Fidelis Medicaid Advantage Plus (HMO) is for individuals who have Medicare and Medicaid coverage and have a chronic illness or disability. They must require health and long-term care services and may be in need of nursing home level of care. Enrollment is voluntary.
Enrollment in the program includes coverage for all of your Medicare and most of your Medicaid services.
Every member has his or her own unique care plan that is coordinated by a Care manager. The Care Manager is a healthcare professional - usually a nurse or social worker.
Her or she will oversee care, make appointments and arrange for transportation, and coordinate all services with the member, the member's family, the primary care provider (PCP), and other medical and community-based care providers and caregivers.
*Covered Services Include:
- Primary care physician office visits
- Specialty care physician office visits
- Inpatient hospital care (including substance abuse and rehabilitation services)
- Inpatient mental health
- Skilled nursing facility
- Home health care
- Medical social services
- Adult day health care
- Social day care
- Home delivered and congregate meals
- Personal emergency response services
- Chiropractic care
- Outpatient surgery
- Ambulance service
- Diagnostic testing
- Emergency room care
- Urgent care
- Outpatient rehabilitation (OT, PT, Speech)
- Durable medical equipment (DME)
- Diabetes monitoring
- Preventive screenings such as mammograms, colo-rectal cancer, cervical cancer, prostate cancer, and bone mass measurement
- Hearing services
- Vision care services
- Medicare Part D Prescription Drug benefits
- Personal care services
- Transportation - non emergency
- Private duty nursing
*Not all covered services are listed