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PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan) in 2025, please refer to our full plan details page.
PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan) is a Medicare-Medicaid Plan plan offered by PHSI, Inc. available for enrollment in 2025 to people living in Counties: Ki, Qu, Brx, NY, Ri, Wes, Suf, Na, Rck. The overall rating for this plan is not yet available for 2025.
It's important to know that PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan)is a Medicare-Medicaide (MMP) plan. This means you can only enroll in this plan if you meet specific criteria for both medicare and medicaid. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan).
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 PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
We don't have information on the Maximum Out-Of-Pocket cost for this plan. You can call our licensed insurance specialists by clicking "Call to Enroll" below for more information.
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:
Sign up for PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The PHP Care Complete FIDA-IDD Plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. If you qualify for the low-income subsidy (LIS), you will pay $0.00 for Part D drugs. After your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000. Once you reach that amount, you will enter the next coverage phase.
Additional Benefits
The PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan) offers a range of covered services. Many services, like ambulance, emergency, and home health services, have no copay. The plan also includes coverage for primary care, hearing, vision, dental, and home infusion services, along with other services. This plan provides comprehensive coverage with some limitations. While the plan covers inpatient and outpatient services, it does not cover some services, such as upgrades for inpatient hospital and certain outpatient services.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute and Psychiatric are covered, as is Non-Medicare-covered Stay for Inpatient Hospital-Acute and Psychiatric. Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services, are covered by the PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan). Outpatient substance abuse services are partially covered, as individual and group sessions are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. There is no information about the cost of this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no copay and no coinsurance. However, ground and air ambulance services are not covered, and transportation services to a plan-approved health-related location are also not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan), with no copay or coinsurance for Emergency Services and Urgently Needed Services. Worldwide Emergency Services is not covered, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The PHP Care Complete FIDA-IDD Plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, podiatry services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services and podiatry services require prior authorization, and podiatry services cover up to 4 visits per year. Mental health specialty services, and individual and group sessions for psychiatric services are not covered.
Preventive Services See details
Preventive services are covered, with some services not covered including annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, home and bathroom safety devices and modifications, and counseling services. The plan also covers health education, adult day health services, nutritional/dietary benefits, telemonitoring services, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit.
Hearing Services See details
Hearing Services include coverage for routine hearing exams and fitting/evaluation for hearing aids, with no copay or coinsurance. Prescription hearing aids are covered, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams, contact lenses, and eyeglasses (lenses and frames), and are covered with no deductible. Routine eye exams are limited to one exam every two years. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, including oral exams, dental x-rays, prophylaxis (cleaning), restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, and oral and maxillofacial surgery. However, fluoride treatment, adjunctive general services, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, with prior authorization required. Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered by the PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan). There is no copay or coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered by the PHP Care Complete FIDA-IDD Plan with no copay and no coinsurance, although Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. Other 1 for Durable Medical Equipment (Environmental Modifications, Adaptive Devices) and Other 2 for Durable Medical Equipment (Assistive Technology) are covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but some services are not covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, and there is no copay.
Home Health Services See details
Home Health Services are covered by the PHP Care Complete FIDA-IDD Plan, with no copay or coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, with a limit of 36 visits over 12-18 weeks, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, including additional days beyond Medicare-covered and non-Medicare-covered stays. There is no cost sharing on the day of discharge, and additional days beyond Medicare-covered are unlimited.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items, Meal Benefit, Other 1, Other 2, Other 3, Other 4, Other 5, Other 6, Other 7, Other 8, Other 9, Other 10, Other 11, Other 12, Other 13, Other 14, Other 15, Other 16, Other 17, Other 18, Other 19, Other 20, Other 21, Other 22, Other 23, Other 24, Other 25, Other 26, and Other 27. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, Self-Directed Personal Assistance Services, and Respiratory Care Services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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