have crrect infrmatin abut yu. These netwrk prviders use yur membership recrd t knw what services and drugs are cvered and the cst-sharing amunts fr yu. Because f this, it is very imprtant that yu help us keep yur infrmatin up t date. Let us knw abut these changes: Changes t yur name, yur address, r yur phne number Changes in any ther health insurance cverage yu have (such as frm yur emplyer, yur spuse s emplyer, wrkers cmpensatin, r Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) r Kentucky Medicaid) If yu have any liability claims, such as claims frm an autmbile accident If yu have been admitted t a nursing hme If yu receive care in an ut-f-area r ut-f-netwrk hspital r emergency rm If yur designated respnsible party (such as a caregiver) changes If yu are participating in a clinical research study EVIDENCE OF COVERAGE If any f this infrmatin changes, please let us knw by calling Member Services (phne numbers are printed n the back cver f this bklet). Yu can als submit a change request via the member prtal n ur website at It is als imprtant t cntact Scial Security if yu mve r change yur mailing address. Yu can find phne numbers and cntact infrmatin fr Scial Security in Chapter 2, Sectin 5.

18 2017 Evidence f Cverage fr Gateway Health Medicare Assured 16 Chapter 1. Getting started as a member Read ver the infrmatin we send yu abut any ther insurance cverage yu have Medicare requires that we cllect infrmatin frm yu abut any ther medical r drug insurance cverage that yu have. That s because we must crdinate any ther cverage yu have with yur benefits under ur plan. (Fr mre infrmatin abut hw ur cverage wrks when yu have ther insurance, see Sectin 7 in this chapter.) Once each year, we will send yu a letter that lists any ther medical r drug insurance cverage that we knw abut. Please read ver this infrmatin carefully. If it is crrect, yu dn t need t d anything. If the infrmatin is incrrect, r if yu have ther cverage that is nt listed, please call Member Services (phne numbers are printed n the back cver f this bklet). SECTION 6 Sectin 6.1 We prtect the privacy f yur persnal health infrmatin We make sure that yur health infrmatin is prtected Federal and state laws prtect the privacy f yur medical recrds and persnal health infrmatin. We prtect yur persnal health infrmatin as required by these laws. Fr mre infrmatin abut hw we prtect yur persnal health infrmatin, please g t Chapter 8, Sectin 1.4 f this bklet. SECTION 7 Sectin 7.1 Hw ther insurance wrks with ur plan Which plan pays first when yu have ther insurance? When yu have ther insurance (like emplyer grup health cverage), there are rules set by Medicare that decide whether ur plan r yur ther insurance pays first. The insurance that pays first is called the primary payer and pays up t the limits f its cverage. The ne that pays secnd, called the secndary payer, nly pays if there are csts left uncvered by the primary cverage. The secndary payer may nt pay all f the uncvered csts. These rules apply fr emplyer r unin grup health plan cverage: If yu have retiree cverage, Medicare pays first. If yur grup health plan cverage is based n yur r a family member s current emplyment, wh pays first depends n yur age, the number f peple emplyed by yur emplyer, and whether yu have Medicare based n age, disability, r End-stage Renal Disease (ESRD): If yu re under 65 and disabled and yu r yur family member is still wrking, yur grup health plan pays first if the emplyer has 100 r mre emplyees r at least ne emplyer in a multiple emplyer plan that has mre than 100 emplyees. If yu re ver 65 and yu r yur spuse is still wrking, yur grup health plan pays first if the emplyer has 20 r mre emplyees r at least ne emplyer in a multiple emplyer plan that has mre than 20 emplyees.

19 2017 Evidence f Cverage fr Gateway Health Medicare Assured 17 Chapter 1. Getting started as a member If yu have Medicare because f ESRD, yur grup health plan will pay first fr the first 30 mnths after yu becme eligible fr Medicare. These types f cverage usually pay first fr services related t each type: N-fault insurance (including autmbile insurance) Liability (including autmbile insurance) Black lung benefits Wrkers cmpensatin Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) r Kentucky Medicaid and TRICARE never pay first fr Medicare-cvered services. They nly pay after Medicare and/r emplyer grup health plans have paid. If yu have ther insurance, tell yur dctr, hspital, and pharmacy. If yu have questins abut wh pays first, r yu need t update yur ther insurance infrmatin, call Member Services (phne numbers are printed n the back cver f this bklet). Yu may need t give yur plan member ID number t yur ther insurers (nce yu have cnfirmed their identity) s yur bills are paid crrectly and n time. EVIDENCE OF COVERAGE

20 CHAPTER 2 Imprtant phne numbers and resurces

21 2017 Evidence f Cverage fr Gateway Health Medicare Assured Chapter 2. Imprtant phne numbers and resurces 19 Chapter 2. Imprtant phne numbers and resurces SECTION 1 SECTION 2 SECTION 3 SECTION 4 SECTION 5 Gateway Health Medicare Assured cntacts (hw t cntact us, including hw t reach Member Services at the plan)...20 Medicare (hw t get help and infrmatin directly frm the Federal Medicare prgram)...25 State Health Insurance Assistance Prgram (free help, infrmatin, and answers t yur questins abut Medicare)...26 Quality Imprvement Organizatin (paid by Medicare t check n the quality f care fr peple with Medicare)...28 Scial Security...29 SECTION 6 SECTION 7 SECTION 8 Pennsylvania Medical Assistance (Medicaid), Ohi Medicaid, Nrth Carlina Medical Assistance (Medicaid) r Kentucky Medicaid (a jint Federal and state prgram that helps with medical csts fr sme peple with limited incme and resurces)...30 Infrmatin abut prgrams t help peple pay fr their prescriptin drugs...34 Hw t cntact the Railrad Retirement Bard...37 EVIDENCE OF COVERAGE

22 2017 Evidence f Cverage fr Gateway Health Medicare Assured 20 Chapter 2. Imprtant phne numbers and resurces SECTION 1 Gateway Health Medicare Assured cntacts (hw t cntact us, including hw t reach Member Services at the plan) Hw t cntact ur plan s Member Services Fr assistance with claims, billing r member card questins, please call r write t Gateway Health Medicare Assured Member Services. We will be happy t help yu. Methd Member Services Cntact Infrmatin CALL PA: OH: NC: KY: Calls t this number are free. Our business hurs are: Octber 1 thrugh February 14: 8 a.m. t 8 p.m., 7 days a week; February 15 thrugh September 30: Mnday thrugh Friday 8 a.m. t 8 p.m. Yu may leave a vice mail message after-hurs, Saturdays, Sundays and hlidays. Member Services als has free language interpreter services available fr nn- English speakers. TTY PA: 711 r OH: 711 r WRITE NC: 711 r KY: 711 r This number requires special telephne equipment and is nly fr peple wh have difficulties with hearing r speaking. Calls t this number are free. Our business hurs are 8 a.m. t 8 p.m., seven days a week. Gateway Health Attn: Member Services 444 Liberty Ave., Suite 2100 Pittsburgh, PA WEBSITE

23 2017 Evidence f Cverage fr Gateway Health Medicare Assured 21 Chapter 2. Imprtant phne numbers and resurces Hw t cntact us when yu are asking fr a cverage decisin abut yur medical care r Part D prescriptin drugs A cverage decisin is a decisin we make abut yur benefits and cverage r abut the amunt we will pay fr yur medical services r yur prescriptin drugs cvered under the Part D benefit included in yur plan. Fr mre infrmatin n asking fr cverage decisins abut yur medical care r Part D prescriptin drugs, see Chapter 9 (What t d if yu have a prblem r cmplaint (cverage decisins, appeals, cmplaints)). Yu may call us if yu have questins abut ur cverage decisin prcess. Methd Cverage Decisins fr Medical Care r Part D prescriptin drugs Cntact Infrmatin CALL PA: OH: NC: KY: Calls t this number are free. Our business hurs are 8 a.m. t 8 p.m., seven days a week. TTY PA: 711 r OH: 711 r NC: 711 r KY: 711 r This number requires special telephne equipment and is nly fr peple wh have difficulties with hearing r speaking. Calls t this number are free. Our business hurs are 8 a.m. t 8 p.m., seven days a week. EVIDENCE OF COVERAGE FAX WRITE (medical care) (Part D prescriptin drugs) Gateway Health Attn: Member Services 444 Liberty Ave., Suite 2100 Pittsburgh, PA 15222

24 2017 Evidence f Cverage fr Gateway Health Medicare Assured 22 Chapter 2. Imprtant phne numbers and resurces Hw t cntact us when yu are making an appeal abut yur medical care r Part D prescriptin drugs An appeal is a frmal way f asking us t review and change a cverage decisin we have made. Fr mre infrmatin n making an appeal abut yur medical care r Part D prescriptin drugs, see Chapter 9 (What t d if yu have a prblem r cmplaint (cverage decisins, appeals, cmplaints)). Methd CALL PA: OH: Appeals fr Medical Care r Part D prescriptin drugs Cntact Infrmatin NC: KY: Calls t this number are free. Our business hurs are 8 a.m. t 8 p.m., seven days a week. TTY PA: 711 r OH: 711 r FAX WRITE NC: 711 r KY: 711 r This number requires special telephne equipment and is nly fr peple wh have difficulties with hearing r speaking. Calls t this number are free. Our business hurs are 8 a.m. t 8 p.m., seven days a week. Gateway Health Attn: Appeals & Grievance P.O. Bx Pittsburgh, PA 15222

25 2017 Evidence f Cverage fr Gateway Health Medicare Assured 23 Chapter 2. Imprtant phne numbers and resurces Hw t cntact us when yu are making a cmplaint abut yur medical care r Part D prescriptin drugs Yu can make a cmplaint abut us r ne f ur netwrk prviders, including a cmplaint abut the quality f yur care. This type f cmplaint des nt invlve cverage r payment disputes. (If yur prblem is abut the plan s cverage r payment, yu shuld lk at the sectin abve abut making an appeal.) Fr mre infrmatin n making a cmplaint abut yur medical care r Part D prescriptin drugs, see Chapter 9 (What t d if yu have a prblem r cmplaint (cverage decisins, appeals, cmplaints)). Methd CALL PA: OH: Cmplaints abut Medical Care r Part D prescriptin drugs Cntact Infrmatin NC: KY: Calls t this number are free. Our business hurs are 8 a.m. t 8 p.m., seven days a week. TTY PA: 711 r OH: 711 r NC: 711 r KY: 711 r This number requires special telephne equipment and is nly fr peple wh have difficulties with hearing r speaking. Calls t this number are free. Our business hurs are 8 a.m. t 8 p.m., seven days a week. EVIDENCE OF COVERAGE FAX WRITE Gateway Health Attn: Appeals & Grievance P.O. Bx Pittsburgh, PA MEDICARE WEBSITE Yu can submit a cmplaint abut Gateway Health Medicare Assured directly t Medicare. T submit an nline cmplaint t Medicare, g t

26 2017 Evidence f Cverage fr Gateway Health Medicare Assured 24 Chapter 2. Imprtant phne numbers and resurces Where t send a request asking us t pay fr ur share f the cst fr medical care r a drug yu have received Fr mre infrmatin n situatins in which yu may need t ask us fr reimbursement r t pay a bill yu have received frm a prvider, see Chapter 7 (Asking us t pay ur share f a bill yu have received fr cvered medical services r drugs). Please nte: If yu send us a payment request and we deny any part f yur request, yu can appeal ur decisin. See Chapter 9 (What t d if yu have a prblem r cmplaint (cverage decisins, appeals, cmplaints)) fr mre infrmatin. Methd Payment Request Cntact Infrmatin CALL PA: OH: NC: KY: Calls t this number are free. Our business hurs are 8 a.m. t 8 p.m., seven days a week. TTY PA: 711 r WRITE WEBSITE OH: 711 r NC: 711 r KY: 711 r This number requires special telephne equipment and is nly fr peple wh have difficulties with hearing r speaking. Calls t this number are free. Our business hurs are 8 a.m. t 8 p.m., seven days a week. Gateway Health Attn: Medicare Reimbursements Administratr P.O. Bx Pittsburgh, PA

27 2017 Evidence f Cverage fr Gateway Health Medicare Assured 25 Chapter 2. Imprtant phne numbers and resurces SECTION 2 Medicare (hw t get help and infrmatin directly frm the Federal Medicare prgram) Medicare is the Federal health insurance prgram fr peple 65 years f age r lder, sme peple under age 65 with disabilities, and peple with End-Stage Renal Disease (permanent kidney failure requiring dialysis r a kidney transplant). The Federal agency in charge f Medicare is the Centers fr Medicare & Medicaid Services (smetimes called CMS ). This agency cntracts with Medicare Advantage rganizatins including us. Methd Medicare Cntact Infrmatin CALL MEDICARE, r Calls t this number are free. 24 hurs a day, 7 days a week. TTY This number requires special telephne equipment and is nly fr peple wh have difficulties with hearing r speaking. Calls t this number are free. WEBSITE This is the fficial gvernment website fr Medicare. It gives yu up-t-date infrmatin abut Medicare and current Medicare issues. It als has infrmatin abut hspitals, nursing hmes, physicians, hme health agencies, and dialysis facilities. It includes bklets yu can print directly frm yur cmputer. Yu can als find Medicare cntacts in yur state. EVIDENCE OF COVERAGE The Medicare website als has detailed infrmatin abut yur Medicare eligibility and enrllment ptins with the fllwing tls: Medicare Eligibility Tl: Prvides Medicare eligibility status infrmatin. Medicare Plan Finder: Prvides persnalized infrmatin abut available Medicare prescriptin drug plans, Medicare health plans, and Medigap (Medicare Supplement Insurance) plicies in yur area. These tls prvide an estimate f what yur ut-f-pcket csts might be in different Medicare plans. Yu can als use the website t tell Medicare abut any cmplaints yu have abut Gateway Health Medicare Assured: Tell Medicare abut yur cmplaint: Yu can submit a cmplaint abut Gateway Health Medicare Assured directly t Medicare. T submit a cmplaint t Medicare, g t Medicare takes yur