Is Fidelis Medicare or Medicaid?

Fidelis Care is a health insurance company that offers both Medicare plans and Medicaid plans to residents of New York State. However, Fidelis Care is more well-known for its Medicaid plans.

Overview of Fidelis Care

Fidelis Care is a health insurance provider owned by Centene Corporation. Key facts about Fidelis Care include:

  • Provides health insurance coverage to over 2.5 million members in New York.

  • Offers Medicaid, Medicare, Child Health Plus, and Qualified Health Plans.

  • Has a statewide network of over 80,000 healthcare providers and facilities.

  • Provides coverage in all 62 counties of New York State.

  • Headquartered in Queens, NY and operates over 70 community offices across the state.

Fidelis Medicaid Plans

Fidelis Care is one of the largest Medicaid managed care organizations in New York. The company focuses heavily on providing Medicaid insurance plans in the state.

Some of the key Medicaid plans offered by Fidelis include:

  • Medicaid Managed Care – Provides comprehensive health coverage to eligible low-income children and adults. Includes physical health, behavioral health and prescription drug benefits.

  • Child Health Plus – Covers uninsured children under age 19 in families who earn too much for Medicaid but cannot afford other health coverage.

  • Essential Plan – Offers free or low-cost coverage for eligible lower-income New Yorkers who are aged 19-64 and do not qualify for Medicaid.

  • Health and Recovery Plan (HARP) – Manages care for Medicaid enrollees with significant behavioral health needs. Integrates physical health, mental health and substance use services.

  • Medicaid Advantage Plus – Dual advantage plan for those with both Medicaid and Medicare coverage. Combines all benefits into one coordinated plan.

Clearly, Fidelis has a strong focus on serving Medicaid populations, from lower-income children and adults to those with disabilities. This makes them one of the predominant Medicaid insurance providers statewide.

Fidelis Medicare Plans

While best known for Medicaid, Fidelis Care does also offer Medicare Advantage plans. These include:

  • Medicare Advantage – Medicare managed care plans that provide all Original Medicare Part A and Part B benefits. Some also cover Part D prescriptions.

  • Special Needs Plans (SNPs) – Medicare Advantage plans focused on people with specific diseases, dual eligibility, or chronic conditions. Fidelis offers several D-SNPs.

  • Medicare-Medicaid Plans (MMPs) – Coordinate Medicare and Medicaid benefits for dual eligible members.

However, Fidelis Medicare plans have much lower enrollment compared to competitors like UnitedHealthcare, Humana and BlueCross BlueShield plans in New York. Fidelis focuses heavily on Medicaid while other insurers have broader Medicare penetration.

Why Fidelis Leads in Medicaid

There are several reasons why Fidelis Care is so highly regarded for Medicaid coverage compared to its Medicare presence:

  • Deep community relationships – Fidelis Care has strong ties with community organizations and providers focused on Medicaid populations across New York.

  • Specialized programs – Fidelis Medicaid plans offer specialized benefits, care coordination and support services tailored to the needs of the populations they serve.

  • Mission-driven focus – As a company, Fidelis Care has a mission centered on providing high-quality accessible coverage to underserved New Yorkers relying on Medicaid.

  • Experience with state contracting – Successfully bidding for and managing statewide Medicaid contracts requires capabilities that Fidelis Care has invested in and excelled at compared to commercial insurers.

  • Provider network development – Building robust provider networks that serve Medicaid members well is a strength of Fidelis Care.

Choosing Between Fidelis Medicare or Medicaid

If you are eligible for either Medicare or Medicaid coverage, choosing between Fidelis Care’s Medicare plans vs. Medicaid plans depends on your specific situation:

  • Do you qualify for Medicaid based on income and asset limits? Medicaid may offer more affordable or free coverage.

  • Do you have complex health needs? Fidelis Medicaid plans include strong supplemental benefits and care coordination.

  • How large is the Medicare provider network you need? Medicare networks may be more limited than competitors.

  • Are you dually eligible for Medicaid and Medicare? Fidelis Medicaid Advantage Plus plan combines both benefits.

  • Is Medicaid eligibility time-limited? Enrolling in Medicare may provide more continuous coverage.

  • Are dependents or family members also enrolling? Look at family plan options and costs for both programs.

Speaking to a licensed insurance agent or broker in New York can help you understand the costs, providers, benefits and eligibility considerations when choosing between Fidelis Care for Medicare or Medicaid coverage.


Key Facts About Fidelis Medicare vs. Medicaid

Medicaid Key Facts

  • Covers over 2 million New Yorkers

  • Includes Child Health Plus, Medicaid Managed Care, Essential Plan

  • Focus on lower-income children, adults, people with disabilities

  • Strong care coordination and community engagement

Medicare Key Facts

  • Much lower enrollment than other NY Medicare insurers

  • Offers Medicare Advantage and D-SNP plans

  • Part D prescription drug coverage

  • More limited Medicare provider network than competitors



Is Fidelis Care considered Medicare?

It is considered part of Original Medicare, the traditional program offered through the federal government. Medicare Part B (medical insurance) covers certain doctors’ services, outpatient care, medical supplies, and preventive services. It is also considered part of Original Medicare.

Is Fidelis Care NY Medicaid?

Prescription and non-prescription drugs (Effective April 1, 2023, members enrolled in Fidelis Care Medicaid Managed Care will receive their pharmacy benefits through NYRx, the Medicaid Fee-for-Service (FFS) Pharmacy Program.) Emergency room and ambulance services. Hospital and outpatient care. Behavioral health …

What’s the difference between Medicaid and Medicare in New York State?

The services covered by these two programs overlap, so you may not need to apply for both. The most significant difference is that Medicaid pays for a broader range of long-term health care. Medicare Part A pays for medically necessary hospital treatment, skilled nursing home, skilled home health, and hospice care.

Is Fidelis an insurance?

health insurance. Fidelis Care offers coverage for children and adults of all ages and at all stages of life.

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