More information will be posted on this website. There is no cost to joining a plan and no premiums, deductibles or copays. FIDA–IDD, which is a program for people with intellectual and developmental disabilities is still active.

Thus, a Medicare recipient can never be forced to, However, the Medicaid program does not contain. Have a Care Manager who can schedule doctor´s appointments, arrange transportation and help you get your medicine. As a demonstration program, NYS is targeting a smaller group of dual eligibles, not the whole state. Now, DOH has clarified that the Part B premium will still be deducted from their checks. Plan must remit difference to CMS if fails test. Anyone passively enrolled will have the right to disenroll   at any time, but since enrollment is by the month, there may be a delay in which they will not have access to their preferred doctors and other providers, if they are not in the FIDA plan's network. Medigap - Medicare supplemental coverage - If you have a Medigap plan to "wrap around" your Original Medicare benefits, paying your out of pocket Medicare costs such as the annual or hospital Medicare dedectibles and coinsurance, that Medigap plan won't do much good when you have FIDA. This may affect not only you but your spouse or other dependents who may rely on this coverage. To contact a lawyer, visit. NYLAG and other non-profits are also participating as part of this program. As mentioned previously, many dual eligibles turn to Medicaid because they need long-term care services that are not covered by Medicare. Some of these services include: Primary Care…, Our plan will help you find the right mix of care and services to live the life you choose. Most of the 2,520 dual eligibles still in FIDA plans are in NYC,  except for 12 in Westchester and 175 in Nassau County. New York's duals demo is also a product of the Medicaid Redesign Team (MRT), a State-based health reform initiative with similar goals to the ACA, but specifically for New York's enormous Medicaid program. Caution:   Your doctor or other provider might not agree to participate in the FIDA plan even for the 90-day transition period. However,  if a Medicaid  or QMB recipient already has a Medigap policy, she may renew it or replace it with a different policy. TTY:    1-888-329-1541. You can only obtain legal advice from a lawyer. Now they must see only in-network doctors. The FIDA benefit package includes everything covered by Medicare, plus everything covered by Medicaid (including long-term care). COSTS to CONSUMER – NO copayments allowed, including Part D drugs. Call New York Medicaid Choice to ask questions about FIDA plans or to join a plan over the phone. The program is called the   Phone:  844-614-8800     TTY Relay Service:  711. Click the link above to continue or CANCEL, 655 3rd Avenue, 2nd Fl., New York, NY 10017. See this Medicare Rights Center Fact Sheet about MAP Plans. Partners Health Plan provides links to web sites of other organizations in order to provide visitors with certain information.

There is no monthly premium, no deductible, and no copayment. This kind of plan is called a FIDA Plan. The basic structure of how they work and the rights of members are based on Medicare Advantage. Therefore, dual eligibles are one of the last groups in the country who have never been enrolled in managed care. Organizations that contributed to these comments include the Medicare Rights Center, the Center for Disability Rights, Center for Independence of the Disabled NY, Community Services Society of NY, Empire Justice Center, Legal Aid Society, New York Association on Independent Living, and Selfhelp Community Services, Inc. Under Federal law, Medicare recipients must have freedom of choice as to whether to enroll in a Medicare Advantage plan or stay with Original Medicare. There are 2 different form letters because FIDA members are being assigned to two different types of plans that provide Medicaid home care and other long-term care services. NOTE: ANNOUNCEMENT NOTICE had some misleading info - but will no longer be used in the future after April 2015. Enrolling in PHP Care Complete FIDA-IDD Plan is simple. The April 2013 amendment eliminated an alternative to the "capitated" managed care model, with a separate "Health Home" alternative of the proposal. Potential Plus Side of FIDA - coordination of all Medicaid and Medicare coverage under a single health plan, with a care planning team that better coordinates Medicaid and Medicare services and transitions to and from the hospital, etc. WHO - This notice was sent to members of Riverspring FIDA plan and those members of SWH Senior Whole Health FIDA plan who live in Manhattan, Brooklyn, Queens, or Staten Island. One extra FIDA benefit is that there are NO Part D copayments, while for other Dual Eligibles there are subsidized copayments under Part D - up to $6.60 for a brand name drug. For information on your long-term care coverage options now that FIDA has ended, see our Medicare Interactive toolkit or contact the Independent Consumer Advocacy Network (ICAN). Notice does not explain that FIDA plans have a limited network of providers and that you must use doctors and other providers in the FIDA plan network. Aetna Better Health FIDA Plan is a managed care plan that contracts with both Medicare and the New York State Department of Health (Medicaid) to provide benefits of both programs to Participants through the Fully Integrated Duals Advantage (FIDA… Most of the downstate MLTC plans are seeking to become FIDA plans.

MLTC plans NOT becoming FIDA plans - United HealthCare, Extended, HHH Choices, Montefiore. Like PACE and Medicaid Advantage Plus, FIDA plans will combine under one managed care plan:  (1) a  Medicare Advantage plan, (2) a Part D prescription drug plan, (3) a Medicaid Managed Long Term Care plan, and (4) a regular Medicaid card covering all other Medicaid services. If you want to enroll as of January 1st, then you must sign up before December 20, 2014 at noon. MLTC members may choose to stay in an MLTC plan and use their Original Medicare or Medicare Advantage cards for their primary medical care. Once you link to another web site not maintained by Partners Health Plan, you are subject to the terms and conditions of that web site, including but not limited to its privacy policy. FIDA plans must allow nursing home residents who were passively enrolled to stay in the same NH for the duration of the demonstration – they cannot make them transfer to a different nursing home. Read about the different types of plans that provide Medicaid long-term care services here and also at the end of this fact sheet. You may be eligible to join PHP Care Complete…, Our participants get covered Medicare and Medicaid benefits directly from PHP Care Complete FIDA-IDD (Medicare-Medicaid) Plan. Did you find this content helpful? This office was charged with more effectively integrating benefits under Medicare and Medicaid, and promoting better coordination between the Federal and State governments. because they need long-term care services that are not covered by Medicare. Since many plans are listed under different corporate names,  NYLAG has compiled a list of the 22 plans showing which MLTC and Medicaid Advantage Plus plans they are affiliated with in each county in the Demonstration area - NYC, Long Island and Westchester.

You will be able to get all of your services through the D– SNP and MAP plans. Beginning in January 2015, New York state will start enrolling some MLTC participants into FIDA plans offered by the same company as their MLTC plan.

As of December 31, 2019, the Fully Integrated Dual Advantage (FIDA) program is no longer available in the State of New York. For updates on Duals Demonstrations nationally see The Dual Agenda - a newsletter of Community Catalyst, a national organization working on various health access initiatives. Medicare Advantage is an optional way for older adults and people with disabilities to receive their Medicare health insurance. PACE plans also cover Medicaid long term care services as well as all Medicare services.

With FIDA-IDD, you have the choice of receiving all your Medicare and Medicaid benefits from one managed care plan, called a FIDA-IDD Plan. See. FIDA plans must allow participants to maintain  ALL current providers and service levels, including prescription drugs, at the time of enrollment for at least the later of 90 days after enrollment, or until a care assessment has been completed by the FIDA plan. This chart shows plans in the FIDA demonstration area. The advantage of enrolling in PHP Care Complete FIDA-IDD Plan is having a single organization manage and integrate all of the services and supports you receive including medical, dental, behavioral health, … In addition, your use of this site does not create an attorney-client relationship. FIDA-IDD is a Medicare and Medicaid program for adults with intellectual and developmental disabilities. Their plans manage their long term care and some other Medicaid services but not their primary and acute medical care, delivered through Medicare.

A unique and positive (hopefully) component of NYS’s FIDA demonstration is that it will integrate into one system appeals for Medicare and Medicaid services. This system provides financial incentives for the Medicare Advantage plan to find more cost-effective ways of caring for its members. In other words, a FIDA member will essentially trade in ALL of their insurance cards -- Medicare (Original or Medicare Advantage), Medicaid, MLTC, Medigap, and Medicare Part D -- and only have one health plan -- their FIDA plan. List of the 22 FIDA contracts is here showing NYC boroughs and counties covered. 42 USC 1395ss(3)(3). FIDA plans must allow participants to maintain ALL current providers and service levels, including prescription drugs, at the time of enrollment for at least the later of 90 days after enrollment, or until a care assessment has been completed by the FIDA plan. Though the state declined federal funding for an Ombudsman program, NYS iis contracting with Community Services Society to operate, On April 25, 2013, NYS amended its final proposal - see, with resources for advocates on the Dual-Eligible proposals --. Then the plan pays its participating medical providers fee-for-service.