Gateway Health
Gateway Health Plan, Inc. (d/b/a Highmark Wholecare) is a Pennsylvania managed care organization and Highmark Inc. subsidiary delivering Medicaid and Medicare D-SNP coverage to more than 400,000 members through a 30,000+ provider network, operating as a Blue Cross Blue Shield independent licensee.
- Company typePrivate
- Founded1992
- HeadquartersPittsburgh, United States
- Headcount501–1,000
- GTM typeB2C
- OfferingServices
What Gateway Health does
Gateway Health Plan, Inc., doing business as Highmark Wholecare, is a Pennsylvania-based managed care organization operating as an independent licensee of the Blue Cross Blue Shield Association and a subsidiary of Highmark Inc. The company delivers two core product lines: Pennsylvania Medicaid managed care plans for low-income individuals and families, and Medicare Dual Eligible Special Needs Plans (D-SNP) for individuals who qualify for both Medicare and Medicaid. Its Medicaid coverage spans 13 counties in central Pennsylvania and 14 counties in western Pennsylvania, while its D-SNP footprint reaches 62 Pennsylvania counties across central, northeastern, southeastern, and western regions. As of the most recent disclosed data, Gateway Health serves more than 400,000 members through a contracted network of over 30,000 healthcare providers, supported by a workforce of more than 1,000 employees.
The underlying technology stack centers on a member portal (member.myhighmark.com) and iOS/Android mobile applications branded Wholecare, a HealthSparq-powered provider directory, an Availity provider portal for eligibility, benefits verification, and prior authorization, and a CMS-compliant HL7 FHIR-based patient access and payer-to-payer API used by over 1,500 third-party developers. Additional digital services include the Wholecare Resource Center, a Health and Wellness Center, mental and behavioral health resources, and machine-readable transparency-in-coverage files. The company is compliant with HIPAA, the No Surprises Act, and federal nondiscrimination requirements, and operates under an Organized Health Care Arrangement with Allegheny Health Network for joint quality and utilization review.
Revenue is generated through capitation premiums paid by the Pennsylvania Department of Human Services for Medicaid managed care and by CMS for Medicare D-SNP coverage. Pricing is not publicly disclosed because government-funded insurance plans operate under regulated premium rates determined by member eligibility and government contracts. Distribution occurs through phone-based enrollment and service lines, the self-service member portal, mobile app stores, and provider network referrals across the Pennsylvania service area. The company was rebranded from Gateway Health to Highmark Wholecare as part of parent-level brand consolidation while retaining its legal corporate identity.
Gateway Health firmographics
Firmographics- Name
- Gateway Health
- Legal name
- Gateway Health Plan, Inc.
- Website
- https://gatewayhealthplan.com
- Company type
- Private
- Founded year
- 1992
- Operating status
- Operating
- Headcount range
- 501–1,000 employees
- Short description
- Gateway Health Plan, Inc. (d/b/a Highmark Wholecare) is a Pennsylvania managed care organization and Highmark Inc. subsidiary delivering Medicaid and Medicare D-SNP coverage to more than 400,000 members through a 30,000+ provider network, operating as a Blue Cross Blue Shield independent licensee.
- Ownership category
- akta.pro rank
Gateway Health industry classification
Industry- Product category
- Managed Care Health Insurance (Medicaid and Medicare D-SNP)
- NAICS
- Direct Health and Medical Insurance Carriers (524114)
- SIC
- Accident & Health Insurance (6321), Hospital & Medical Service Plans (6324)
- akta.pro primary industry
- D-SNP Plan Sponsorship & Benefit Design (HLAEAFAA)
- akta.pro secondary industries
- Dual-Eligible Special Needs Plans (D-SNP) (FSAIAGAD), D-SNP Medicare–Medicaid Integration & State Contracting (HLAEAFAH), D-SNP Long-Term Services & Supports (LTSS) Coordination (HLAEAFAD)
Keywords
Where Gateway Health is headquartered
LocationHeadquarters
- HQ city
- Pittsburgh
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
Gateway Health business model
Business model- GTM type
- B2C
- Offering type
- Services
- Cost components
- Personnel, Operations, Technology or R&D, Marketing or Sales, Others
Revenue model
- Government- Funded Health Insurance Premiums: Revenue from Medicaid and Medicare managed care premiums paid by government programs for member coverage
- Medicare D-SNP Plans: Dual Eligible Special Needs Plans combining Medicare and Medicaid benefits for qualifying beneficiaries
Go-to-market motion1 record
Distribution channels4 records
Marketing channels4 records
Gateway Health product offering
Product offeringCore offering
Gateway Health Plan, Inc. d/b/a Highmark Wholecare is a Pennsylvania managed care organization that sells government-funded health insurance plans: Medicaid managed care plans for low-income individuals and families and Medicare Dual-Eligible Special Needs Plans (D-SNP) for those who qualify for both Medicare and Medicaid. Members access benefits, provider directories, and care management through a web member portal, iOS/Android mobile apps, and partner platforms (HealthSparq for provider search, Availity for provider eligibility and prior authorization).
Product overview
Gateway Health Plan, Inc. d/b/a Highmark Wholecare operates as a Medicaid and Medicare managed care organization in Pennsylvania. The company offers two core health insurance products: Medicaid Plans providing comprehensive benefits including dental, vision, pregnancy/pediatric services, and behavioral health; and Medicare Dual Eligible Special Needs Plans (D-SNP) for individuals who qualify for both Medicare and Medicaid, covering dental, vision, hearing, transportation, food, and utility assistance. These products are supported by digital services including the My Highmark member portal (web and mobile apps), the Wholecare Resource Center, a Health and Wellness Center, mental health services platform, provider directory tools, and Transparency in Coverage reporting tools. The company serves more than 400,000 members through a network of over 30,000 providers.
Differentiator
Problem solved
Functional benefit
Products and services
- Highmark Wholecare Medicaid Plans
Companies that use Gateway Health
Customer profileNamed customers2 records
Segments2 records
Ideal customer profiles3 records
Gateway Health technology and API
TechnologyTechnology focussed No
API detail
- Has API
- Yes
- API docs
- API detail
Core technology
AI maturity
App detail
Integration2 records
Feature3 records
Gateway Health partnerships and signals
Strategic signalPartnerships
Four partnerships are on record, tiered core.
- Blue Cross Blue Shield AssociationcoreGateway Health Plan, Inc. d/b/a Highmark Wholecare operates as an independent licensee of the Blue Cross Blue Shield Association, using the BCBS brand for Medicaid and Medicare health insurance products in Pennsylvania
- 30,000+ Healthcare ProviderscoreNetwork of doctors, specialists, hospitals, pharmacies, and other healthcare providers delivering covered services to members
- HealthsparqcoreProvider directory and care finder technology platform integrated into member services for locating in-network providers
- Pennsylvania Department of Human ServicescoreGovernment partner administering Medicaid managed care contracts for Pennsylvania beneficiaries
Scale indicators3 records
Recent moves6 records
Expansion highlights5 records
Gateway Health competitors and assessment
Company assessmentDirect peers
- UPMC Health Plan: The largest Pennsylvania-headquartered health insurer and a direct competitor to Gateway Health across Medicaid managed care and Medicare D-SNP products. Operates with vertically integrated UPMC provider assets, making it the primary share-of-mind rival in PA Medicaid/D-SNP procurement.
- Geisinger Health Plan: Pennsylvania-based provider-sponsored health plan offering Medicaid managed care and Medicare Advantage products in overlapping PA service areas. Directly comparable to Gateway in product mix and target dual-eligible and low-income populations.
- AmeriHealth Caritas Pennsylvania: Medicaid managed care plan serving Pennsylvania beneficiaries with the same dual-eligible focus as Gateway. Competes head-to-head in PA Medicaid procurement and offers comparable supplemental benefits for low-income and complex-needs members.
- Molina Healthcare: Government-sponsored health plan focused on Medicaid and Medicare D-SNP across multiple states. Closely comparable business model to Gateway's, with similar concentration on dual-eligible populations and government-program revenue streams.
- CareSource: Non-profit, government-sponsored managed care plan with Medicaid and D-SNP products in multiple states. Closely comparable mission-driven, government-program-focused business model and target population to Gateway Health.
Broad incumbents
- Centene Corporation: The largest US Medicaid managed care insurer, operating multiple state plans including Pennsylvania. Competes with Gateway in PA Medicaid/D-SNP and brings national scale, broader risk pools, and deeper government-relations resources than a single-state operator.
- UnitedHealthcare: The largest US health insurer with national Medicare Advantage and D-SNP footprints, including Pennsylvania. Competes with Gateway on D-SNP plans and brings substantially greater scale, capital, and provider-negotiating leverage.
- Humana: National leader in Medicare Advantage and a major D-SNP sponsor, with growing Medicaid exposure. Comparable to Gateway in D-SNP-specific product focus and dual-eligible member experience, though at materially larger scale.
- Aetna (CVS Health): National health insurer owned by CVS Health, offering Medicare Advantage and D-SNP plans in Pennsylvania. Competes with Gateway in D-SNP and brings integrated pharmacy and retail care assets that raise competitive intensity.
Regional players
- Health Partners Plans: Philadelphia-headquartered Medicaid managed care plan serving Pennsylvania beneficiaries with dual-eligible and low-income populations. Closely comparable to Gateway in product mix and regional concentration, but focused on southeastern PA.
Market position
Strengths4 records
Weaknesses4 records
Competitive moat4 records
Key risks5 records
Key highlights7 records
Customer concentration
Gateway Health social profiles
Digital presenceGateway Health compliance and trust
Trust signalCompliance5 records
Gateway Health financial estimates
Financial estimateRevenue estimate
Valuation estimate
Gateway Health leadership team
Management profileNumber of profiles
Gateway Health funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Gateway Health M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Gateway Health
What does Gateway Health do?
Gateway Health Plan, Inc. d/b/a Highmark Wholecare is a Pennsylvania managed care organization that sells government-funded health insurance plans: Medicaid managed care plans for low-income individuals and families and Medicare Dual-Eligible Special Needs Plans (D-SNP) for those who qualify for both Medicare and Medicaid. Members access benefits, provider directories, and care management through a web member portal, iOS/Android mobile apps, and partner platforms (HealthSparq for provider search, Availity for provider eligibility and prior authorization).
Is Gateway Health a public or private company?
Gateway Health is a private company. It is classified as corporate owned and is currently operating.
When was Gateway Health founded?
Gateway Health was founded in 1992. It employs 501 to 1,000 people.
Where is Gateway Health based?
Gateway Health is headquartered in Pittsburgh, United States, in the North America region.
How does Gateway Health make money?
Two revenue lines are on record. Government- Funded Health Insurance Premiums are the primary driver. The others are medicare D-SNP Plans.
Who are Gateway Health's main competitors?
Direct peers on record are UPMC Health Plan, Geisinger Health Plan, AmeriHealth Caritas Pennsylvania, Molina Healthcare and CareSource. Broad incumbents are Centene Corporation, UnitedHealthcare, Humana and Aetna (CVS Health). Health Partners Plans is listed as a regional player.
Does Gateway Health have an API?
Yes. Gateway Health participates in the CMS Interoperability and Patient Access Rule, implementing an open Application Programming Interface (API) using the HL7 Fast Health Care Interoperability Resources (FHIR) programming standard. This API enables third-party developers to create applications that help beneficiaries access their health data and allows health care systems to exchange information in an interoperable format. The CMS API supports patient access to claims and clinical data, and the Payer to Payer data exchange allowing patients to take their clinical data when switching insurance companies. Over 1,500 developers are building apps using this API. Developer documentation is at cmsapiportal.hmhs.com/highmark-getting-started.
What industry is Gateway Health in?
Gateway Health's product category is Managed Care Health Insurance (Medicaid and Medicare D-SNP). Its primary akta.pro industry code is HLAEAFAA, D-SNP Plan Sponsorship & Benefit Design, with a secondary code of FSAIAGAD, Dual-Eligible Special Needs Plans (D-SNP). Its NAICS code is 524114 and its SIC code is 6321.