What is Fidelis Dual Advantage Flex (Local HMO D-SNP)?
Fidelis Dual Advantage Flex is a 2020 D-SNP Medicare Special Needs Plan, from Fidelis Care, available in Herkimer County, New York.
- It's a Local HMO health plan.
- It includes prescription drug coverage (Medicare Part D).
- It offers the same health insurance benefits as Original Medicare.
- It offers extras that Medicare does not cover.
- Most of the costs of joining this Medicare Special Needs Plan will be covered for you.
How to Qualify to Enroll in Fidelis Dual Advantage Flex
If you qualify and enroll, this Local HMO plan replaces your Original Medicare coverage. To qualify, you must meet the following criteria:
- You have Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance).
- You live in the plan's service area.
- You have both Medicare and Medicaid.
If you're not sure if you qualify for both Medicare and Medicaid, contact your local Medicaid office.
IMPORTANT: If you qualify for this plan based on your dual eligibility status, but you also have one or more chronic conditions, you should also investigate C-SNP plans in your areas, as they may offer a care manager to help coordinate your healthcare needs.
If you don't qualify to join this plan, you might want to compare Medicare Advantage plans in Herkimer County, New York. Another popular option is to add a New York Medicare supplement plan and a stand-alone New York Medicare prescription drug plan.
Before Joining Fidelis Dual Advantage Flex, Consider These Questions:
- Does the plan coordinate my Medicare and Medicaid benefits to make them easily accessible?
- What costs should I expect for my coverage (premiums, deductibles, copayments)?
- Is there an annual limit on my out-of-pocket expenses?
- Will I be able to use my doctors? Are they in the plan's network?
- Are the plan's in-network providers and facilities in convenient locations?
- Does the plan provide coverage for services I receive from out-of-network providers?
- Do I need a referral to see a specialist?
- Are my medications on the plan's formulary?
- What special accommodations does the plan make for persons with disabilities?
- What special language and cultural accommodations does the plan make?
How Much Does Fidelis Dual Advantage Flex Cost?
The premium on this plan is $27.10 per month. That includes your prescription drugs, as well. Plus, you must continue to pay your monthly Medicare Part B premium. Co-payments and/or co-insurances also apply with most healthcare services, except preventive care mandated by CMS (see H3328-017 Summary of Benefits below).
Although the health plan itself does not have a deductible, the prescription drug plan does. It's $0.00 per year. That means you have first dollar coverage.
Medicare 5-Star Ratings
In this section we show you the quality rating for this Fidelis Care plan. Each year CMS rates health plans (Part C) in five broad categories and drug plans (Part D) in four broad categories. We do not recommend joining a plan with an overall rating less than 3.0. The following marks will give you an idea of the level of care you will receive if you join this health plan.
Fidelis Dual Advantage Flex Medicare Part D Co-Pays
This SNP plan includes prescription drug coverage (Medicare Part D). If you have regular prescriptions, it's critical that you evaluate your costs using the plan's formulary.
In addition to the monthly premium and Part D deductible, the drug plan has copayments (fixed dollar amount) and/or coinsurances (percentage) that you must pay when you pickup your medications. Here's the drug coverage schedule for this plan:
|1 (Preferred Generic)||$0.00 copay|
|2 (Generic)||$20.00 copay|
|3 (Preferred Brand)||$47.00 copay|
|4 (Non-Preferred Drug)||$100.00 copay|
|5 (Specialty Tier)||25%|
How Much are the Copays & Co-Insurance?
Co-pay data coming soon. For assistance call: 1-855-266-4865.
Contact Fidelis Care
For more information about this plan, call the Enrollment Assistance line, or visit the Enrollment Website or the plan website:
For assistance 24 hours a day, call 800-633-4227. TTY users should call 877-486-2048. If you qualify for Medicare but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov. To learn more about this plan, visit the Fidelis Care Medicare website.
Fidelis Dual Advantage Flex is available to beneficiaries living in Cold Brook, Dolgeville, Eagle Bay, Frankfort, Herkimer, Ilion, Jordanville, Little Falls, Middleville, Mohawk, Newport, Old Forge, Poland, Salisbury Center, Thendara, Van Hornesville, West Winfield, and all other areas of Herkimer County, New York; Medicare plans are the same throughout the County.