Coverage Information for Bronx Patients
Insurance Accepted at Mace Avenue Medical
We want every patient who needs care to be able to access it. At Mace Avenue Medical, we accept most major health insurance plans and work with our patients to navigate their coverage and ensure they receive the care they need.
Insurance Plans We Accept
Mace Avenue Medical accepts most major health insurance plans, including:
- Medicare (Parts A and B)
- Medicaid and Medicaid Managed Care plans
- Most commercial insurance plans
- Most HMO and PPO plans in network
- Empire BlueCross BlueShield
- United Healthcare plans
- Aetna plans
- Cigna plans
- MetroPlus Health Plan
- Fidelis Care
- HealthFirst
- Other managed care and commercial plans
To verify that your specific plan and network are accepted, please call our office at
(718) 652-4647 before scheduling. Insurance network participation can change, and we want to confirm your coverage before your visit.
Understanding Your Coverage
Most health insurance plans include several key components that affect what you pay:
1
Copay — A fixed amount you pay at each visit
2
Deductible — The amount you pay out of pocket before insurance begins covering services
3
Coinsurance — Your percentage of covered costs after your deductible is met
4
Out-of-pocket maximum — The most you will have to pay in a plan year; insurance covers 100% after this is reached
5
In-network vs. out-of-network — Staying with in-network providers (like Mace Avenue Medical) results in lower costs
When in doubt, call your insurance company’s member services line (the number on the back of your card) to ask what your cost-sharing will be for a primary care visit at our office.
Preventive Care Coverage
Under the Affordable Care Act (ACA), most health plans are required to cover preventive services at 100% when provided by an in-network provider. This typically includes:
- Annual wellness visits / physical exams
- Blood pressure and cholesterol screenings
- Diabetes screening
- Cancer screenings (mammogram, colonoscopy, Pap smear)
- Adult immunizations
You should not have a copay for these preventive services if they are the sole purpose of your visit. If you raise new medical concerns during a preventive visit, a separate billing code may apply.
Medicare Patients
Medicare is welcome at Mace Avenue Medical. We accept both Original Medicare (Parts A and B) and Medicare Advantage plans (Medicare Part C). We also handle Medicare Annual Wellness Visits (AWV), which are covered at no cost to Medicare beneficiaries once per year and include a health risk assessment, cognitive screening, and preventive care review.
If You Are Uninsured or Underinsured
We understand that not everyone has comprehensive health coverage. If you are uninsured, underinsured, or between insurance plans, please call our office at
(718) 652-4647 to discuss your options. We are committed to working with our patients to ensure access to necessary care for the East Bronx community we have served for over 75 years.
Frequently Asked Questions
Does Mace Avenue Medical accept Medicare?
Yes. Mace Avenue Medical accepts Original Medicare (Parts A and B) and most Medicare Advantage plans. Call (718) 652-4647 to confirm your specific Medicare Advantage plan is accepted.
Does Mace Avenue Medical accept Medicaid?
Yes, we accept Medicaid and most Medicaid Managed Care plans. Please call to verify your specific Medicaid managed care plan.
How do I find out if my insurance is accepted at Mace Avenue Medical?
The fastest way is to call us at (718) 652-4647. You can also call your insurance company’s member services line (on the back of your insurance card) and ask whether Mace Avenue Medical at 2460 Mickle Ave, Bronx, NY 10469 is in your network.
What happens if my insurance is not accepted?
If your insurance plan is not in our network, you may still be able to receive care as a self-pay or out-of-pocket patient. Call us to discuss options if you do not have in-network coverage.
Will I have a copay for my annual physical?
Annual preventive wellness visits are covered at 100% by most insurance plans under ACA preventive care rules, with no copay. However, if you address new medical concerns during the same visit, a separate copay may apply for the sick-visit portion of the encounter.
