What does FIDA mean?
FIDA stands for Fully Integrated Duals Advantage. FIDA is designed to better coordinate care for “dual eligibles,” or, in other words, those who receive both Medicare and Medicaid and need long-term care services and supports. New York State is one of 15 states to receive a federal grant to develop this program.
What is Elderplan FIDA Total Care?
Elderplan FIDA Total Care is Elderplan’s version of the FIDA program. Elderplan is authorized by New York State to provide the full set of Medicare and Medicaid benefits you already receive, with four key additions: 1) an expanded network of physicians from which to choose; 2) comprehensive dental coverage that includes dentures, fixed bridges, root canals, and more; 3) transportation to and from medically necessary appointments; and 4) a dedicated Care Manager who will help coordinate the care you need to remain safely in your home. This Care Manager will work with you, your doctor, your home health aide, and, if you choose, your family members or other providers to develop a plan of care specific to your needs in order to help you stay safely at home for as long as possible.
What health care services will be covered under Elderplan FIDA Total Care?
Elderplan FIDA Total Care will cover all of the services you get with Medicare and Medicaid now, but coordinated by your dedicated Care Manager. Dental coverage is expanded to include dentures, fixed bridges, root canals, and other procedures not normally covered by Medicare and/or Medicaid. In addition, the following services, not included in Medicare and/or Medicaid, are also covered: Transportation to and from medically necessary appointments; routine podiatry (foot care); home-delivered meals; and nutrition and wellness counseling.
Will I have a primary care doctor?
Yes. Elderplan FIDA Total Care will make sure that you have a primary care doctor who will work with your Care Manager and other providers in a team to meet your care needs.
Does it cost anything to join Elderplan FIDA?
No. You pay nothing to join or receive care from this plan.
What happens if Elderplan leaves the Medicare program or is no longer available in your service area?
If Elderplan leaves the Medicare program, by contract termination, or is no longer available in your area because of a service area reduction, we will provide you with a termination notice or plan change notice, well in advance. This notice will provide information about Medicare coverage options available to you because of the plan change, including guaranteed Medigap rights.
Whether leaving the plan is your choice or not, you can find more information about your Medicare choices after you leave and the rules that apply in the Participant Handbook.
What is an IDT? What role do they play in my care?
An Interdisciplinary Team (IDT) is a group of people that will get to know your needs and work with you to develop and carry out a Person-Centered Service Plan specific to your needs. Your IDT may include a Care Manager, doctors, service providers, or other health professionals who are there to help you get the care you need.
Can I use doctors outside of Elderplan's network?
If you need care that our plan covers and our network providers cannot give it to you, you can get permission from Elderplan FIDA Total Care or your IDT to get the care from an out-of-network provider. In this situation, we will cover the care as if you got it from a network provider and at no cost to you. The plan will cover emergency care or urgently needed care from an out-of-network provider; this does not require prior authorization. If you need medical care that Medicare or Medicaid requires our plan to cover and the providers in our network cannot provide this care, you can get this care from an out-of-network provider (non-emergent care requires prior authorization). You may also receive kidney dialysis services at a Medicare-certified dialysis facility when you are temporarily outside the plan’s service area. You must contact us to get authorization prior to seeking this care. Please contact Participant Services at 1-855-462-3167 to obtain any necessary prior authorizations.
Remember, when you first join the plan, you can continue seeing the providers you see now during the “transition period.” In most cases, the transition period will last for 90 days or until your Person-Centered Service Plan is finalized and implemented, whichever is later. During the transition period, our Care Manager will contact you to help you find and switch to providers that are in our network. After the transition period, we will no longer pay for your care if you continue to see out-of-network providers, unless Elderplan FIDA Total Care or your IDT has authorized you to continue to see the out-of-network provider.
Please note: If you need to go to an out-of-network provider, please work with Elderplan FIDA Total Care or your IDT to get approval to see an out-of-network provider and to find one that meets applicable Medicare or Medicaid requirements. If you go to an out-of-network provider without first getting Plan or IDT approval, you may have to pay the full cost of the services you get.
Do I need to complete a special form to request services from my FIDA Plan?
To access the services you need please call your FIDA Care Manager directly or our Participant Services Department and we will assist you. Your doctor or your services provider may also make a request for services on your behalf. It is not necessary to submit a specific Elderplan form to request new services or a change to your current services, but based on the type of services or item you are requesting, we may request specific documents from your doctor that are necessary to help us or the Interdisciplinary Team (IDT) make a decision. Your Care Manager will discuss with you the reason why you would like to add or change your services and make a determination if your request reflects a need for your Assessment Nurse to visit you, if we need to meet with your IDT to discuss any changes in your health care needs, or if the Plan is able to authorize your services prior to your next scheduled IDT meeting.
How do I get care during a state of disaster or emergency?
Our plan does not cover urgently needed care or any other care that you get outside the United States.
Getting care during a disaster
If the Governor of your state, the U.S. Secretary of Health and Human Services, or the president of the United States declares a state of disaster or emergency in your geographic area, you are still entitled to care from Elderplan FIDA Total Care.
During a declared disaster, we will allow you to get care from out-of-network providers at no cost to you. If you cannot use a network pharmacy during a declared disaster, you will be able to fill your prescription drugs at an out-of-network pharmacy. Please see Chapter 5: English | Español for more information.
What if you are billed directly for the full cost of services and items covered by Elderplan FIDA Total Care?
Providers should only bill Elderplan FIDA Total Care for the cost of your covered services and items. If a provider sends you a bill instead of sending it to Elderplan FIDA Total Care, you can send it to us to pay. You should not pay the bill yourself. But if you do, Elderplan FIDA Total Care may pay you back.
If you have any questions, please call:
Elderplan FIDA Total Care
8 a.m. to 8 p.m., 7 days a week
The call is free.