FIDA: You Must Opt Out

Beginning in March 2015, if you are Medicare and Medicaid eligible (dual eligible) in Suffolk County, you will receive a notice alerting you of the option to enroll in a FIDA plan.  FIDA stands for Fully Integrated Duals Advantage.  This is a new health coverage program which will allow you to throw away all your health insurance cards and replace them with one FIDA card. FIDA will cover doctor and hospital visits, medicines, and long term care, including home care and nursing home care and will replace Medicare Parts A, B and D and Medicaid.

To be eligible to participate in a FIDA plan you must be 21 years or older, a recipient of Medicare and Medicaid, AND need long term care at home or in a nursing home setting.  These are persons who are currently enrolled in plans for Managed Long Term Care (MLTC).

Despite some positive aspects to FIDA plans, such as no premiums, deductibles or copayments, this is a demonstration program, the mechanisms of which are not yet tested.  As with any demonstration program, there is likely to be growing pains as the system works itself out.  The goal of the program is coordinated care but it is too early to tell what the actual impact on participants will be.

The notice being sent by the State does not include some very critical pieces of information about the FIDA system, including:

  • You can opt out of FIDA
  • If you do not opt out, you will be passively enrolled
  • FIDA is not completely free, you will still owe your Medicaid spend-down if you have one
  • All care received must be “in-network”
  • Prescription drugs must be on the FIDA plan’s formulary

While the notice will be sent to Suffolk County residents in March 2015, passive enrollment will not occur in Suffolk County until July 2015.  This means that in order to maintain your current methods of coverage, you must opt out of FIDA before July 2015.  You will be able to opt out by calling the phone number provided in the notice.

If you are eligible for FIDA, it is imperative that you make an educated decision regarding enrollment.  The decision should take into account your current coverage, whether you have retiree health coverage and if you are currently paying for a Medicare Supplement policy.  If you or a loved one are currently enrolled in a MLTC plan, you are eligible for FIDA and should keep watch for the notice in March.  Once you receive the notice, remember that you have to go through the process of opting out to avoid passive enrollment.  Make sure to review all the options and ramifications with a family member or trusted Elder Law attorney to assist you in making the decision.

- Nancy Burner, Esq.

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