FOR BREAKING NEWS VISIT www.qns.com november 3, 2016 • HEALTH • The Queens Courier 41 The Benefits You Care About... Fidelis Care’s Medicare Advantage Plans for 2017 Benefit Original Medicare* Fidelis Medicare Advantage Flex (HMO-POS) Fidelis Medicare $0 Premium (HMO) Monthly Part B Premium** $121.80 $41.00 $0 Flex Benefit None $250 per year None Part B Deductible $166 None None PCP Copay 20% $0 $15 Specialist Copay 20% $25 $45 Outpatient Surgery in a Hospital 20% $350 $350 Outpatient Surgery in an Ambulatory Surgical Center 20% $350 $350 Lab Tests $0 or 20% 20% 20% X-rays 20% $10 $10 Preventive Services $0 $0 $0 MRIs, CT Scans, PET Scans 20% 20% 20% Inpatient Copay $1,288 $350 per day for days 1-5, per admission $350 per day for days 1-5, per admission Part D Prescription Drug Coverage No Yes, with $0 copay for preferred generics $250 deductible Yes, with $0 copay for preferred generics Preventive Dental None Yes Yes *These are 2016 amounts and may change for 2017. **You must continue to pay your Medicare Part B premium. Premiums, copays, coinsurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1 of each year. This information is available for free in other languages. Please contact our Member Services number at 1-800-860-8707 (TTY: 1-800-558-1125). Fidelis Care is a Coordinated Care plan with a Medicare contract and a contract with the New York State Department of Health Medicaid program. Enrollment in Fidelis Care depends on contract renewal. H3328_FC 16143 Accepted It’s easy to join. Call us today! 1-800-860-8707 TTY: 1-800-558-1125 Monday–Sunday, 8:00 a.m.–8:00 p.m. from October 1–February 14 Monday–Friday, 8:00 a.m.–8:00 p.m. from February 15–September 30 www.fideliscare.org
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