Inpatient hospital - psychiatric $374 per day for days 1 through 5 / $0 per day for days 6 through 90 Outpatient group therapy visit with a psychiatrist $40 copay Outpatient individual therapy. Primary Care Doctor Visit $0 Copay $0 Copay $0 Copay $. Please check with your Fidelis Care representative or visit fideliscare.org for information on products.
Jump to:
Fidelis Medicare Advantage Flex (HMO-POS) H5599-007 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Fidelis Care available to residents in New York. This plan includes additional Medicare prescription drug (Part-D) coverage. The Fidelis Medicare Advantage Flex (HMO-POS) has a monthly premium of $10.90 and has an in-network Maximum Out-of-Pocket limit of $7,550 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $7,550 out of pocket. This can be a extremely nice safety net.
Fidelis Medicare Advantage Flex (HMO-POS) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.
Fidelis Care works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Fidelis Medicare Advantage Flex (HMO-POS) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Fidelis Care and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Fidelis Care except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.
Ready to Enroll?
Or Call
1-855-778-4180
Mon-Fri 8am-9pm EST
Sat 9am-9pm EST
2021 Fidelis Care Medicare Advantage Plan Costs
| Name: |
|---|
| Plan ID: | H5599-007 |
|---|
| Provider: | Fidelis Care |
|---|
| Year: | 2021 |
|---|
| Type: | Local HMO |
|---|
| Monthly Premium C+D: | $10.90 |
|---|
| Part C Premium: | $0 |
|---|
| MOOP: | $7,550 |
|---|
| Part D (Drug) Premium: | $10.90 |
|---|
| Part D Supplemental Premium | $0 |
|---|
| Total Part D Premium: | $10.90 |
|---|
| Drug Deductible: | $445.0 |
|---|
| Tiers with No Deductible: | 1 |
|---|
| Gap Coverage: | No |
|---|
| Benchmark: | not below the regional benchmark |
|---|
| Type of Medicare Health: | Enhanced Alternative |
|---|
| Drug Benefit Type: | Enhanced |
|---|
| Similar Plan: | H5599-009 |
|---|
Fidelis Medicare Advantage Flex (HMO-POS) Part-C Premium
Fidelis Care plan charges a $0 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
H5599-007 Part-D Deductible and Premium
Fidelis Medicare Advantage Flex (HMO-POS) has a monthly drug premium of $10.90 and a $445.0 drug deductible. This Fidelis Care plan offers a $10.90 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0 this Premium covers any enhanced plan benefits offered by Fidelis Care above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $10.90. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.
Fidelis Care Gap Coverage
In 2021 once you and your plan provider have spent $4130 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA 'donut hole') You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Fidelis Care plan does not offer additional coverage through the gap.
Premium Assistance
The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Fidelis Medicare Advantage Flex (HMO-POS) medicare insurance offers a $0 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $2.70 for 75% low income subsidy $5.40 for 50% and $8.20 for 25%.
| Full LIS Premium: | $0 |
|---|
| 75% LIS Premium: | $2.70 |
|---|
| 50% LIS Premium: | $5.40 |
|---|
| 25% LIS Premium: | $8.20 |
|---|
H5599-007 Formulary or Drug Coverage
Fidelis Medicare Advantage Flex (HMO-POS) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers.By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.
2021 Fidelis Medicare Advantage Flex (HMO-POS) Summary of Benefits
Additional Benefits
Comprehensive Dental
| Diagnostic services | $0 copay |
|---|
| Endodontics | $0 copay |
|---|
| Extractions | $0 copay |
|---|
| Non-routine services | $0 copay |
|---|
| Periodontics | $0 copay |
|---|
| Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay |
|---|
| Restorative services | $0 copay |
|---|
Deductible
Diagnostic Tests and Procedures
| Diagnostic radiology services (e.g., MRI) | 20% coinsurance |
|---|
| Diagnostic tests and procedures | 0-20% coinsurance |
|---|
| Diagnostic tests and procedures | 50% coinsurance (Out-of-Network) |
|---|
| Lab services | $0-20 copay |
|---|
| Outpatient x-rays | $10 copay |
|---|
Doctor Visits
| Primary | $0 copay |
|---|
| Specialist | 50% coinsurance per visit (Out-of-Network) |
|---|
| Specialist | $40 copay per visit |
|---|
Emergency care/Urgent Care
| Emergency | $90 copay per visit (always covered) |
|---|
| Urgent care | $40 copay per visit (always covered) |
|---|
Foot Care (podiatry services)
| Foot exams and treatment | $40 copay |
|---|
| Foot exams and treatment | 50% coinsurance (Out-of-Network) |
|---|
| Routine foot care | Not covered |
|---|
Ground Ambulance
Hearing
| Fitting/evaluation | $0 copay |
|---|
| Hearing aids | $0 copay |
|---|
| Hearing exam | $0 copay |
|---|
Inpatient Hospital Coverage
| $1,600 per stay |
|---|
| Not Applicable (Out-of-Network) |
|---|
Medical Equipment/Supplies
| Diabetes supplies | $0 copay |
|---|
| Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item |
|---|
| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item |
|---|
Medicare Part B Drugs
| Chemotherapy | 20% coinsurance |
|---|
| Other Part B drugs | 20% coinsurance |
|---|
Mental Health Services
| Inpatient hospital - psychiatric | Not Applicable (Out-of-Network) |
|---|
| Inpatient hospital - psychiatric | $1,600 per stay |
|---|
| Outpatient group therapy visit | $40 copay |
|---|
| Outpatient group therapy visit | 50% coinsurance (Out-of-Network) |
|---|
| Outpatient group therapy visit with a psychiatrist | $40 copay |
|---|
| Outpatient group therapy visit with a psychiatrist | 50% coinsurance (Out-of-Network) |
|---|
| Outpatient individual therapy visit | 50% coinsurance (Out-of-Network) |
|---|
| Outpatient individual therapy visit | $40 copay |
|---|
| Outpatient individual therapy visit with a psychiatrist | $40 copay |
|---|
| Outpatient individual therapy visit with a psychiatrist | 50% coinsurance (Out-of-Network) |
|---|
MOOP
Option
Optional supplemental benefits
Outpatient Hospital Coverage
| $500 copay or 20% coinsurance per visit |
|---|
Preventive Care
| $0 copay (Out-of-Network) |
|---|
| $0 copay |
|---|
Preventive Dental
| Cleaning | $0 copay |
|---|
| Dental x-ray(s) | $0 copay |
|---|
| Fluoride treatment | $0 copay |
|---|
| Oral exam | $0 copay |
|---|
Rehabilitation Services
| Occupational therapy visit | $40 copay |
|---|
| Occupational therapy visit | 50% coinsurance (Out-of-Network) |
|---|
| Physical therapy and speech and language therapy visit | $40 copay |
|---|
| Physical therapy and speech and language therapy visit | 50% coinsurance (Out-of-Network) |
|---|
Skilled Nursing Facility
| Not Applicable (Out-of-Network) |
|---|
$0 per day for days 1 through 20
$184 per day for days 21 through 100 |
|---|
Fidelis Copayment
Transportation
Vision
| Contact lenses | $0 copay |
|---|
| Eyeglass frames | $0 copay |
|---|
| Eyeglass lenses | $0 copay |
|---|
| Eyeglasses (frames and lenses) | $0 copay |
|---|
| Other | Not covered |
|---|
| Routine eye exam | $0 copay |
|---|
| Upgrades | Not covered |
|---|
Wellness Programs (e.g. fitness nursing hotline)
Ready to Enroll?
Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST
Coverage Area for Fidelis Medicare Advantage Flex (HMO-POS)
(Click county to compare all available Advantage plans)
| State: | New York
|
|---|
| County: | Albany,Bronx,Clinton,Dutchess,Essex,
Fulton,Hamilton,Montgomery,New York,
Rensselaer,Richmond,Rockland,Saratoga,
Schenectady,Schoharie,Ulster,Warren,
Washington,Westchester, |
|---|
Go to top
What Medications Does Fidelis Cover
Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.Includes 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.
What Does Fidelis Cover
| Medicare Advantage Plan Benefit Details in Plain Text |
The following Medicare Advantage plan benefits apply to the Fidelis Dual Advantage Flex (HMO D-SNP) (H5599 - 001) in Clinton, New York .
This plan is administered by NEW YORK QUALITY HEALTHCARE CORPORATION. To switch to a different Medicare Advantage plan or to change your location, click here. |
Click here to see the Fidelis Dual Advantage Flex (HMO D-SNP) health and prescription benefit details in chart format or email and view benefits chart
|
| Plan Premium |
The Fidelis Dual Advantage Flex (HMO D-SNP) has a monthly premium of $21.60. That is $259.20 for 12 months. There are a few factors that can increase or decrease this premium. If you qualify for full or partial extra help, your premium will be lower. If you have a premium penalty, your premium will be higher. Please remember that the $21.60 montly premium is in addition to your Medicare Part B premium. If you have a premium penalty, your premium will be higher. Or if you have a higher income you would be subject to the Income Related Adjustment Amount (IRMAA).
|
This Medicare Advantage Plan with Prescription Drug Coverage is a Local HMO plan.
|
| Plan Membership |
The Fidelis Dual Advantage Flex (HMO D-SNP) (H5599 - 001) currently has 42,104 members. There are 270 members enrolled in this plan in Clinton, New York.
|
| Prescription Drug Coverage: Deductible, Cost-sharing, Formulary |
This plan has a $445 deductible. So, you are 100% responsible for the first $445 in medication costs. After you have met the deductible, the Fidelis Dual Advantage Flex (HMO D-SNP) will share the costs of your medications with you -- see cost-sharing below. $445 is the maximum deductible for 2021. There are other plans with a lower deductible or even a $0 deductible for all formulary drugs. Click here to review plans with a $0 deductible.
|
| The following information is about the Fidelis Dual Advantage Flex (HMO D-SNP) formulary (or drug list). There are 3168 drugs on the Fidelis Dual Advantage Flex (HMO D-SNP) formulary. Click here to browse the Fidelis Dual Advantage Flex (HMO D-SNP) Formulary. |
The Initial Coverage Phase (ICP) can be thought of as the cost-sharing phase of the plan. During this phase, you and the insurance company share your prescription costs. Once you have spent $445, your initial coverage phase will start. All medication are divided into tiers within the plans formulary. This helps the plan to organize and manage the prescription cost-sharing. The Fidelis Dual Advantage Flex (HMO D-SNP)’s formulary is divided into 5 tiers. Every plan can name their tiers differently, and can place medications on any tier. The cost-sharing for this plan is divided as follows: - Tier 1 (Preferred Generic) contains 452 drugs and has a co-payment of $0.00.
- Tier 2 (Generic) contains 1,526 drugs and has a co-payment of $10.00.
- Tier 3 (Preferred Brand) contains 313 drugs and has a co-insurance of 24% of the drug cost.
- Tier 4 (Non-Preferred Drug) contains 256 drugs and has a co-insurance of 39% of the drug cost.
- Tier 5 (Specialty Tier) contains 623 drugs and has a co-insurance of 25% of the drug cost.
Click here to browse the Fidelis Dual Advantage Flex (HMO D-SNP) Formulary.
|
The Coverage Gap, which is also known as the Donut (Doughnut) Hole is the phase of your Medicare Part D plan where you are responsible for 100% of your medication costs. Healthcare Reform mandates that the insurance carrier pay 75% of your generic drug prescription costs in the donut hole on your behalf.
The brand-name drug manufacturer will pay 70% and your plan will pay an additional 5% of the cost of your brand-name drugs purchased in the Donut Hole, for a total of 75% discount. The 70% paid by the brand-name drug manufacturer is paid on your behalf and therefore counts toward your TrOOP (or True Out-of-Pocket) costs. The portion paid by your plan, does not count toward TrOOP. Some Medicare Part D plans offer coverage during the Coverage Gap that is beyond the mandated discounts. Any drug not covered by the plan’s Gap Coverage will still receive the discounts noted above -- even if the plan has 'No Gap Coverage'. This plan (Fidelis Dual Advantage Flex (HMO D-SNP)) offers No Coverage during the Coverage Gap phase.
|
| The Fidelis Dual Advantage Flex (HMO D-SNP) offers many Health and Prescription Drug Coverage Benefits. The following section will describe these benefits in detail. |
| ** Base Plan ** | | Premium | | • Health plan premium: $0 | | • Drug plan premium: $21.60 | | • You must continue to pay your Part B premium. | | • Part B premium reduction: No | | Deductible | | • Health plan deductible: Coming soon | | • Other health plan deductibles: In-network: No | | • Drug plan deductible: $445.00 annual deductible | | Maximum out-of-pocket enrollee responsibility (does not include prescription drugs) | | • $7,550 In-network | | Optional supplemental benefits | | • No | | Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions? | | • In-network: No | | Doctor visits | | • Primary: 0% or 20% coinsurance per visit | | • Specialist: 0% or 20% coinsurance per visit | | Diagnostic procedures/lab services/imaging | | • Diagnostic tests and procedures: 0% or 0-20% coinsurance (authorization required) | | • Lab services: $0 copay (authorization required) | | • Diagnostic radiology services (e.g., MRI): 0% or 20% coinsurance (authorization required) | | • Outpatient x-rays: 0% or 20% coinsurance (authorization required) | | Emergency care/Urgent care | | • Emergency: 0% or 20% coinsurance per visit (always covered) | | • Urgent care: 0% or 20% coinsurance per visit (always covered) | | Inpatient hospital coverage | | • Coming soon (authorization required) | | Outpatient hospital coverage | | • 0% or 20% coinsurance per visit (authorization required) | | Skilled Nursing Facility | | • Coming soon (authorization required) | | Preventive care | | • $0 copay | | Ground ambulance | | • 0% or 20% coinsurance | | Rehabilitation services | | • Occupational therapy visit: 0% or 20% coinsurance (authorization required) | | • Physical therapy and speech and language therapy visit: 0% or 20% coinsurance (authorization required) | | Mental health services | | • Inpatient hospital - psychiatric: Coming soon (authorization required) | | • Outpatient group therapy visit with a psychiatrist: 0% or 20% coinsurance | | • Outpatient individual therapy visit with a psychiatrist: 0% or 20% coinsurance | | • Outpatient group therapy visit: 0% or 20% coinsurance | | • Outpatient individual therapy visit: 0% or 20% coinsurance | | Medical equipment/supplies | | • Durable medical equipment (e.g., wheelchairs, oxygen): 0% or 20% coinsurance per item (authorization required) | | • Prosthetics (e.g., braces, artificial limbs): 0% or 20% coinsurance per item (authorization required) | | • Diabetes supplies: $0 copay (authorization required) | | Hearing | | • Hearing exam: 0% or 20% coinsurance | | • Fitting/evaluation: Not covered | | • Hearing aids - inner ear: Not covered | | • Hearing aids - outer ear: Not covered | | • Hearing aids - over the ear: Not covered | | Preventive dental | | • Oral exam: $0 copay (limits apply) | | • Cleaning: $0 copay (limits apply) | | • Fluoride treatment: Not covered | | • Dental x-ray(s): $0 copay (limits apply) | | Comprehensive dental | | • Non-routine services: Not covered | | • Diagnostic services: Not covered | | • Restorative services: Not covered | | • Endodontics: Not covered | | • Periodontics: Not covered | | • Extractions: Not covered | | • Prosthodontics, other oral/maxillofacial surgery, other services: Not covered | | Vision | | • Routine eye exam: $0 copay (limits apply) | | • Other: Not covered | | • Contact lenses: $0 copay (limits apply) | | • Eyeglasses (frames and lenses): $0 copay (limits apply) | | • Eyeglass frames: $0 copay (limits apply) | | • Eyeglass lenses: $0 copay (limits apply) | | • Upgrades: Not covered | | Wellness programs (e.g., fitness, nursing hotline) | | • Covered | | Transportation | | • $0 copay (limits apply) | | Foot care (podiatry services) | | • Foot exams and treatment: 0% or 20% coinsurance | | • Routine foot care: Not covered | | Medicare Part B drugs | | • Chemotherapy: 0% or 20% coinsurance (authorization required) | | • Other Part B drugs: 0% or 20% coinsurance (authorization required) |
|