Plan ID: H5599-007

What You Need to Know:

  • Fidelis Medicare Advantage Flex (HMO-POS) is a Medicare Advantage Health Maintenance Organization Local HMO plan.
  • It must provide all of the same hospital and medical benefits as Medicare Part A and Part B, however, costs may be different.
  • It has additional benefits not included in Medicare Part A and Part B, including prescription drug coverage.
  • The plan's monthly premium is $11, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is $445 (Tier 1 and 2 excluded from the Deductible.).
  • The plan includes an out-of-pocket maximum of $7,550 per year (in-network).
  • Fidelis Medicare Advantage Flex (HMO-POS) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is $445 (Tier 1 and 2 excluded from the Deductible.).
  • This plan's Part D Initial Coverage Limit is $11.

$11

Monthly Premium

Medicare Plan Features
Monthly Premium: $10.90
Part C Premium: $0
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$10.90 $0 $10.90 $0 $10.90 $445.0 1.0
Gap Coverage: No
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local HMO
Similar Plan: H5599-009
Special Needs Type: NULL
Chronic Condition: NULL
Additional Gap Coverage: No additional gap coverage, only the Donut Hole Discount
Maximum Out-of-Pocket Limit for Parts A & B (Moop): $7,550
Annual Deductible: $445 (Tier 1 and 2 excluded from the Deductible.)
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Schoharie, New York: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
less than 10 members New plan - No summary rating as of yet. New plan - not yet rated. New plan - not yet rated.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 3,213 drugs
Number of Members Enrolled in this Plan in Schoharie, New York: NULL
Number of Drugs Per Tier: NULL
Preferred Pharmacy Cost Sharing During Initial Coverage Phase: NULL
Special Needs Plan SNP Eligibility Requirement: NULL
Monthly Premium Split as Follows:
Part C Premium Part D Base Premium Part D Supplemental Premium Total Premium
$0.00 $10.90 $0.00 $10.90
Monthly Premium with Extra Help Low Income Subsidy:
LIS100 Subsidy Total Monthly Premium with LIS Parts CD LIS25 Subsidy Monthly PartD Premium with LIS LIS25 Subsidy Total Monthly Premium with LIS Parts CD LIS50 Monthly PartD Premium with LIS LIS50 Subsidy Total Monthly Premium with LIS Parts CD LIS75 Monthly PartD Premium with LIS LIS75 Subsidy Total Monthly Premium with LIS Parts CD
$0.00 $8.20 $8.20 $5.40 $5.40 $2.70 $2.70
Formulary Drug Details:
Tier 1 # of Drugs per Tier Tier 1 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 2 # of Drugs per Tier Tier 2 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 3 # of Drugs per Tier Tier 3 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 4 # of Drugs per Tier Tier 4 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 5 # of Drugs per Tier Tier 6 Preferred Pharmacy Cost Sharing (initial coverage phase)
455 $0.00 1538 $20.00 320 $47.00 249 50% 651 25%

Other Medicare Advantage Plans in Schoharie, New York

Plan Name Type Premium MOOP Rx Deduct. Rating
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UnitedHealthcare Medicare Advantage Patriot (Regional PPO (2023)Regional PPO *$6,700$-
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MVP Medicare WellSelect with Part D (PPO) (2023)Local PPO$7,550$325
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UnitedHealthcare Medicare Advantage Choice Plan 3 (Region (2023)Regional PPO$6,700$275
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UnitedHealthcare Medicare Advantage Choice Plan 4 (Region (2023)Regional PPO$6,700$150
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Aetna Medicare Premier Plan (PPO) (2023)Local PPO$7,550$200
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Aetna Medicare Elite Plan (PPO) (2023)Local PPO$7,550$100
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CDPHP Choice (HMO) (2023)Local HMO *$5,000$-
5
Aetna Medicare Credit Plan (PPO) (2023)Local PPO$7,550$250
5
CDPHP Choice Rx (HMO) (2023)Local HMO$5,000$0
5
CDPHP Value Rx (HMO) (2023)Local HMO$5,800$0
5
CDPHP Vital Rx (PPO) (2023)Local PPO$7,500$350
5
Fidelis Medicare $0 Premium (HMO) (2023)Local HMO$7,550$0
New plan - not yet rated.
MVP Medicare Secure Plus with Part D (HMO-POS) (2023)Local HMO$7,550$0
4
CDPHP Flex Rx (PPO) (2023)Local PPO$5,500$0
5
MVP SmartFund (MSA) (2023)MSA *$-$-
4
CDPHP Basic RX (HMO) (2023)Local HMO$6,700$0
5
Aetna Medicare Eagle Plan (PPO) (2023)Local PPO *$7,550$-
5
CDPHP Flex (PPO) (2023)Local PPO *$5,500$-
5
CDPHP $0 Medicare Rx (HMO) (2023)Local HMO$7,500$300
5
WellCare Today's Options Premier 300 (PFFS) (2023)PFFS *$-$-
5
WellCare Absolute (PPO) (2023)Local PPO$7,550$150
5
MVP Medicare Secure with Part D (HMO-POS) (2023)Local HMO$7,550$150
4
WellCare Summit (PPO) (2023)Local PPO$6,700$445
5
WellCare Today's Options Advantage Plus 150A (PPO) (2023)Local PPO$3,400$0
5
MVP Medicare Preferred Gold without Part D (HMO-POS) (2023)Local HMO *$7,550$-
4
MVP Medicare Preferred Gold with Part D (HMO-POS) (2023)Local HMO$5,800$0
4
WellCare Today's Options Premier Plus 250A (PFFS) (2023)PFFS$-$0
5
Aetna Medicare Value Plan (HMO) (2023)Local HMO$7,550$250
5
Empire MediBlue Access (PPO) (2023)Local PPO$6,200$310
Insufficient data to rate this plan.
WellCare Today's Options Premier Plus 650B (PFFS) (2023)PFFS$-$0
5
WellCare Today's Options Advantage Plus 550B (PPO) (2023)Local PPO$6,700$0
5
WellCare Today's Options Premier 200 (PFFS) (2023)PFFS *$-$-
5
Medicare Advantage Plans by Fidelis Care
Fidelis Medicare $0 Premium (HMO) (2023)Local HMO$7,550$0
New plan - not yet rated.

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