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

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

At Moses Medical Center, we accept over 38 insurance plans, including every major Medicaid managed care plan in New York City. This guide is here to answer the questions our front desk team hears every single day: What does my plan cover? Do I need a referral? 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 without needing a referral. 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
• Healthfirst — widely used across the Bronx and Brooklyn
• Amerigroup — an Anthem subsidiary with a strong Bronx network
• WellCare of New York — part of Centene, growing rapidly in the city
• Molina Healthcare — another major managed care option
• United Healthcare Community Plan — UHC’s Medicaid product

Moses Medical Center 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, behavioral 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
• Behavioral 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, Healthfirst, and all other Medicaid managed care plans.

Referral Requirements: 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 a primary care provider (PCP) referral for most specialist visits. Your PCP must submit the referral to MetroPlus, and MetroPlus must authorize it before the specialist visit takes place. If you come to Moses Medical Center for primary care, we can generate the referral and submit it the same day.

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

Healthfirst Medicaid HMO: Requires referrals for specialists. Healthfirst has a somewhat streamlined referral system for in-network providers, but prior authorization is still needed for specific procedures.

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

Important: Some services do NOT require a referral under any Medicaid managed care plan. These include behavioral health/mental health visits, OB/GYN visits, family planning services, and emergency care. You can walk into Moses Medical Center for a behavioral health appointment or a PrEP consultation without a referral from anyone.

How We Verify Your Coverage

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

1. When you schedule. Whether you call (646) 741-2111 or book online, our team will ask for your plan name, member ID, and date of birth. We run a real-time eligibility check to confirm your coverage is active and that Moses Medical Center is in-network for your plan.

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 you need a referral. If your plan requires a specialist referral and you do not have one, we will work with your PCP’s office to obtain it. If your PCP is at Moses Medical Center, the referral can often be completed internally within 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 never have to call your insurance company yourself for a prior auth — that is our job.

Services Covered Under Medicaid at Moses Medical Center

Here is a straightforward list of what your Medicaid plan covers when you come to see us:

Service	Covered?	Referral Needed?
Primary care visit	Yes, $0	No
Internal medicine	Yes, $0	Varies by plan
Cardiology	Yes, $0	Yes (most plans)
Dermatology	Yes, $0	Yes (most plans)
Behavioral health	Yes, $0	No — learn more
Wound care	Yes, $0	Yes (most plans)
PrEP consultation	Yes, $0	No — learn more
Lab work (on-site)	Yes, $0	No
Medical weight loss (visit)	Yes, $0	Varies by plan
GLP-1 medications	Varies — see weight loss guide	Prior auth required
IV therapy	Not typically covered	N/A — self-pay
Botox/fillers (cosmetic)	Not covered	N/A — self-pay
Genetic testing	Covered with medical necessity	Prior auth required

What Is NOT Covered — And What To Do About It

Medicaid does not cover everything. Services generally excluded include:

• Cosmetic procedures — Botox, fillers, and cosmetic dermatology are self-pay
• IV vitamin therapy — generally considered wellness, not medically necessary, and paid out-of-pocket
• Some weight loss medications — coverage varies by plan; we handle prior authorizations and explore alternatives
• Over-the-counter supplements and vitamins

For self-pay services, Moses Medical Center offers transparent pricing. We will always tell you the cost before a service is rendered so there are no surprises.

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 determine eligibility and, if appropriate, connect you with an enrollment counselor who can get you covered — often within days. In the meantime, we do not turn anyone away for inability to pay. If you are new to the practice, our first visit guide explains exactly 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 Center 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 Center, 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 a referral requirement, 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 8 AM to 6 PM and Saturday 9 AM to 2 PM.

Your coverage is already working. Let us help you use it.