Medicare Advantage & Dual Advantage in NY
Have questions about Medicare Advantage or Dual Advantage health insurance in New York? Wellcare By Fidelis Care can help you understand Medicare coverage options, eligibility, costs, and benefits.
Whether you are new to Medicare, comparing plans for 2027, or eligible for both Medicare and Medicaid, explore the frequently asked questions below. View Medicare Advantage and Dual Advantage plans.
Understanding Medicare Advantage Plans
What is a Medicare Advantage plan?
Medicare Advantage, also called Medicare Part C, is health insurance offered by private companies approved by Medicare. It provides all Medicare Part A (hospital) and Part B (medical) benefits, except hospice care, which Original Medicare continues to cover. Many plans also include Part D prescription drug coverage and additional dental, vision, hearing, or fitness benefits.
Wellcare By Fidelis Care offers Medicare Advantage plans in New York. Explore Medicare Advantage plans in New York.
What is the difference between Original Medicare and Medicare Advantage?
Original Medicare includes Part A and Part B. Medicare Advantage provides these benefits through a Medicare-approved private plan and may offer additional benefits, such as routine dental, vision, hearing, and prescription drug coverage. Unlike Original Medicare, Medicare Advantage plans often use provider networks and have plan-specific copays, coinsurance, and rules for receiving care.
Does Medicare Advantage include prescription drug coverage?
Many Medicare Advantage plans include Medicare Part D prescription drug coverage, but not all do. For 2027, Wellcare Fidelis Assist (Plan 002) and Wellcare Fidelis Simple (Plan 004) include Part D. Wellcare Fidelis Patriot Simple (Plan 010) does not include Part D.
Covered drugs, pharmacy networks, and costs vary. View Medicare formularies and prescription drug resources.
What additional benefits are available with Medicare Advantage plans?
Depending on the plan, benefits may include routine dental care, vision and hearing services, fitness programs, virtual care, and allowances for eligible over-the-counter (OTC) items.
For 2027, Wellcare Fidelis Assist (Plan 002) includes a $13 monthly Wellcare Spendables® allowance, and Wellcare Fidelis Patriot Simple (Plan 010) includes $35 monthly. Eligible purchases and services depend on the plan. Learn about Wellcare Spendables and OTC benefits.
Understanding Dual Advantage Plans
What is a Dual Advantage plan?
Dual Advantage coverage is designed for people eligible for both Medicare and Medicaid, sometimes called dual eligible. Dual Eligible Special Needs Plans (D-SNPs) are Medicare Advantage plans that help coordinate Medicare and Medicaid benefits. Depending on the plan, benefits may include prescription drug coverage, dental, vision, hearing, and care coordination.
Explore Dual Advantage plans in New York.
Who qualifies for a Dual Advantage plan in New York?
Generally, you must have Medicare Parts A and B, qualify for the level of Medicaid required by the plan, live in its service area, and meet its other enrollment requirements. Medicaid eligibility can depend on income, resources, and other factors.
Some plans have additional requirements. Wellcare Fidelis Dual Align Unity (Plan 003), a Medicaid Advantage Plus plan, requires an eligible assessment conducted by an independent nurse evaluator.
What is the difference between Medicare Advantage and Dual Advantage?
Medicare Advantage is for people who qualify for Medicare and meet a plan’s enrollment requirements. Dual Advantage D-SNPs are designed for individuals who qualify for both Medicare and Medicaid. D-SNPs help coordinate coverage across the two programs and may provide additional care management and benefits, depending on eligibility and the plan.
Compare Medicare Advantage and Dual Advantage plans.
Can I have Medicare and Medicaid at the same time?
Yes. People who qualify for both programs can receive Medicare and Medicaid coverage simultaneously. Medicare generally pays first for Medicare-covered services; Medicaid may help with certain remaining costs and services, depending on eligibility. A Dual Advantage plan may help coordinate benefits.
What are the benefits of a Dual Eligible Special Needs Plan (D-SNP)?
Depending on the plan and eligibility, D-SNP benefits may include $0 monthly plan premiums, $0 copays for covered primary care and specialist visits, Part D prescription drug coverage, dental, vision, hearing, OTC allowances, and care coordination. Benefits and cost-sharing vary by plan and Medicaid eligibility.
View 2027 Dual Advantage plan options.
Medicare Costs, Coverage & Benefits
How much do Medicare Advantage plans cost in New York?
Costs vary by plan and may include monthly premiums, deductibles, copays, and coinsurance. Some plans have a $0 monthly plan premium, but you generally must continue paying your Medicare Part B premium unless another program pays it for you.
For 2027, Wellcare Fidelis Assist (Plan 002), Fidelis Simple (Plan 004), and Fidelis Patriot Simple (Plan 010) have $0 monthly plan premiums. Review the plan’s Summary of Benefits for specific costs. Compare plan costs and benefits.
Do Medicare Advantage plans cover dental, vision, and hearing services?
Many plans offer additional routine dental, vision, and hearing benefits. For example, the 2027 Wellcare Fidelis Assist (Plan 002) includes up to $1,000 in routine comprehensive dental coverage per plan year, up to $200 annually for eligible eyewear, and up to $350 per ear annually toward hearing aids, with a maximum of two hearing aids per year. Limits, provider requirements, and member costs vary.
View the 2027 Fidelis Assist Summary of Benefits.
What is the Wellcare Spendables card?
Wellcare Spendables® is a benefit card available with certain Wellcare By Fidelis Care plans. It provides a plan-specific allowance for eligible OTC items and, with some plans, other eligible services. For 2027, monthly amounts include $13 for Fidelis Assist (002), $35 for Fidelis Patriot Simple (010), and $80 for Fidelis Dual Liberty Sync (015).
Eligible purchases and additional benefits depend on the plan; some benefits have special eligibility criteria. Learn how Wellcare Spendables works.
Can I keep my doctor with a Medicare Advantage plan?
You may be able to keep your doctor if they participate in the plan’s provider network. Many HMO plans generally require in-network providers for non-emergency care, subject to coverage rules and exceptions. Certain HMO-POS plans permit specified out-of-network services, sometimes at a higher cost. Confirm your doctors, specialists, and hospitals participate before enrolling.
Are prescription drugs covered under Dual Advantage plans?
Yes. D-SNPs include Medicare Part D prescription drug coverage. Covered medications, pharmacy networks, copays, and restrictions vary by plan. Review the plan’s formulary to check your medications.
Explore Medicare formularies and prescription drug resources.
2027 Wellcare By Fidelis Care Plan Benefits
What Medicare Advantage plans does Wellcare By Fidelis Care offer for 2027?
Wellcare Fidelis Assist (HMO-POS), Plan 002: $0 monthly plan premium, $0 in-network primary care copays, Part D coverage, dental benefits, and a $13 monthly Wellcare Spendables allowance. View the 2027 Summary of Benefits.
Wellcare Fidelis Simple (HMO-POS), Plan 004: $0 monthly plan premium, $0 in-network primary care copays, covered dental services with no annual maximum allowance, and Part D coverage. View the 2027 Summary of Benefits.
Wellcare Fidelis Patriot Simple (HMO-POS), Plan 010: $0 monthly plan premium, $0 in-network primary care copays, up to $2,000 in annual routine comprehensive dental coverage, and a $35 monthly Wellcare Spendables allowance. Part D coverage is not included. View the 2027 Summary of Benefits.
Plan availability varies by service area. Explore Medicare Advantage plans.
What Dual Advantage plans are available for 2027?
Wellcare Fidelis Dual Align Unity (HMO D-SNP), Plan 003: Coordinates Medicare and most Medicaid services for eligible members meeting additional assessment requirements. Includes nurse care management and a $165 monthly OTC allowance. View the 2027 Summary of Benefits.
Wellcare Fidelis Dual Liberty Sync (HMO D-SNP), Plans 014 and 015: Includes coordinated Medicare and Medicaid benefits, $0 copays for covered primary care and specialist visits, Part D coverage, and monthly Wellcare Spendables allowances of $25 (014) or $80 (015). Plan 014 Summary of Benefits | Plan 015 Summary of Benefits.
Wellcare Fidelis Dual Access (HMO D-SNP), Plans 016 and 017: Includes $0 monthly plan premiums, $0 copays for covered primary care and specialist visits, Part D coverage, and additional dental, vision, and hearing benefits. Monthly Wellcare Spendables allowances are $41 (016) or $14 (017). Plan 016 Summary of Benefits | Plan 017 Summary of Benefits.
Eligibility, service areas, and benefits vary. Compare all 2027 Dual Advantage plans.
Medicare Enrollment & Eligibility
When can I enroll in a Medicare Advantage plan?
You can generally enroll in or change Medicare Advantage plans during designated Medicare enrollment periods. The Annual Enrollment Period is October 15 through December 7, with changes generally effective January 1. Other opportunities may include your Initial Enrollment Period, the Medicare Advantage Open Enrollment Period, or a qualifying Special Enrollment Period.
Can I enroll in a Dual Advantage plan at any time?
Some people eligible for both Medicare and Medicaid may qualify for a Special Enrollment Period to join or switch to an eligible integrated D-SNP. Enrollment opportunities depend on the plan, Medicaid eligibility, and Medicare rules. Year-round enrollment is not available for every plan or circumstance.
Explore Dual Advantage eligibility and plans.
How do I choose the right Medicare Advantage or Dual Advantage plan?
Consider your preferred doctors, prescription medications, monthly premium, copays, provider network, dental and vision benefits, and expected health care needs. If you qualify for both Medicare and Medicaid, consider whether a Dual Advantage plan could help coordinate your coverage.
Compare Wellcare By Fidelis Care plans.
Explore Your Medicare Coverage Options
Wellcare By Fidelis Care offers Medicare Advantage and Dual Advantage plans for eligible New York residents. Review your options and official plan documents to learn about coverage, costs, and benefits.
Benefits, costs, eligibility, and plan availability vary. Refer to each plan’s official documents for complete details. Content should be reviewed for Medicare compliance before publication.