Fidelis Care is both Medicaid and Medicare, depending on which plan you choose
Fidelis Care is a health insurance company that runs plans under both Medicaid and Medicare. Which one you're in depends on which plan you picked or were assigned to — they are separate programs with different rules, costs, and coverage. If you have a Fidelis Care plan, your member card or enrollment letter will tell you which program it is.
The confusion happens because Fidelis Care uses the same company name for both. But Medicaid and Medicare are run by different government agencies, have different income rules, and cover different groups of people. Knowing which one you have matters because it changes what you pay, which doctors you can see, and how to get help if something goes wrong.
Key Takeaways
- Fidelis Care offers plans under both Medicaid (for lower-income adults and families) and Medicare (for people 65 and older, or some younger people with disabilities).
- Your Fidelis Care member card or enrollment letter states whether you are in a Medicaid or Medicare plan.
- Medicaid plans through Fidelis Care have no monthly premium, while Medicare plans have a monthly premium that varies by plan.
- Fidelis Care operates in New York, New Jersey, and Connecticut, so availability depends on where you live.
- Contacting Fidelis Care directly is the fastest way to confirm which program you are in and what your coverage includes.
How to tell which program your Fidelis Care plan is in
The easiest way is to look at your member ID card. Medicaid plans usually say "Medicaid" or "Medicaid Managed Care" on the card. Medicare plans say "Medicare" or "Medicare Advantage" (also called Part C). If you do not have the card in front of you, check any letter Fidelis Care sent you when you first joined — it will state the program name.
You can also call Fidelis Care directly. Their customer service number is on any bill or letter you have received. When you call, have your member ID ready and ask them to confirm whether you are in a Medicaid or Medicare plan. They can also tell you what your specific coverage includes and answer questions about copays or which doctors are in your network.
Fidelis Care Medicaid plans and who they cover
Fidelis Care Medicaid plans cover adults and families with lower incomes. The income limit varies by state and family size, but generally Medicaid is for people earning less than 138% of the federal poverty level (though some states set it higher). Medicaid covers children, pregnant women, parents, and non-elderly adults without children, depending on the state.
Fidelis Care Medicaid plans have no monthly premium — you do not pay to have the insurance. You may have small copays when you see a doctor or fill a prescription, but many services are free. Medicaid is jointly funded by the federal government and the state, so coverage rules can differ slightly between New York, New Jersey, and Connecticut, where Fidelis Care operates.
Fidelis Care Medicare plans and who they cover
Fidelis Care Medicare plans are for people 65 and older, and some younger people who may have access to for Medicare because of a disability or end-stage renal disease. These are Medicare Advantage plans, which means Fidelis Care is a private insurance company contracted by Medicare to provide your coverage. You must already be enrolled in Medicare Part A and Part B to join a Fidelis Care Medicare plan.
Fidelis Care Medicare plans have a monthly premium that you pay in addition to your Medicare Part B premium. The amount varies by plan and changes each year. These plans typically include prescription drug coverage (Part D) and extra benefits like dental or vision, which Original Medicare does not cover. You will have copays and deductibles, just like with other Medicare Advantage plans.
The main differences between Fidelis Care Medicaid and Medicare plans
| Feature | Fidelis Care Medicaid | Fidelis Care Medicare |
|---|---|---|
| Who it covers | Lower-income adults and families | People 65+, or younger with disability |
| Monthly premium | None | Yes, varies by plan |
| Copays | Usually small or none | Varies by plan and service |
| Prescription coverage | Included in plan | Included (Part D) |
| Dental and vision | Varies by state and plan | Often included as extra benefit |
| Who funds it | Federal and state government | Federal government (Medicare) |
Where Fidelis Care operates and how to reach them
Fidelis Care runs Medicaid and Medicare plans in New York, New Jersey, and Connecticut. If you live in one of these states, you may see Fidelis Care as an option when you enroll in Medicaid or Medicare. If you live elsewhere, Fidelis Care plans are not available to you.
To contact Fidelis Care, call the customer service number on your member card or any letter they sent you. You can also visit their website at fideliscare.org. They can answer questions about your specific plan, help you understand your coverage, and tell you which doctors and hospitals are in your network.
What to do if you are unsure which program you are in
Start by gathering any paperwork from Fidelis Care — your member card, a welcome letter, or a bill. These documents will state whether you are in Medicaid or Medicare. If you cannot find any paperwork, call Fidelis Care customer service with your name and date of birth, and they will look up your account and tell you which program you are in.
You can also contact your local Medicaid office or your state's Medicare program (called the State Health Insurance information Program, or SHIP) if you want a second confirmation. Both can tell you which program you are enrolled in and answer basic questions about how it works. Having this information clear will help you understand your coverage and know what to expect when you use your insurance.
Frequently Asked Questions
Can I switch from Fidelis Care Medicaid to Fidelis Care Medicare?
No, because Medicaid and Medicare are for different groups of people. You move from Medicaid to Medicare when you turn 65 or when you become may be able to access for Medicare due to disability. At that point, you can choose to enroll in a Fidelis Care Medicare plan if one is available in your area, but you cannot straightforward switch between the two programs.
Do I pay the same copays in Fidelis Care Medicaid and Medicare?
No. Fidelis Care Medicaid plans usually have very small copays or none at all. Fidelis Care Medicare plans have copays that vary by plan and by service — a doctor visit might cost one amount, a specialist visit another, and a hospital stay another. Check your plan documents or call Fidelis Care to see your specific copays.
What if I have both Medicaid and Medicare?
Some people may have access to for both programs — they are called "dual may be able to access." In that case, you might have a Fidelis Care plan that covers both, or you might have separate Medicaid and Medicare coverage. Your member card or enrollment letter will show which situation you are in. Call Fidelis Care to confirm how your coverage works.
Can I use my Fidelis Care plan in other states?
Fidelis Care plans only work in New York, New Jersey, and Connecticut. If you move to another state, your Fidelis Care coverage will end, and you will need to enroll in a Medicaid or Medicare plan in your new state. Contact Fidelis Care before you move to understand your options.
How do I know if my doctor is in the Fidelis Care network?
Call Fidelis Care customer service or visit their website and use the provider search tool. You can search by doctor name or specialty. If your doctor is not in the network, you can ask Fidelis Care about out-of-network coverage or whether they can add your doctor to the network.