THINGS TO KNOW
In 2015 Medicaid recipients 21 years old or older, who are dual eligible, have both Medicare and Medicaid, and receive either home care services or nursing home care through a Managed Long Term Care Agency (MLTCA) will be eligible to join FIDA (Fully Integrated Dual Advantage) program.
Current MLTCA plan provides the following services: home care services, adult day care, dental, eyeglasses, transportation to your doctor, medical supplies, and hearing aids, but does not cover your regular primary medical care. Those in an MLTCA plan continue to use Medicare and their supplemental health insurance plans. Those covered by Medicare Advantage plans must use the plan’s network for Medicare services and prescriptions.
Starting in 2015 FIDA (Fully Integrated Dual Advantage) plans came into existence.
WHAT IS FIDA PLAN?
FIDA plans will combine under one managed care plan the following:
(1) Medicare Advantage plan,
(2) Part D prescription drug plan, and
(3) a Medicaid Managed Long Term Care (MLTC) plan & all Medicaid services.
Basically, FIDA members will “trade in” ALL of their insurance cards — and replace it with one health plan – a FIDA plan.
Presently everyone will receive the following choices:
- OPT OUT of FIDA, or
- Enroll in a FIDA plan, or
- If you do nothing, you will automatically be assigned to a FIDA plan.
WHICH PLAN TO CHOOSE?
21 of the 25 companies in NYC that have MLTC and MAP plans will have FIDA plans. Present MLTC members will be assigned to the plan sponsored by their MLTC plan.
Dis-enrollment:
Presently, everyone has the option to dis-enroll from FIDA at any time, and go back to their Original Medicare or Medicare Advantage, and your former MLTC plan.
How to Choose which FIDA plan is best for you:
If you have special doctors that you need to see, make sure that they are members of your FIDA plan; otherwise, you’ll have to choose doctors from the particular FIDA network plan you choose. Additionally, you will want to check if your prescription drugs are on the plans formulary.
HOW DO I OPT OUT? After December 1st, in NYC and Nassau County, you can call New York Medicaid Choice to OPT OUT. CALL 1-855-600-FIDA (1-855-600-3432) Monday to Friday 8:30 am to 8:00 pm and Saturday from 10:00 am to 6:00 pm.
Can I disenroll from FIDA, or switch to a different FIDA plan, after I join?
YES. You can disenroll from FIDA during any month. The following month, you will be back with your “Original Medicare” or your Medicare Advantage Plan. Or you can switch to a different FIDA plan. If you disenroll from FIDA, make sure you have enrolled in an MLTC plan and in a Part D plan for your prescription drugs.