Fidelis is a private insurance company that offers Medicare Advantage plans in the state of New York. These plans offer extra benefits like vision and hearing, vision, and dental.
Medicare Advantage plans are health insurance options that private insurance companies sell. Some people enroll in these plans as an alternative to Original Medicare.
In 2024, about 54% of the Medicare population — more than 38 million people — had a Medicare Advantage plan.
Fidelis is an insurance company that offers Medicare Advantage plans in New York.
Keep reading as we:
- discuss the different types of Fidelis plans
- explore what benefits they cover
- examine their potential costs
The Medicare Advantage plans available through Fidelis are HMO and HMO-POS plans. Let’s examine these plans.
Fidelis HMO plan
In a Health Maintenance Organization (HMO) plan, you must receive your care from an in-network provider. If you use an out-of-network provider, you may be responsible for paying for the entire cost of your care.
In 2024, Fidelis has one HMO plan available. It’s called Wellcare Fidelis No Premium (HMO).
Fidelis HMO-POS plan
HMO Point-of-Service (HMO-POS) plans are very similar to HMO plans.
In an HMO-POS plan, you may be allowed to get some types of care from an out-of-network provider. However, your coinsurance and copay for these services will be higher than if you were in a network.
In 2024, Fidelis offers one Medicare Advantage HMO-POS plan, Wellcare Fidelis Assist (HMO-POS).
Fidelis HMO D-SNPs
HMO Dual Eligible Special Needs Plans (D-SNPs) are available to those who qualify for both Medicare and Medicaid. These plans are not sold through Medicare and must be purchased through Medicaid.
With this type of plan, your healthcare costs are covered seamlessly between Medicare and Medicaid. This will prevent gaps in coverage and give you one point of contact with little or no out-of-pocket costs for covered services.
Fidelis offers three Medicare Advantage HMO D-SNPs:
- Wellcare Fidelis Dual Access (HMO D-SNP)
- Wellcare Fidelis Dual Plus Metro (HMO D-SNP)
- Wellcare Fidelis Dual Plus (HMO D-SNP)
Fidelis Part D options
Medicare Part D plans cover your prescription drugs. They can be sold separately or bundled with a Medicare Advantage plan.
Fidelis doesn’t sell separate Part D plans. However, most of the Fidelis Medicare Advantage plans include Part D prescription drug coverage.
Fidelis Medicare Advantage plans are available in many areas throughout New York.
Since the types of plans that are offered can vary by location, some Fidelis Medicare Advantage plans may not be available in your county or ZIP code. You can use Medicare’s Find a Plan tool to search for plans by your ZIP code.
Medicare Advantage covers the same basic benefits as Original Medicare (Medicare Part A and Medicare Part B). Therefore, Fidelis Medicare plans will always cover:
- outpatient visits to primary care doctors or specialists
- outpatient mental health visits
- diagnostic tests and laboratory tests
- preventive care
- limited inpatient stays at hospitals and skilled nursing facilities
- emergency care
- urgent care visits
- emergency ambulance transportation
- occupational therapy, physical therapy, and speech-language therapy
- acupuncture
- durable medical equipment and medical supplies, including wheelchairs, oxygen, or diabetic supplies
- treatment programs for substance use disorders
Medicare Advantage plans may also include benefits that aren’t covered under Original Medicare. For example, all Fidelis Medicare Advantage plans offer some coverage for:
- prescription medications
- vision
- hearing
- dental
- telehealth
- fitness benefits like the SilverSneakers program
- emergency care during foreign travel
Additionally, certain Fidelis Medicare Advantage plans may offer additional benefits, such as transportation to medical appointments and over-the-counter medications.
Now, let’s look into the different costs that may be associated with a Fidelis Medicare Advantage plan.
- Monthly premiums: This is the monthly cost for your plan. Some plans have a $0 monthly premium.
- Copays and coinsurance: These are set costs you’ll pay after receiving care from a provider. With HMO-POS plans, copays and coinsurance are more expensive for an out-of-network provider.
- Deductibles: Some Medicare Advantage plans may have a health or drug deductible that you’ll pay before coverage begins.
- Out-of-pocket costs: If a service or provider isn’t included in your plan, you’ll be responsible for paying any costs. Most plans have a maximum out-of-pocket limit, but these can vary by plan.
The tables below compare some of the costs Fidelis Medicare Advantage plans in New York.
Wellcare Fidelis No Premium (HMO) costs:
| Monthly premium | Copay: Primary MD | Copay: Specialist | Max in-network out-of-pocket cost |
| $0 | $0 | $45 | $7,550 |
Wellcare Fidelis Assist (HMO-POS) costs:
| Monthly premium | Copay: Primary MD | Copay: Specialist | Max in- and out-of-network out-of-pocket cost |
| $27.50 | $0 | $30 | $7,550 |
Medicare Advantage (Part C) plans are health insurance plans that private insurance companies sell. You can choose to enroll in a Medicare Advantage plan instead of using Original Medicare for your medical benefits.
There’s variation in both the costs and services included in Medicare Advantage plans. These can depend on factors like:
- your location
- the type of plan
- the company that’s selling the plan
Fidelis offers several different Medicare Advantage plans in New York. The plans available include one HMO plan and one HMO-POS plan.
All Fidelis plans cover the same benefits as Original Medicare. They may also include additional benefits like dental, vision, and hearing aids. These extras will depend on the specific plan you choose.
The costs and benefits of Medicare Advantage plans can vary based on where you live. You can compare multiple plans in your area to make sure that you select one that best suits your needs.