How to Use the Fidelis Care Cost Calculator
Navigating health insurance premiums in New York can be complex, but our fidelis care cost calculator simplifies the process. This tool is designed to help New York residents estimate their monthly out-of-pocket costs for various Fidelis Care plans, including the Essential Plan, Metal Levels (Bronze, Silver, Gold, Platinum), and Child Health Plus.
To get an accurate estimate, you will need to provide basic financial and household information. Follow these steps to use the calculator effectively:
- Select Plan Type
- Choose between Essential Plans (for low-to-moderate income), Metal Plans (for standard marketplace enrollment), or Child Health Plus (for children under 19).
- Estimated Monthly Income
- Enter your total gross monthly income before taxes. This includes wages, tips, and other taxable income sources.
- Household Size
- The number of people living in your home that you claim on your tax return. This significantly affects your eligibility for subsidies.
How the Calculation Works
The fidelis care cost calculator uses the current Federal Poverty Level (FPL) guidelines specific to New York State to determine your premium. The primary formula for Metal Plans relies on the concept of the "benchmark plan" and tax credits.
Estimated Premium = (Base Rate for Age/Region) - (Advance Premium Tax Credit)
- FPL Calculation: Your income is compared against the FPL for your household size. For 2024, a 1-person household baseline is approximately $1,255 per month.
- Subsidy Eligibility: If your income is between 138% and 400% of the FPL, you likely qualify for tax credits that lower your Fidelis Care premium.
- Essential Plan Logic: If your income is below 250% of the FPL (for 2024), you may qualify for the Essential Plan, which often results in a $0 monthly premium.
Real-World Calculation Example
Example Scenario: A 35-year-old individual living alone in Queens, NY, earning $30,000 per year (approx. $2,500/month).
Step-by-step solution using the fidelis care cost calculator:
- Plan Type: Selected "Metal Plan (Silver)".
- Monthly Income: $2,500.
- Household Size: 1.
- FPL Status: This income is roughly 200% of the Federal Poverty Level.
- Subsidy: At 200% FPL, the individual qualifies for a significant tax credit.
- Calculation: $480 (Base Silver Rate) - $350 (Tax Credit) = $130.
- Final Result: The estimated monthly premium is $130.00.
Understanding Fidelis Care Plan Tiers
When using the fidelis care cost calculator, it is helpful to understand what each plan tier offers in terms of cost-sharing and benefits:
1. The Essential Plan
This is a New York State program for lower-income individuals who don't qualify for Medicaid. It features $0 premiums for most enrollees and very low out-of-pocket costs for doctor visits and prescriptions. This is often the best value for those who qualify.
2. Bronze and Silver Plans
Bronze plans have the lowest monthly premiums but the highest deductibles. They are ideal for healthy individuals who want protection against catastrophic medical bills. Silver plans are the most popular because they offer "Cost Sharing Reductions" (CSRs) if your income is within certain limits, lowering your deductible and co-pays significantly.
3. Gold and Platinum Plans
These plans have higher monthly premiums but much lower costs when you actually receive care. If you have chronic conditions or visit the doctor frequently, the fidelis care cost calculator might show a higher monthly cost, but your total yearly spending could be lower due to reduced co-pays.
Frequently Asked Questions
Does the calculator include dental and vision?
Most Essential Plans and Child Health Plus plans include dental and vision for children. For adult Metal Plans, dental and vision are often optional add-ons that carry a separate premium not calculated in the basic tool.
What if my income changes during the year?
If your income increases, your subsidy may decrease, and you might owe money back at tax time. If your income decreases, you may be eligible for a higher subsidy or a transition to the Essential Plan. It is vital to update your information on the NY State of Health marketplace as soon as changes occur.
Are Fidelis Care plans available in all NY counties?
Fidelis Care has a very broad network, but availability and specific regional "Base Rates" vary by county. The fidelis care cost calculator provides a state-wide average, but your specific zip code might result in a 5-10% variance in the final quote provided by the marketplace.