The Complete Guide to Medicaid, MetroPlus, and Fidelis Coverage at Moses Medical

Navigating Medicaid in New York should not require a law degree. But between fee-for-service plans, managed care organizations, prior authorizations, plan rules, and a dozen different carrier names, it is no wonder that patients in the Bronx sometimes avoid care altogether — not because they lack coverage, but because they cannot figure out what their coverage actually does.

At Moses Medical, we accept MetroPlus, Fidelis Care, Amerigroup, and WellCare, along with several other Medicaid managed care plans, Medicare, and a number of commercial plans. This guide answers common front desk questions: What does my plan cover? What does my plan require first? Will this visit cost me anything?

Medicaid Fee-for-Service vs. Managed Care: What’s the Difference?

Medicaid Fee-for-Service (FFS) is “straight Medicaid” — the state pays your providers directly for each service. You can see any provider who accepts Medicaid. This is less common today; most New York Medicaid recipients are enrolled in managed care.

Medicaid Managed Care means you are enrolled in a specific health plan that manages your Medicaid benefits. In the Bronx, the most common managed care plans are:

• MetroPlus Health Plan — NYC’s public health plan, administered by NYC Health + Hospitals
• Fidelis Care — one of the largest Medicaid managed care plans in New York State
• Amerigroup — an Anthem subsidiary with a strong Bronx network
• WellCare of New York — part of Centene, growing rapidly in the city
• Molina Healthcare — another large Medicaid managed care plan in New York
• United Healthcare Community Plan — UHC’s Medicaid product

Moses Medical is an in-network provider for all of these plans. We also accept Affinity Health Plan and Hamaspik Choice.

What Medicaid Managed Care Covers

Regardless of which managed care plan you have, New York Medicaid provides comprehensive coverage that includes:

• Primary care visits — routine checkups, sick visits, preventive screenings
• Specialist visits — cardiology, dermatology, mental health, wound care, and more
• Prescription medications — covered through the plan’s formulary (brand and generic options vary)
• Lab work and diagnostics — blood tests, imaging, EKGs
• Mental health services — therapy, psychiatric evaluation, medication management
• Preventive care — vaccinations, cancer screenings, annual wellness exams
• Emergency room visits — at any hospital, regardless of network
• PrEP and HIV prevention services — at zero cost
• Prenatal and maternity care
• Dental and vision — through separate carved-out plans in some cases
• Medical equipment and supplies — wheelchairs, glucose monitors, wound care supplies

The cost to you for in-network covered services is zero. No copay. No deductible. No coinsurance. This is true for MetroPlus, Fidelis, and all other Medicaid managed care plans.

Plan Rules: The Part That Trips People Up

This is where managed care plans differ from one another — and where patients most often get stuck.

MetroPlus Medicaid HMO: Requires primary care provider (PCP) approval for most specialist visits. Your PCP submits the request to MetroPlus, and MetroPlus must authorize it before the specialist visit takes place. If you come to Moses Medical for primary care, we handle that paperwork and submit it for you.

Fidelis Care Medicaid Managed Care: Also requires PCP approval for specialist visits. Fidelis uses a prior authorization system for certain services, including advanced imaging (MRI, CT), some surgical procedures, and certain medications. Approval processing typically takes 3-5 business days.

Amerigroup Medicaid: Requires PCP approval for specialist care. Their authorization system is phone-based and generally responsive.

Important: Some services need no plan approval under any Medicaid managed care plan. These include mental health visits, OB/GYN visits, family planning services, and emergency care. You can book a mental health appointment or a PrEP consultation at Moses Medical directly.

How We Verify Your Coverage

At Moses Medical, we verify insurance eligibility before every visit. Here is the process:

1. When you schedule. Call (646) 741-2111 and share your plan name. The office can tell you what information is needed to review your specific coverage before the visit.

2. When you arrive. Bring your insurance card and a valid photo ID. We will verify your information again at check-in. If there is any discrepancy, we resolve it before your visit — not after.

3. If your plan needs approval first. If your plan requires approval before a specialist visit, our team handles the request with your PCP’s office. If your PCP is at Moses Medical, it can often be completed during the same visit.

4. If prior authorization is needed. For services like advanced imaging, genetic testing, or certain medications, our team handles the prior authorization process. We know the documentation each plan requires, and we submit on your behalf. You should not have to call your insurance company yourself for a prior auth. Your plan decides the outcome, and we will tell you what it says and what the options are if a request is denied.

Services Covered Under Medicaid at Moses Medical

Here is a straightforward list of what New York Medicaid generally covers. Ask your plan whether a specific visit is covered before you come in:

Service	Covered?	Plan approval?
Primary care visit	Yes, $0	No
Chronic condition follow-up	Yes, $0	Varies by plan
Dermatology	Yes, $0	Usually
Mental health	Yes, $0	No — learn more
Wound care	Yes, $0	Usually
PrEP consultation	Yes, $0	No — learn more
Lab work (on-site)	Yes, $0	No
IV therapy	Not typically covered	N/A — self-pay

What Is NOT Covered — And What To Do About It

Medicaid does not cover everything. Services generally excluded include:

• IV vitamin therapy — generally considered wellness, not medically necessary, and paid out-of-pocket
• Over-the-counter supplements and vitamins

For self-pay services, Moses Medical reviews pricing before care begins so you can decide how to proceed.

What If You Do Not Have Insurance?

If you are uninsured, you may qualify for Medicaid and not know it. New York’s income eligibility threshold for adults is 138% of the federal poverty level, and for children it is even higher. Undocumented immigrants in New York may qualify for Emergency Medicaid or for coverage under the state’s coverage expansion programs.

Our front desk team can help you figure out whether you may be eligible and, if appropriate, point you toward an enrollment counselor. If you are new to the practice, our first visit guide explains what to bring and what to expect.

Switching Plans

If you are enrolled in a Medicaid managed care plan that does not include Moses Medical in its network (rare, but possible), you can request a plan change during the open enrollment period or within 90 days of your initial enrollment. You can also change plans if you move, lose your current PCP, or experience certain qualifying life events.

The New York State of Health marketplace can be reached at 1-855-355-5777 for assistance with plan changes.

The Bottom Line

Your Medicaid card is not a lesser form of insurance. It provides real, comprehensive coverage for real medical care. At Moses Medical, we treat Medicaid patients with the same thoroughness, the same quality, and the same respect as any other patient — because that is the standard, not the exception.

If you have questions about your specific plan, need help understanding your plan’s rules, or want to verify your coverage before an appointment, call us at (646) 741-2111. We are at 871B Westchester Ave, Bronx, NY 10459, open Monday through Friday 9 AM to 5 PM.