Member Rights

Grievance and Appeals

Click here for more information about:

  • Part D (Prescription Drug) Grievances and Appeals
  • How to file a pharmacy appeal (Part D Redetermination)
  • Part C (Medical Services) Grievances and Appeals
  • Appointed Representatives

Written requests for Reconsideration, Redetermination, and Grievances can be sent to this address by mail:

Gateway Health SM
Attn: Member Appeals Department
P.O. Box 22278
Pittsburgh, PA 15222

To fax your request: 412-255-4503

To make your request by telephone:
Call Member Services from 8:00 a.m. to 8:00 p.m., 7 days a week. 

  • 1-800-685-5209 in Pennsylvania (TTY users: 711)
  • 1-888-447-4505 in Ohio (TTY users: 711)
  • 1-855-847-6430 in North Carolina (TTY users: 711)
  • 1-855-847-6380 in Kentucky (TTY users: 711)

Disenrollment Rights

Click your plan’s name to review your disenrollment rights. *

MAPD -  OH, KY, NC: 

*Please refer to your Evidence of Coverage booklet for more information.

Report Fraud or Abuse


Potential Contract Termination

Click here to read about what happens if Gateway HealthSM leaves the Medicare program or Gateway Health Plan Medicare Assured® (HMO SNP) leaves the area where you live.

Gateway HealthSM 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. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. These plans are available to anyone with Medicare and Medicaid.