Currently on fidelis medicaid- how to switch to private?

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Forum -> Inquiries & Offers -> New York related Inquiries

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amother

Tue, Jan 23 2024, 9:47 pm

My provider stopped taking fidelis, now only United. How do I make this switch, how does it work? Not familiar with private insurance.
Thank you!

amother

Rainbow

Tue, Jan 23 2024, 9:48 pm

I did with my social worker , it was a process on the phone etc.. takes some time to transfer

amother

Dimgray

Tue, Jan 23 2024, 9:49 pm

UHC Medicaid? Or HMO?

Cuz you can’t just ‘switch’ to an HMO. You need to either get it through an employer or purchase an individual plan

If UHC Medicaid you need to Call Medicaid choice and request to switch plans

amother

Tue, Jan 23 2024, 9:53 pm

amother Dimgray wrote:

I need specific optum under united something like that so I'm guessing that's fully private not Medicaid. How would I go about leaving the current plan and purchasing an individual plan ? I don't have a social worker like previous poster suggested
Thanks

amother

Dimgray

Tue, Jan 23 2024, 9:55 pm

amother OP wrote:

Firstly definitely find out what you need. Then you gotta find it if you can afford it then you may find out if it’s with it or preferable to keep current insurance and find another provider . You may need to speak to insurance broker

amother

Narcissus

Tue, Jan 23 2024, 10:02 pm

amother OP wrote:

It’s very unusual to need one specific insurance. Are you sure you’re clear on what you need?

amother

Camellia

Tue, Jan 23 2024, 10:28 pm

You can only get insurance through Medicaid, the Marketplace, or employers. You can easily see plan options on your marketplace, you fill out an application with all your info and it’ll show you available plans and premium amounts.

If you qualify for Medicaid, you will not get the premium tax credits. You can purchase the new insurance as secondary insurance and keep both, but it’ll be very expensive since there’s no discounts. (I do this)

Also, you only have until next week to apply and enroll. Past 1/31, open enrollment ends and the only way to get on a Marketplace plan is to have a qualifying life event, like pregnancy, birth, marriage, etc.

yshmitty

Tue, Jan 23 2024, 10:48 pm

Reach out to acheizer- they’re great about insurance stuff

Amarante

Wed, Jan 24 2024, 10:15 am

You need to confirm whether your provider has stopped taking ANY Medicaid plans or just a specific Medicaid plan.

FWIW, Medicaid reimbursement rates are very low - lower than Medicare and much lower than private insurance which is why many doctors don't accept any Medicaid plans.

Realistically as posted, switching to private insurance is probably not realistic because of the cost of the premiums. Not only would the premiums be very expensive but you will also find that most private insurance plans have significant other costs including high deductible; high co-payments and high co-insurance. They also don't cover a lot of what Medicaid covers especially if you are in a state like New York which has very generous Medicaid benefits.

Even if you have private insurance, it doesn't mean a doctor will take a particular plan because every plan - even a PPO will have a relatively small network. Even if the provider is the "same" - e.g. Blue Cross or Aetna or United - they will have different plans with slightly different names which will have different providers in the network.

amother

Brown

Wed, Jan 24 2024, 10:38 am

It’s hard to get non-marketplace insurance if you’re not getting it through an employer. If it’s a one off, you might be better off just paying the doctor out of pocket.
If you go through an insurance broker, you either need 3 people in your company, or a broker who can include you in an organization. And as stated above , the premiums and deductibles are high.
The fallacy of the marketplace (Obamacare) was that you’d be able to keep your doctors. That’s proven untrue.

amother

Taupe

Wed, Jan 24 2024, 10:42 am

You can’t switch to private insurance. You would need to purchase it in addition to your Medicaid plan and it is super expensive. It may make more sense to pay out of pocket for your visits. Also, open enrollment ends in a week so you would need to enroll before then.

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