Centene Medicare Advantage Plans New York 2025

Centene Medicare Advantage plans in New York may provide more than just basic Medicare coverage; they are designed to enhance your healthcare experience. With an array of plan options through Fidelis Care, Centene ensures affordability, choice, and comprehensive benefits.

This concise guide outlines key details of the Centene Medicare advantage plans in New York for 2025, the enrollment window, unique health benefits, and support services awaiting New York residents who choose Centene for their Medicare Advantage needs.

 

Key Takeaways

 

 

  • Centene’s Medicare Advantage Prescription Drug plans include Part D coverage and feature a network of preferred pharmacies, ensuring enhanced prescription drug access and cost savings for New York members.

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Exploring Centene’s Medicare Advantage Offerings in New York

 

Centene Medicare Advantage Plans New York 2025, Exploring Centene's Medicare Advantage Offerings in New York

 

Centene, through its subsidiary Fidelis Care, offers Medicare Advantage plans tailored to fit the needs of New Yorkers eligible for Medicare. These plans provide choice and flexibility to meet individual healthcare needs, with benefits that exceed those offered by Medicare Parts A and B.

 

Centene’s Commitment to New York Members

Centene consistently demonstrates its dedication to New York members. With over 2.4 million New Yorkers served through its subsidiary, Fidelis Care, Centene’s commitment to quality and affordable health insurance is evident.

Wellcare By Fidelis Care, Centene’s Medicare brand in New York, provides members with:

  • Affordable access to a network of doctors, nurses, and specialists

 

  • Continuity of care

 

  • Innovative solutions and partnerships to improve health outcomes for Medicare beneficiaries.

 

Plan Variety and Options

Centene provides a wide variety of Medicare Advantage plans in New York, including HMO, PPO, and SNP types. This broad coverage and diverse plan options are demonstrated by Wellcare’s presence in 37 states.

To ensure members have access to appropriate care, Fidelis Care offers a ‘Find a doctor’ tool, which allows members to search for in-network providers by plan type, medical specialty, and location.

 

Enrollment Process and Periods

Medicare Advantage plans, such as those provided by Centene in New York, follow an Annual Election Period from October 15 to December 7. During this time, individuals can join, switch, or drop a plan. Also, the Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31, allows individuals already enrolled to make coverage adjustments.

Occasionally, life events may require enrollment modifications outside of the regular periods. Special Enrollment Periods address this need. They allow for enrollment changes throughout the year due to events that qualify, like relocation or loss of previous insurance coverage, ensuring that your coverage options remain available.

For individuals transitioning from Medicaid to Medicare, a special enrollment period eliminates late enrollment penalties and may even start Medicare coverage retroactively to the day after Medicaid coverage ends.

Throughout the enrollment process, WellCare by Fidelis Care representatives are on standby to offer assistance, ensuring a seamless transition into Centene’s Medicare Advantage plans.

Understanding Dual Special Needs Plans (D-SNP)

 

Centene Medicare Advantage Plans New York 2025, Understanding Dual Special Needs Plans (D-SNP)

 

With healthcare, a one-size-fits-all approach is rarely sufficient. This is where a dual special needs plan (D-SNP) comes in. Designed for individuals eligible for both Medicare and Medicaid, D-SNPs provide a combination of benefits from both programs.

This unique plan requires an enhanced coordination of Medicare and Medicaid benefits compared to other Medicare Advantage plans, focusing on:

  • Improved patient outcomes

 

  • Comprehensive coverage

 

  • Care coordination

 

  • Specialized services

 

In New York, Fidelis Care offers the Medicare Advantage Dual Advantage Flex Plan, designed specifically for individuals dual-eligible for Medicaid and Medicare. These plans usually offer additional benefits not available in traditional Medicare and generally provide these services without charging a premium.

 

Eligibility and Benefits

The benefits of D-SNPs are plentiful, and they are available for enrollment year-round. D-SNPs provide benefits not typically covered by Medicare, such as long-term services and support.

Members enrolled in D-SNPs experience:

  • Seamless coverage between Medicare and Medicaid without coverage gaps

 

  • Little to no out-of-pocket costs

 

  • Additional savings for healthy foods, a unique benefit that comes with D-SNP Medicare Advantage plans.

 

How D-SNPs Enhance Coverage

D-SNPs significantly enhance coverage by integrating Medicare and Medicaid services. One example is FIDE SNPs, the most integrated model, offering coordination of services including Long-Term Services and Support.

These plans establish contracts with state Medicaid programs detailing the provision and coordination of Medicare and Medicaid services, influenced by state requirements to optimize integrated care.

Despite facing alignment issues between Medicare and Medicaid, D-SNPs are continuously evolving. They focus on better care management and network standards to enhance care integration.

Through various models of integration and continuous improvement efforts, D-SNPs strive to offer comprehensive coverage that ensures seamless healthcare experiences for dual-eligible members.

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Navigating Prescription Drug Coverage with Centene

 

Centene Medicare Advantage Plans New York 2025, Navigating Prescription Drug Coverage with Centene

 

Centene’s Medicare Advantage Prescription Drug plans in New York, operated by the Wellcare brand, offer comprehensive care that includes:

  • Dental services

 

  • Hearing services

 

  • Vision services

 

  • Prescription drugs

 

These plans also incorporate Medicare Part D, which significantly enhances prescription drug coverage.

 

The Importance of Formularies

Formularies, lists detailing the drugs covered under a specific health plan, are essential in managing prescription drug coverage. Typically, medications are grouped into cost-based tiers within these formularies.

Formularies are subject to change, but any changes made must meet guidelines set by Medicare to ensure they do not disadvantage plan members. Understanding your plan’s formulary can help you anticipate drug costs, allowing for better financial planning around your healthcare needs.

 

Pharmacy Networks and Accessibility

Members of Centene’s Medicare Advantage Prescription Drug plans have access to a network of preferred pharmacies, which are a key aspect of prescription drug coverage. These pharmacies have agreed to offer certain drugs at reduced costs, resulting in more value for plan members.

Pharmacy networks can change from one year to the next, so it’s important to verify whether your preferred pharmacy is in-network each year. This will help ensure you’re getting the most out of your prescription drug benefits.


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Tailored Services for Individuals and Families

 

Centene Medicare Advantage Plans New York 2025, Tailored Services for Individuals and Families

 

Centene goes beyond basic coverage by offering a range of tailored services for individuals and families. These services include:

  • Preventive care

 

  • Wellness programs

 

  • Chronic disease management support

 

  • Language assistance services

 

This ensures comprehensive family care.

 

Preventive Care and Wellness Programs

Preventive care and wellness programs are integral parts of Centene’s Medicare Advantage plans. These services include:

  • Annual wellness visits

 

  • Cancer screenings

 

  • Vaccinations

 

  • Routine check-ups

 

In addition, the annual flu vaccine is offered to prevent influenza, supporting the overall preventive health strategy.

Centene’s wellness programs cater to a variety of health needs, focusing on both physical fitness and mental well-being. Members can also utilize the Over The Counter (OTC) benefit to obtain necessary items for injury treatment and illness management, adding an aspect of self-care to their wellness routine.

Plus, for members managing chronic conditions, Centene provides a 24/7 nurse advice line, offering valuable guidance on health management and informed care decisions.

 

Chronic Disease Management Support

Managing a chronic disease can be a challenging task. Recognizing this, Centene incorporates behavioral health screenings and comprehensive health assessments into their chronic disease management programs. These services facilitate the effective management of chronic conditions.

In addition to these services, Centene’s approach to chronic disease management includes:

  • Education on self-care to increase patient knowledge and medication adherence for better self-management of health conditions

 

  • Personalized care plans that feature regular monitoring and coordination of care

 

  • Consistent and tailored health management for plan members

The Role of Fidelis Care in Centene’s Network

 

Centene Medicare Advantage Plans New York 2025, The Role of Fidelis Care in Centene's Network

 

Acquired by Centene in 2018, Fidelis Care acts as Centene’s local health plan in New York state. Its robust portfolio of Medicare Advantage plans and a strong healthcare provider network position Fidelis Care as a key player within Centene’s network.

 

Fidelis Care’s Local Impact

Fidelis Care’s significant local presence in New York ensures that its Medicare Advantage plans are designed with a deep understanding of the specific needs of New Yorkers. This local expertise contributes to the value of Centene’s Medicare Advantage offerings by providing region-specific health solutions.

 

Accessing Fidelis Care Resources

Access to resources and plan documents is made easy through the Member Portal on the Fidelis Care website. Here, members can:

  • Manage their healthcare

 

  • Review plan details

 

  • Track claims

 

  • View claims history

 

  • Find healthcare providers.

 

Additionally, Centene plan members can access Fidelis Care’s customer service through a dedicated hotline for assistance with plan details, coverage questions, and other inquiries.

Transitioning from Medicaid to Medicare Advantage

 

Centene Medicare Advantage Plans New York 2025

 

The transition from Medicaid to Medicare can introduce more cost-effective health coverage options for individuals. A special enrollment period ensures that eligible individuals can enroll in Medicare Advantage without facing late penalties.

 

Making the Move: Steps and Considerations

The transition from Medicaid to Medicare should start before reaching age 65. By seeking guidance from the state’s Medicaid office and the Medicare SHIP, individuals can understand their eligibility. It’s important to bear in mind that asset limits for Medicaid and Medicare Savings Programs (MSPs) come into effect at age 65.

A re-evaluation for traditional Medicaid and MSPs can lead to various outcomes, determining the extent of coverage and out-of-pocket expenses upon transitioning to Medicare eligibility. To help navigate this transition, a Medicare broker can provide in-depth knowledge to make informed decisions regarding Medigap, Part D, and Medicare Advantage plans.

 

Continuity of Care Assurance

The transition to Medicare Advantage from expanded Medicaid can significantly improve overall access to affordable healthcare through the health insurance marketplace.

Especially for those previously in the coverage gap, this transition can maintain the continuity of care, ensuring that individuals continue to receive the healthcare they need without interruption. With Medicaid Advantage, individuals can experience a seamless transition in their healthcare journey.

Summary

In conclusion, Centene’s Medicare Advantage plans in New York, offered through WellCare by Fidelis Care, provide comprehensive coverage and tailored services. From the variety of plans to the enhanced coverage of the D-SNPs, Centene’s offerings cater to a wide range of needs.

Prescription drug coverage, preventive care, wellness programs, and chronic disease management support are just some of the services available to members.

With the local expertise of Fidelis Care and the seamless transition from Medicaid to Medicare, Centene is committed to providing quality, affordable healthcare to New Yorkers.

 

Frequently Asked Questions

 

What is the difference between WellCare and Centene?

The main difference between WellCare and Centene is that WellCare is a wholly owned subsidiary of Centene Corporation, with Centene acquiring WellCare in January 2020. This acquisition positioned Centene as a leading healthcare enterprise dedicated to improving community health.

 

What types of Medicare Advantage plans does Centene offer in New York?

Centene offers a range of Medicare Advantage plans in New York, such as HMO, PPO, and SNP plans, available through its subsidiary Fidelis Care. These plans cater to different healthcare needs in the state.

 

What is a Dual Special Needs Plan (D-SNP)?

A Dual Special Needs Plan (D-SNP) is a type of plan for people who are eligible for both Medicare and Medicaid, providing a combination of benefits from both programs and requiring enhanced coordination of these benefits.

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Speak with a licensed insurance agent

1-844-350-0776
TTY 711

Mon-Fri : 8am-9pm ET