2023 PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan)
PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan) H9869-001 is a 2023 Medicare Advantage Plan or Part-C by Partners Health Plan available to residents in New York. This plan includes extra prescription drug (Part-D) coverage. Partners Health Plan PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $- (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay
$- out-of-pocket. This can be an extremely nice safety net.
Partners Health Plan works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan) you still retain Original Medicare. But you will get extra Part A (Hospital Insurance)
and Part B (Medical Insurance) coverage from Partners Health Plan and not Original Medicare. With 2023 Medicare Advantage Plan you are always covered for urgently needed and emergency care. Plus, you receive all
the benefits of Original Medicare from Partners Health Plan except hospice care. Original Medicare still provides you with hospice care if you sign up for
Medicare Advantage in New York.
What type of plan is PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan)
How much does PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan) cost?
Monthly Premium
A monthly premium is the fee you pay to the plan in exchange for coverage. Partners Health Plan charges a $0 consolidated premium. The Part C premium is this charge covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
Part-D Deductible and Premium
An annual deductible is the amount you pay out-of-pocket for your prescription drugs before your plan begins to pay. PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan) has a monthly drug premium of $0 and a $0 drug deductible. This Partners Health Plan plan offers a $0 Part-D Basic Premium that is Not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0. This Premium covers any enhanced plan benefits offered by Partners Health Plan above and beyond the standard PDP benefits. This can include extra coverage in the gap, lower co-payments, and coverage of non-Part D drugs. The Part D Total Premium is $0. The Part D Total Premium is the addition of supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.
Partners Health Plan Gap Coverage
In 2023 once you and your plan provider have spent $4660 on covered drugs. (Combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers extra coverage. This Partners Health Plan plan does offer extra coverage through the gap.
Formulary and Drug Coverage
PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers.
By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.
The benefit information provided is a summary of what PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Partners Health Plan helps
get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.
Physical therapy and speech and language therapy visit
Rehabilitation services
$0 copay
Cleaning
Preventive dental
$0 copay
Dental x-ray(s)
Preventive dental
$0 copay
Fluoride treatment
Preventive dental
Not covered
Oral exam
Preventive dental
$0 copay
Preventive care
$0 copay
Outpatient hospital coverage
$0 copay
In-Network Other health plan deductibles?
No
Optional supplemental benefits
No
Inpatient hospital - psychiatric
Mental health services
$0 copay
Outpatient group therapy visit
Mental health services
$0 copay
Outpatient group therapy visit with a psychiatrist
Mental health services
$0 copay
Outpatient individual therapy visit
Mental health services
$0 copay
Outpatient individual therapy visit with a psychiatrist
Mental health services
$0 copay
Chemotherapy
Medicare Part B drugs
$0 copay
Other Part B drugs
Medicare Part B drugs
$0 copay
Diabetes supplies
Medical equipment/supplies
$0 copay
Durable medical equipment (e.g., wheelchairs, oxygen)
Medical equipment/supplies
$0 copay
Prosthetics (e.g., braces, artificial limbs)
Medical equipment/supplies
$0 copay
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
Not Applicable
Inpatient hospital coverage
$0 copay
Fitting/evaluation
Hearing
$0 copay
Hearing aids
Hearing
$0 copay
Hearing exam
Hearing
$0 copay
Health plan deductible
$0
Ground ambulance
$0 copay
Foot exams and treatment
Foot care (podiatry services)
$0 copay
Routine foot care
Foot care (podiatry services)
$0 copay
Emergency
Emergency care/Urgent care
$0 copay
Urgent care
Emergency care/Urgent care
$0 copay
Primary
Doctor visits
$0 copay
Specialist
Doctor visits
$0 copay
Diagnostic radiology services (e.g., MRI)
Diagnostic procedures/lab services/imaging
$0 copay
Diagnostic tests and procedures
Diagnostic procedures/lab services/imaging
$0 copay
Lab services
Diagnostic procedures/lab services/imaging
$0 copay
Outpatient x-rays
Diagnostic procedures/lab services/imaging
$0 copay
Diagnostic services
Comprehensive dental
$0 copay
Endodontics
Comprehensive dental
$0 copay
Extractions
Comprehensive dental
$0 copay
Non-routine services
Comprehensive dental
$0 copay
Periodontics
Comprehensive dental
$0 copay
Prosthodontics, other oral/maxillofacial surgery, other services
Comprehensive dental
$0 copay
Restorative services
Comprehensive dental
$0 copay
In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
No
Coverage Area
(Click county or state to compare all available Advantage plans)
The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan) requires you to live in that plan’s service area. The service area is listed below:
How much does PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan) cost?
Partners Health Plan charges a $0 consolidated monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage of Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
How much is PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan) MOOP?
The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan) by Partners Health Plan MOOP is $-. Once you spend $- you will pay nothing for Part A or Part B covered services.
What type of plan is PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan)?
Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer extra cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit.
Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.
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Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. Enrollment depends on the plan’s contract renewal.
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