Five FIDA Plans Closed in Early 2018

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Choosing healthcare as a senior requires taking a series of complicated actions, especially for those who are “dual eligible”—that is, eligible for both Medicare and Medicaid. You must sign up for Medicare or Medicare Advantage, find a prescription drug plan, and if you need long-term care services, enroll in a managed long-term care (MLTC) plan. These different plans also require filling out and filing different forms and calling different phone numbers, which can confuse anyone. Wouldn’t it be ideal if there were one point of contact for all your medical needs?

New York, among other states, has opted to offer a plan that integrates all of these different healthcare benefits into one integrated plan, called FIDA (for “Fully Integrated Duals Advantage”). Unfortunately, five FIDA plans closed in January 2018, leaving the program in a state of flux. An unexpected close of your plan doesn’t necessarily leave you without medical coverage, but your actions upon receiving notice that your FIDA plan was closing will determine your options. Read on to learn whether you are affected and what to do if you are.

Plans Closing

According to the NY Health Access website, the five Nassau County and New York City plans that closed in early 2018 were:

  • Aetna
  • Fidelis
  • ICS
  • North Shore-LIJ
  • GuildNet (in Nassau County only)

In Nassau County alone, almost half of the 344 FIDA members were enrolled in one of the above plans. In total, 530 people were affected by the closures and should have received notifications in late 2017 warning them of the shutdowns.

What to Do Next

All affected plan participants were given options for choosing different plans, as spelled out in the October 2017 notification sent to them. If they did nothing before the end of the year, then they defaulted into a new plan based on how they originally enrolled in their now-defunct FIDA plan:

  • FIDA participants who had passively enrolled before December 2015 were given until the end of 2017 to pick a new plan. If they didn’t, then they were assigned to a new FIDA plan automatically. An effort was made to retain the same home care agency that their original plan used.
  • If they were not passively enrolled into your FIDA plan, then they had until December 11, 2017, to pick a new plan. If they failed to do so, then they were assigned to a managed long term care (MLTC) plan under Medicaid and sent back to original Medicare as well.

Not Receiving the Same Services?

Transfer to a new plan can cause stress for everybody, especially when they do not receive the same services they once did. If this describes your situation, contact the Independent Consumer Advocacy Network (ICAN) Ombudsprogram. To do so, call (844) 614-8800, or send an email to ican@cssny.org.

Speak With a Elder Law Attorney in New York

Seniors have unique legal needs and require attorneys with extensive experience in the field. If you have a legal issue, you need an advocate in your corner from the very beginning. At Goldfarb Abrandt Salzman & Kutzin LLP, we have represented seniors for several decades and are happy to meet with you. To schedule your consultation, please call (212) 387-8400 or submit our contact form.