- 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 and HMO-POS plans.
- All Fidelis Medicare Advantage plans offer additional benefits like vision and hearing exams, and some may also cover dental, hearing aids, and prescription drugs.
- The benefits and costs of a Fidelis Medicare Advantage plan can vary based on where you live.
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.
About
Fidelis is an insurance company that offers three types of 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
Fidelis Medicare Advantage plans are available throughout the state of 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.
Now, let’s examine the different types of Medicare Advantage plans that are available through Fidelis.
Fidelis Medicare Advantage 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 Medicare Advantage 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)
Medicare Part D plans cover prescription drugs. They can either be sold separately or bundled with a Medicare Advantage plan.
Fidelis doesn’t sell separate Part D plans. However, except for the Fidelis Medicare Advantage Without Rx HMO-POS plan, all other Fidelis plans include Part D prescription drug coverage.
Medicare Advantage plans always cover the same basic benefits as original Medicare (Medicare Part A and Medicare Part B). Due to this, 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
- 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 of:
- routine eye exams
- hearing exams
- emergency care during foreign travel
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 benefits
- transportation for nonemergency medical care
- acupuncture
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 of the different Fidelis Medicare Advantage plans in three different cities in New York. As you can see, costs can vary a bit based on your location.
| Buffalo, NY | Syracuse, NY | New York, NY | |
|---|---|---|---|
| Fidelis Medicare Advantage $0 Premium (HMO) | Monthly premium: $0, estimated yearly cost: $4,687, max in-network out-of-pocket cost: $6,700 | Monthly premium: $0, estimated yearly cost: $4,687, max in-network out-of-pocket cost: $6,700 | Monthly premium: $0, estimated yearly cost: $5,155, max in-network out-of-pocket cost: $6,700 |
| Fidelis Medicare Advantage Flex (HMO-POS) | Monthly premium: $22.50, estimated yearly cost: $4,549, max in-network out-of-pocket cost: $6,700 | Monthly premium: $22.50, estimated yearly cost: $4,549, max in-network out-of-pocket cost: $6,700 | Monthly premium: $22.50, estimated yearly cost: $4,753, max in-network out-of-pocket cost: $6,700 |
| Fidelis Medicare Advantage Without Rx (HMO-POS) | Monthly premium: $0, estimated yearly cost: $7,327, max in-network out-of-pocket cost: $6,700 | Monthly premium: $0, estimated yearly cost: $7,327, max in-network out-of-pocket cost: $6,700 | — |
Medicare Advantage plans are health insurance plans that private insurance companies sell. You may also see Medicare Advantage called Medicare Part C.
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:
- dental
- hearing
- vision
- annual physicals
- telehealth benefits
- fitness benefits like the SilverSneakers program
- transportation
- 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
Medicare Part D is the part of Medicare that covers prescription drugs. Similar to Medicare Advantage plans, private insurance companies sell Part D plans.
Many Medicare Advantage plans come bundled with a Part D plan. However, some companies also sell separate Part D plans as well.
Each company that offers a Part D plan provides a list of drugs that the plan covers. This is called a formulary. There are typically two drugs in each drug category included in the formulary.
From time to time, an insurance company may decide to change the drugs that are included in their formulary. If these changes affect one of your prescriptions, you’ll receive a notification.
Fidelis offers three Medicare Advantage plans in the state of New York. The types of plans that are available include one HMO plan and two 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.
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.
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