Optum Health to Drop Fidelis Care Plans, Impacting Thousands in New York

Kingston, N.Y. – Optum Health, a significant healthcare provider in the Hudson Valley, will no longer accept Fidelis/Wellcare insurance plans in-network starting January 1, 2026. This change is poised to affect a substantial number of New Yorkers, including self-employed individuals who rely on plans like Fidelis Care, a major New York State version of Obamacare. The decision has raised concerns about healthcare access and affordability across the region.

The development was highlighted by social media user Michael Brendan Dougherty, who stated in a tweet, "Biggest provider in my area no longer accepts the most common NY State version of Obamacare, Fidelis. Self employed people already paying through the nose and can. Barely find anyone in network. Insane system." This sentiment underscores the potential challenges for patients seeking in-network care.

Optum Health, a subsidiary of UnitedHealth Group, announced that Fidelis/Wellcare plans, encompassing Medicaid, Medicare Advantage, Commercial, Individual Exchange, and Dual Special Needs plans, will be out of network. An Optum spokesperson indicated the change is part of an "ongoing commitment to delivering long-term, affordable care for the communities we serve." Patients wishing to retain their Optum providers are advised to explore other in-network plans listed on optum.com/tri/insurance.

The move has drawn sharp criticism from public officials. U.S. Rep. Pat Ryan decried the change as a "greedy pursuit of profits," arguing that UnitedHealth's acquisitions have created a monopoly that harms the community. Ryan, who introduced the "Patients Over Profits Act" to prevent insurers from buying medical practices, emphasized the need to break up such monopolies to ensure affordable and accessible care.

Fidelis Care, a mission-driven health plan with over 2.4 million members statewide, offers various government-sponsored programs, including Medicaid, Child Health Plus, and the New York Essential Plan. These plans are crucial for many low-income individuals and families, as well as self-employed residents. The withdrawal of a major provider from the Fidelis network could exacerbate existing difficulties for these populations in finding accessible healthcare.