Plan ID: H5599-009

What You Need to Know:

  • Fidelis Medicare $0 Premium (HMO) 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 $0, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is .
  • The plan includes an out-of-pocket maximum of $7,550 per year (in-network).
  • Fidelis Medicare $0 Premium (HMO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is .
  • This plan's Part D Initial Coverage Limit is $0.

$0

Monthly Premium

Medicare Plan Features
Monthly Premium: $0
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:
$0 $0 $0 $0 $0 $0 0.0
Gap Coverage: No
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local HMO
Similar Plan: H5599-002
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: NULL
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Rensselaer, 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 Rensselaer, 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 $0.00 $0.00 $0.00
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 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
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 $5.00 1538 $20.00 320 $47.00 249 50% 651 33%

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MVP Medicare WellSelect Plus with Part D (PPO) (2023)Local PPO$6,500$0
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MVP Medicare WellSelect with Part D (PPO) (2023)Local PPO$7,550$325
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MVP Medicare Patriot Plan with Part D (PPO) (2023)Local PPO$7,550$250
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UnitedHealthcare Medicare Advantage Choice Plan 4 (Region (2023)Regional PPO$6,700$150
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HumanaChoice H5970-015 (PPO) (2023)Local PPO$6,500$250
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BlueShield Forever Blue 770 (PPO) (2023)Local PPO$6,700$0
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Aetna Medicare Premier Plan (PPO) (2023)Local PPO$7,550$200
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Humana Honor (PPO) (2023)Local PPO *$4,500$-
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BlueShield Freedom Nation (PPO) (2023)Local PPO$7,550$375
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Humana Gold Plus H3533-013 (HMO) (2023)Local HMO$6,700$275
4
BlueShield Freedom Plus (HMO) (2023)Local HMO$6,700$275
3
Aetna Medicare Elite Plan (PPO) (2023)Local PPO$7,550$100
5
BlueShield Freedom Value (HMO) (2023)Local HMO$7,550$295
3
HumanaChoice H5970-018 (PPO) (2023)Local PPO$7,550$310
4
BlueShield Freedom Premier (HMO) (2023)Local HMO$6,700$100
3
BlueShield Freedom No Rx (HMO) (2023)Local HMO *$6,700$-
3
HumanaChoice H5970-019 (PPO) (2023)Local PPO$5,500$0
4
CDPHP Choice (HMO) (2023)Local HMO *$5,000$-
5
WellCare Value (HMO) (2023)Local HMO$6,700$0
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Aetna Medicare Credit Plan (PPO) (2023)Local PPO$7,550$250
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CDPHP Choice Rx (HMO) (2023)Local HMO$5,000$0
5
Fidelis Medicare Advantage Flex (HMO-POS) (2023)Local HMO$7,550$445
New plan - not yet rated.
CDPHP Vital Rx (PPO) (2023)Local PPO$7,500$350
5
CDPHP Value Rx (HMO) (2023)Local HMO$5,800$0
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EmblemHealth VIP Rx Saver (HMO) (2023)Local HMO$7,550$395
2
CDPHP Basic RX (HMO) (2023)Local HMO$6,700$0
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EmblemHealth VIP Part B Saver (HMO) (2023)Local HMO$7,550$445
2
CDPHP Flex Rx (PPO) (2023)Local PPO$5,500$0
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Aetna Medicare Eagle Plan (PPO) (2023)Local PPO *$7,550$-
5
CDPHP Flex (PPO) (2023)Local PPO *$5,500$-
5
MVP SmartFund (MSA) (2023)MSA *$-$-
4
WellCare Today's Options Premier 300 (PFFS) (2023)PFFS *$-$-
5
EmblemHealth VIP Go (HMO-POS) (2023)Local HMO$7,550$250
2
MVP Medicare Secure with Part D (HMO-POS) (2023)Local HMO$7,550$150
4
CDPHP $0 Medicare Rx (HMO) (2023)Local HMO$7,500$300
5
WellCare Absolute (PPO) (2023)Local PPO$7,550$150
5
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4
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5
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5
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5
MVP Medicare Preferred Gold without Part D (HMO-POS) (2023)Local HMO *$7,550$-
4
Aetna Medicare Value Plan (HMO) (2023)Local HMO$7,550$250
5
BlueShield Senior Blue 652 (HMO) (2023)Local HMO$6,700$0
3
MVP Medicare Preferred Gold with Part D (HMO-POS) (2023)Local HMO$5,800$0
4
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$0
5
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4
WellCare Today's Options Premier 200 (PFFS) (2023)PFFS *$-$-
5
Medicare Advantage Plans by Fidelis Care
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New plan - not yet rated.

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