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Wellcare Fidelis Assist (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Fidelis Assist (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Fidelis Assist (HMO-POS) in 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Wellcare Fidelis Assist (HMO-POS) is a HMO-POS plan offered by New York Quality Healthcare Corporation available for the 2026 plan year to people living in Select counties in NY. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Wellcare Fidelis Assist (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellcare Fidelis Assist (HMO-POS).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Wellcare Fidelis Assist (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $32.50. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
Health deductible: information not available.
This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $9250.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Wellcare Fidelis Assist (HMO-POS) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay an $18 copay for a one-month supply at preferred pharmacies, while Tier 2 generic drugs carry a $19 copay. Additionally, Tier 6 select care drugs are available with no copay across all pharmacy and mail-order options, and three-month supplies of Tier 1 and Tier 2 drugs also have no copay when using preferred mail order. For higher-tier medications, Tier 3 preferred brand drugs require a 23% coinsurance, and Tier 4 non-preferred drugs have a $100 copay for a one-month supply. Specialty medications in Tier 5 carry a 25% coinsurance for a one-month supply at both preferred and standard pharmacies. Understanding these tier-based copays and coinsurance rates helps you accurately estimate your out-of-pocket prescription costs under this plan.
Additional Benefits
Wellcare Fidelis Assist (HMO-POS) offers comprehensive medical coverage featuring no copay and no coinsurance for primary care doctor visits, annual physicals, and home health services. Specialist consultations, outpatient therapy, and mental health services are highly affordable with a $25 copay and no coinsurance. For emergency care, members pay a $115 copay, which is waived if admitted, while acute inpatient hospital stays require a $475 copay for the first five days and no copay thereafter. In addition to medical care, this plan provides robust wellness benefits, including preventive and comprehensive dental coverage with no copay up to a $1,500 annual limit. Members also enjoy no copay for routine eye and hearing exams, along with a $200 annual allowance for eyewear and up to $500 per ear annually for prescription hearing aids. Essential medical equipment and prosthetics are covered with a 20% coinsurance and no copay, helping keep out-of-pocket costs predictable.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Wellcare Fidelis Assist (HMO-POS) with no coinsurance, requiring a $475 copay for days 1 through 5 of acute stays (no copay for days 6 through 100) and a $400 copay for days 1 through 5 of psychiatric stays (no copay for days 6 through 90). Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered under Wellcare Fidelis Assist (HMO-POS), including outpatient hospital care with no copay and 30% coinsurance, and observation services with a $115 copay and 30% coinsurance. Ambulatory surgical center services require a $300 copay and no coinsurance, outpatient substance abuse sessions carry a $25 copay and no coinsurance, and outpatient blood services are provided with no copay and no coinsurance.
Partial Hospitalization See details
Wellcare Fidelis Assist (HMO-POS) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Wellcare Fidelis Assist (HMO-POS) covers ground and air ambulance services with a $325 copay and no coinsurance per service, requiring prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Wellcare Fidelis Assist (HMO-POS) covers emergency services with a $115 copay and urgently needed services with a $30 copay, both featuring no coinsurance and waived fees if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with a $115 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Fidelis Assist (HMO-POS) covers primary care physician services with no copay and no coinsurance, while specialist, therapy, and mental health visits require a $25 copay and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance for routine care (other chiropractic services are not covered), whereas podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by Wellcare Fidelis Assist (HMO-POS), with annual physicals, fitness benefits, alternative therapies, and remote access technologies available for no copay and no coinsurance. Kidney disease education has no copay and a 20% coinsurance, while glaucoma screenings and diabetes training have no copay and no coinsurance. However, sub-services such as health education, weight management, in-home safety assessments, and therapeutic massage are not covered.
Hearing Services See details
Wellcare Fidelis Assist (HMO-POS) covers Medicare-covered hearing exams for a $25 copay and no coinsurance, while routine exams and fitting evaluations have no copay. Prescription hearing aids are partially covered with no copay or coinsurance up to $500 per ear annually, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Wellcare Fidelis Assist (HMO-POS), as other eye exam services are not covered. Covered benefits, which require prior authorization, include one routine eye exam annually and eyewear up to a $200 yearly limit with no copay, no coinsurance, and no deductible.
Dental Services See details
Wellcare Fidelis Assist (HMO-POS) dental services are partially covered, featuring a $25 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for covered preventive and comprehensive services up to a $1,500 annual maximum. Sub-services that are not covered under this plan include removable prosthodontics, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Wellcare Fidelis Assist (HMO-POS) with no copay and no coinsurance, subject to prior authorization. Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs feature no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Wellcare Fidelis Assist (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Fidelis Assist (HMO-POS) covers medical equipment, including durable medical equipment, prosthetics, and medical supplies, with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Wellcare Fidelis Assist (HMO-POS) covers diagnostic and radiological services with prior authorization, offering lab services with no copay and no coinsurance. Diagnostic procedures and tests have a $0 to $50 copay and no coinsurance, while therapeutic radiology carries a 20% coinsurance and outpatient X-rays require a $50 copay along with coinsurance.
Home Health Services See details
Wellcare Fidelis Assist (HMO-POS) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Wellcare Fidelis Assist (HMO-POS) with no coinsurance. However, some services are not covered, including standard cardiac rehabilitation with a $30 copay, intensive cardiac rehabilitation with a $40 copay, pulmonary rehabilitation with a $25 copay, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) with a $20 copay.
Skilled Nursing Facility (SNF) See details
Wellcare Fidelis Assist (HMO-POS) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 to 20 and days 71 to 100, a $218 copay for days 21 to 70, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Wellcare Fidelis Assist (HMO-POS), which provides acupuncture for up to 12 treatments per year (prior authorization required) and over-the-counter items via reimbursement with no copay and no coinsurance. Meal benefits are not covered under this benefit category.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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