Health insurance can be confusing, especially when trying to choose between different plans like MetroPlus and Fidelis in New York.
This comprehensive guide examines the key features, pros and cons of MetroPlus and Fidelis to help you determine which may be better for your needs.
A Brief Comparison Table
| Features | MetroPlus | Fidelis |
| Coverage Area | New York City only | All 62 counties in NYS |
| Plans Offered | Medicaid, Child Health Plus, Essential Plan | Medicaid, Child Health Plus, Essential Plan, Qualified Health Plans |
| Provider Network | 42,000+ providers, 70 hospitals/clinics in NYC | 69,000+ providers, 180 hospitals across NYS |
| Referrals | Not required for specialist visits | Required for some plans |
| Extra Benefits | $100 gym reimbursement, cell phone minutes, help with NYC social services | YMCA/Weight Watchers membership, massage discounts, assisted reproductive benefits |
| Enrollment | Through NY State of Health or NYC HRA | Through NY State of Health |
| Cost | $0 premium plans available | $0 premium plans available |
| Customer Service | Can be long wait times | Generally good reputation |
| Best For | New York City residents, especially on Medicaid/Essential Plan | Statewide coverage, middle income customers |
Overview of MetroPlus And Fidelis
MetroPlus Health Plan is a New York Medicaid managed care plan owned by NYC Health + Hospitals. It serves over 500,000 members across New York City’s five boroughs.
Fidelis Care is a New York State Catholic Health Plan offering affordable health insurance to qualifying individuals and families. Fidelis serves over 1.7 million members across New York State.
Both MetroPlus and Fidelis offer Medicaid, Child Health Plus, Essential Plan, and Qualified Health Plans on the NY State of Health Marketplace. They contract with many of the same doctors and facilities in New York.
MetroPlus Health Plan Overview
MetroPlus is one of the largest Medicaid providers in New York City.
Key features include:
- Available to New York City residents on Medicaid, Child Health Plus, and the Essential Plan.
- No referrals needed to see specialists.
- Members can choose from over 42,000 participating providers and 70 hospitals and clinics in all 5 NYC boroughs.
- Extra benefits like gym membership reimbursement, cell phone minutes, and assistance connecting to social services.
MetroPlus Pros
- Large NYC provider network.
- No referrals required for specialist visits.
- Extra benefits tailored for the NYC area.
MetroPlus Cons
- Only available to New York City residents.
- More limited provider network outside of the five boroughs.
- Doesn’t offer plans on the NY Health Exchange outside of the Essential Plan.
Fidelis Care Health Plan Overview
Fidelis Care is a statewide health plan providing coverage both on Medicaid and the NY Health Exchange.
Key features include:
- Available in all 62 counties of New York State.
- Provides Medicaid, Child Health Plus, Essential Plan and Qualified Health Plans.
- Access to over 69,000 providers and 180 hospitals across NYS.
- Partners with Catholic Medical Partners for additional medical facilities.
Fidelis Pros
- Broad provider network across New York State.
- Offers plans on the NY Health Exchange.
- Access to Catholic Health Partners medical facilities.
Fidelis Cons
- Requires referrals to see specialists.
- Slightly smaller provider network in the NYC area compared to MetroPlus.
- Doesn’t offer some of the extra MetroPlus benefits like cell phone minutes.
Also Read: Comparison Between Quotacy And Policygenius
Comparing Plan Benefits
When it comes to covered services, MetroPlus and Fidelis offer fairly comparable benefits. Both provide all of the Essential Health Benefits required by the Affordable Care Act, including:
- Ambulatory services (outpatient care)
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitative and habilitative services (occupational, physical and speech therapy)
- Laboratory services
- Preventive care and chronic disease management
- Pediatric services, including dental and vision care
The main differences are in supplemental benefits offered:
MetroPlus Extra Benefits
- $100 reimbursement for health club membership
- Up to 1,000 cell phone minutes
- Help connecting to NYC social services
Fidelis Extra Benefits
- YMCA or Weight Watchers membership
- Discounts on services like massage therapy and acupuncture
- Assisted reproductive technology financial assistance
So, in terms of covered services, the plans are quite similar. The choice may come down to the provider network, extra benefits and which plans you qualify for based on eligibility.
Also Read: Comparison Between Healthfirst And UnitedHealthcare.
Eligibility And Enrollment
Eligibility and how to enroll for MetroPlus Vs. Fidelis depends on what type of plan you are applying for:
Medicaid and Child Health Plus
Both MetroPlus and Fidelis accept Medicaid and Child Health Plus. To qualify for Medicaid in New York, you must be a resident and meet income limits based on family size. Child Health Plus covers uninsured children up to age 19 in families who exceed Medicaid income levels but can’t afford private coverage.
You can enroll in Medicaid or Child Health Plus through the NY State of Health Marketplace website, by phone or in person.
Essential Plan
The Essential Plan provides affordable coverage for low to moderate income residents who earn too much for Medicaid. Only MetroPlus offers the Essential Plan in New York City. Fidelis offers it in all other New York counties.
To qualify for the Essential Plan you must:
- Reside in NY State
- Be a citizen or lawfully present immigrant
- Not be eligible for Medicaid
- Earn less than $25,760 for an individual or $53,040 for a family of four
You can enroll online through the NY State of Health marketplace.
Qualified Health Plans
To purchase qualified health insurance plans on the NY marketplace you must be a New York resident but there are no income limits. Fidelis offers plans both On and Off the marketplace but MetroPlus does not offer QHPs.
Enrollment is done online through NY State of Health or directly with the carrier if purchasing an Off-exchange plan. Open enrollment is once per year but special enrollment is available for qualifying life events like losing other coverage.
Cost Of Coverage
The amount you’ll pay for MetroPlus Vs. Fidelis depends on your household income and the type of plan:
Medicaid – Free for those who qualify
Child Health Plus – $0 to $9 per child per month
Essential Plan – $0 to $20 per person per month
Qualified Health Plans – Varies, financial assistance available based on income
Both MetroPlus and Fidelis also offer some plans with $0 premiums and low out of pocket costs through the NY State of Health marketplace.
Be sure to use the marketplace Shop and Compare tool to see the full premium and cost-sharing estimates based on your situation.
Choosing The Right Plan
When deciding between MetroPlus and Fidelis, some key factors to consider:
- Coverage Area – MetroPlus is only available in the 5 boroughs. Fidelis covers all of NY State.
- Provider Network – Make sure your doctors participate. Both have large networks but MetroPlus may offer better access within the 5 boroughs.
- Plan Offerings – Fidelis offers QHPs on the marketplace; MetroPlus does not outside of NYC.
- Medicaid Managed Care – Both offer Medicaid but MetroPlus may have shorter wait times in NYC.
- Extra Benefits – Compare perks like gym reimbursement offered.
- Cost – Check if you qualify for $0 premium plans or financial assistance.
- Customer Service – Ask trusted sources about their member experience.
No matter which plan you choose, be sure to review details on the provider network, prescription drug coverage and estimated pricing for your situation. This can prevent surprises after enrollment.
Watch the video of MetroPlus!
Frequently Asked Questions (FAQ)
Yes, MetroPlus generally provides good, affordable coverage, especially for New York City residents on Medicaid or the Essential Plan. Members have access to a large provider network within the 5 boroughs and extra benefits that make sense for city living.
The “best” health insurance depends on your location, medical needs, budget and plan eligibility. Top options in NY include MetroPlus in NYC, Fidelis, Healthfirst, Oscar, EmblemHealth, BlueCross BlueShield (BCBS) plans and more.
Compare features like provider access, prescription coverage and costs to choose what’s best for you. Those with low incomes may find the most affordable plans through Medicaid, Child Health Plus or the Essential Plan.
Yes, MetroPlus is one of the Medicaid managed care providers you can choose if eligible for Medicaid in New York City. It participates in Medicaid, Medicaid Advantage Plus, Medicaid Choice, HARP and MAP plans.
Yes, Fidelis coverage is only available to residents of New York State. However, they provide coverage in all 62 counties of NY through Medicaid, Child Health Plus, the Essential Plan and Qualified Health Plans.
Also Read: Comparison Between Fidelis Care And Excellus BCBS.
Conclusion
So, in summary, MetroPlus and Fidelis both offer quality health insurance options for New Yorkers on Medicaid or seeking affordable plans through the NY Health marketplace. Consider your location, healthcare needs, and budget to decide if MetroPlus or Fidelis better fits your situation. Analyze plan specifics carefully before enrolling to ensure you select the right coverage.
