Fidelis Essential Plan Medicaid is a health insurance program that provides comprehensive healthcare coverage to qualified low-income individuals and families in New York. This Medicaid plan offers a wide range of benefits, including doctor’s visits, hospital stays, prescription drugs, and mental health services. Fidelis Essential Plan Medicaid also provides preventive care, such as screenings and immunizations, to help keep beneficiaries healthy. The program is designed to ensure that all New Yorkers have access to quality, affordable healthcare.
Fidelis Care: An Overview
Fidelis Care is a New York-based health insurance company that offers a range of health insurance plans, including Medicaid, Medicare, and commercial plans. Fidelis Care is a not-for-profit organization that provides health insurance coverage to over 2 million members in New York State.
Fidelis Care’s mission is to provide affordable, quality health insurance coverage to New Yorkers. The company offers a variety of plans to meet the needs of its members, including:
- Medicaid
- Medicare
- Commercial plans
- Child Health Plus
- Essential Plan
Fidelis Care is committed to providing its members with access to quality health care. The company has a network of over 40,000 providers, including doctors, hospitals, and specialists. Fidelis Care also offers a variety of programs and services to help its members stay healthy, including:
- Preventive care screenings
- Chronic disease management programs
- Mental health and substance abuse treatment
- Dental and vision care
Fidelis Care is a reliable and affordable health insurance option for New Yorkers. The company offers a variety of plans to meet the needs of its members, and it is committed to providing quality health care.
Essential Plan
The Essential Plan is a health insurance plan offered by Fidelis Care. The Essential Plan is a Medicaid managed care plan that provides comprehensive health coverage to low-income New Yorkers. The Essential Plan covers a wide range of services, including:
- Doctor visits
- Hospital stays
- Emergency care
- Mental health and substance abuse treatment
- Dental and vision care
- Prescription drugs
The Essential Plan is a cost-effective way to get health insurance coverage. The plan has low premiums and copays, and it covers a wide range of services. The Essential Plan is also easy to use. Members can find a doctor or hospital in the Fidelis Care network, and they can get their prescriptions filled at any pharmacy.
| Income Level | Monthly Premium | Copay |
|---|---|---|
| Up to 138% of the federal poverty level | $0 | $0 |
| 139% to 200% of the federal poverty level | $20 | $5 |
| 201% to 400% of the federal poverty level | $40 | $10 |
The Essential Plan is a good option for low-income New Yorkers who need health insurance coverage. The plan is affordable, easy to use, and it covers a wide range of services.
Medicaid Coverage
Medicaid is a health care program that provides medical benefits to people with low income and resources. Depending on the state, it is run by the state government itself or in conjunction with the federal government. Medicaid covers a wide range of medical services, including doctor visits, hospital care, prescription drugs, and mental health care.
To qualify for Medicaid, you must meet certain eligibility criteria, such as income and asset limits. Eligibility for Medicaid also varies from state to state, so it’s important to check with your state’s Medicaid agency to see if you qualify.
Medicaid Eligibility
To be eligible for Medicaid, you must meet certain requirements, which can vary from state to state:
- Income: Your income must be below a certain level, which is based on the federal poverty level (FPL). In most states, the income limit for Medicaid is 138% of the FPL for adults and 163% of the FPL for children.
- Assets: You must also have limited assets, which can include things like cash, savings, and investments. The asset limit for Medicaid varies from state to state, but it is typically around $2,000 for individuals and $3,000 for couples.
- Residency: You must be a resident of the state in which you are applying for Medicaid.
- Citizenship: In most states, you must be a U.S. citizen or a legal resident to be eligible for Medicaid. However, some states do offer Medicaid to undocumented immigrants.
- Age: In most states, children, pregnant women, and people with disabilities are eligible for Medicaid. Some states also offer Medicaid to adults who meet certain criteria.
In order to apply for Medicaid, you will need to contact your state’s Medicaid agency. You can find the contact information for your state’s Medicaid agency on the Medicaid.gov website.
Medicaid Coverage
Medicaid covers a wide range of medical services, including:
- Doctor visits
- Hospital care
- Prescription drugs
- Mental health care
- Dental care
- Vision care
- Hearing aids
- Durable medical equipment
- Nursing home care
- Home health care
The specific services that are covered by Medicaid vary from state to state. To find out what services are covered in your state, you can contact your state’s Medicaid agency.
| Family Size | Annual Income Limit |
|---|---|
| 1 | $17,130 |
| 2 | $23,020 |
| 3 | $28,910 |
| 4 | $34,800 |
| 5 | $40,690 |
Fidelis Essential Plan Benefits and Services
The Fidelis Essential Plan is a Medicaid health insurance plan that provides comprehensive coverage for eligible New Yorkers. The plan offers a wide range of benefits and services, including:
- Preventive care, such as checkups, screenings, and immunizations
- Doctor visits and specialist care
- Hospital stays and emergency care
- Mental health and substance abuse treatment
- Prescription drugs
- Pregnancy and childbirth care
- Pediatric care
- Dental and vision care
- Transportation to medical appointments
The Fidelis Essential Plan also covers a range of other services, such as:
- Case management
- Care coordination
- Health education
- Nutrition counseling
- Smoking cessation
- Weight management
The Fidelis Essential Plan is a comprehensive health insurance plan that provides a wide range of benefits and services to eligible New Yorkers. The plan is designed to help members get the care they need to stay healthy and well.
| Benefit | Service |
|---|---|
| Preventive care | Checkups, screenings, immunizations |
| Doctor visits and specialist care | Visits to primary care physicians and specialists |
| Hospital stays and emergency care | Inpatient and outpatient hospital care, emergency room visits |
| Mental health and substance abuse treatment | Individual and group therapy, medication management |
| Prescription drugs | Generic and brand-name medications |
| Pregnancy and childbirth care | Prenatal care, labor and delivery, postpartum care |
| Pediatric care | Well-child visits, immunizations, sick child visits |
| Dental and vision care | Cleanings, exams, fillings, vision exams, glasses |
| Transportation to medical appointments | Transportation to and from doctor’s appointments and other medical services |
Differences Between Medicaid and the Essential Plan
Medicaid and the Essential Plan are both health insurance programs that provide coverage to low-income individuals and families. However, there are some key differences between the two programs.
Eligibility
Medicaid:
- Eligibility for Medicaid is based on income and family size.
- In most states, adults must have a dependent child, be pregnant, disabled, or be 65 or older to qualify.
- Children under the age of 19 are generally eligible for Medicaid regardless of their family’s income.
Essential Plan:
- Eligibility for the Essential Plan is based on income and household size.
- To qualify, individuals must have an income between 138% and 400% of the federal poverty level (FPL).
- Household size is not a factor in determining eligibility.
Benefits
Medicaid:
- Medicaid covers a wide range of benefits, including doctor visits, hospital care, prescription drugs, and mental health services.
- The specific benefits covered by Medicaid vary from state to state.
Essential Plan:
- The Essential Plan covers a narrower range of benefits than Medicaid.
- The Essential Plan covers doctor visits, hospital care, prescription drugs, and preventive care.
- Mental health and substance abuse services are not covered by the Essential Plan.
Costs
Medicaid:
- Medicaid is generally free for those who qualify.
- However, some states may charge a small premium or copayment for certain services.
Essential Plan:
- The Essential Plan is not free.
- Individuals who qualify for the Essential Plan will pay a monthly premium.
- The amount of the premium will vary depending on the individual’s income and the plan they choose.
Which Program is Right for Me?
The best way to determine which program is right for you is to talk to a health insurance agent or broker. They can help you compare the benefits and costs of Medicaid and the Essential Plan and make the best decision for your individual needs.
| Medicaid | Essential Plan | |
|---|---|---|
| Eligibility | Based on income and family size | Based on income and household size |
| Benefits | Wide range of benefits, including doctor visits, hospital care, prescription drugs, and mental health services | Narrower range of benefits, including doctor visits, hospital care, prescription drugs, and preventive care |
| Costs | Generally free for those who qualify | Individuals who qualify will pay a monthly premium |
Alright everyone, that’s all I’ve got for you on the topic of Fidelis Essential Plan Medicaid. Thanks a million for sticking with me and giving this article a read. I hope you found some information that was helpful to you. If you’re still curious about other aspects of Medicaid or have more questions about Fidelis Essential Plan, please feel free to visit again at any time. I’ll be updating the site with new information and resources as soon as I get my hands on them. Until then, take care and stay healthy!