at a glance
- Fidelis is a private insurance company that offers Medicare Advantage plans in the state of New York.
- The Medicare Advantage plans available through Fidelis are HMO, HMO D-SNP, HMO-POS plans.
- All Fidelis Medicare Advantage plans offer extra benefits like vision and hearing exams, and some may also cover dental, hearing aids, and prescription drugs.
- Fidelis provides healthcare coverage to more than 2.1 million beneficiaries across New York.
Medicare Advantage plans are a health insurance option that private insurance companies sell. Some choose to enroll in these plans as an alternative to original Medicare.
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Fidelis is an insurance company that offers a few different 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
Let’s look at the different types of Medicare Advantage plans that are available through Fidelis.
Fidelis HMO plans
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.
Fidelis has one HMO plan available. It’s called Fidelis Medicare Advantage $0 Premium (HMO).
Fidelis HMO-POS plans
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 network.
Fidelis offers two types of Medicare Advantage HMO-POS plans. They are:
- Fidelis Medicare Advantage Flex (HMO-POS)
- Fidelis Medicare Advantage Without Rx (HMO-POS)
Fidelis HMO D-SNPs
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:
- Fidelis Dual Advantage Flex (HMO D-SNP)
- Fidelis Dual Advantage (HMO D-SNP)
- Fidelis Medicaid Advantage Plus (HMO D-SNP)
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 search for plans by ZIP code here.
- 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
- 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:
Additionally, certain Fidelis Medicare Advantage plans can offer even further benefits, such as:
- prescription drug coverage (Part D)
- preventive and comprehensive dental care options
- vision, including things like eye exams, contacts, and eyeglasses
- hearing aids, which also includes evaluation and fitting
- over-the-counter drug benefits
- fitness membership benefits
- transportation for nonemergency medical care
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 will be 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 table below compares the costs some of the Fidelis Medicare Advantage plans in different cities in New York. As you can see, costs can vary based on your location.
|Buffalo, NY||Syracuse, NY||New York, NY|
|Fidelis Medicare Advantage $0 Premium (HMO)||monthly premium: $0; estimated yearly cost: $3,727; max in-network out-of-pocket cost: $7,550||monthly premium: $0; estimated yearly cost: $3,727; max in-network out-of-pocket cost: $7,550||monthly premium: $0; estimated yearly cost: $4,219; max in-network out-of-pocket cost: $7,550|
|Fidelis Medicare Advantage Flex (HMO-POS)||monthly premium: $7.40; estimated yearly cost: $3,240; max in-network out-of-pocket cost: $7,550||monthly premium: $7.40; estimated yearly cost: $3,240; max in-network out-of-pocket cost: $7,550||monthly premium: $10.90; estimated yearly cost: |
$3,474; max in-network out-of-pocket cost: $7,550
|Fidelis Medicare Advantage Without Rx (HMO-POS)||monthly premium: $0; estimated yearly cost: $4,423; max in-network out-of-pocket cost: $7,550||monthly premium: $0; estimated yearly cost: $4,423; max in-network out-of-pocket cost: $7,550||—|
|Fidelis Dual Advantage (HMO D-SNP)||monthly premium: $0; max in-network out-of-pocket cost: $3,450||monthly premium: $0; max in-network out-of-pocket cost: $3,450||monthly premium: $0; max in-network out-of-pocket cost: $3,450|
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.
All Medicare Advantage plans have the same basic coverage as original Medicare. However, they can also include additional benefits like:
- annual physicals
- telehealth benefits
- fitness benefits like the SilverSneakers program
- alternative treatments like acupuncture and massage therapy
- installation of safety devices in your home, such as a grab bar in your shower
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 a few different Medicare Advantage plans in the state of New York. The types of plans that are available include one HMO plan, HMO D-SNP, and HMO-POS plans.
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.