Fidelis Medicaid

Fidelis Medicaid: What It Is, Who Qualifies, and What It Covers

Is Fidelis Medicaid or Medicare? Eligibility, income limits, benefits, and how to apply

Fidelis Care is a managed Medicaid health plan operating primarily in New York and New Jersey. It is one of the largest Medicaid managed care organizations in New York State, serving low-income adults, seniors, children, and people with disabilities who qualify for Medicaid.

If you’ve come across the Fidelis name and aren’t sure whether it’s Medicaid, Medicare, or something else entirely — this guide answers that clearly, along with what it covers and how to apply.

Is Fidelis Medicaid or Medicare?

This is the most common question people have about Fidelis — and the answer is: Fidelis Care is a Medicaid managed care plan, not Medicare.

Here’s the key distinction:

• Medicare is a federal health insurance program for people 65 and older (or those with certain disabilities). It is not based on income.
• Medicaid is a state and federally funded program for people with limited income. Fidelis Care is a Medicaid plan — meaning you must qualify for Medicaid first, then choose Fidelis as your managed care provider.

  Get the Complete Medicaid Guide for Seniors →

Some seniors qualify for both Medicare and Medicaid at the same time — this is called dual eligibility. In those cases, Fidelis Care can serve as the Medicaid plan that works alongside Medicare, covering costs Medicare doesn’t pay.

Where Does Fidelis Care Operate?

Fidelis Care operates primarily in New York State, serving all 62 counties. It also has a presence in New Jersey through Fidelis Care NJ. If you are outside of New York or New Jersey, Fidelis is not available in your state — you would need to look at your state’s Medicaid managed care options instead.

Who Qualifies for Fidelis Medicaid?

To enroll in Fidelis Care, you must first be approved for Medicaid in New York or New Jersey. Eligibility is based primarily on income and household size. In New York, Medicaid covers adults with income at or below 138% of the Federal Poverty Level (FPL). Seniors and people with disabilities may qualify under different thresholds.

Who May Qualify	Key Requirement
Adults under 65	Income at or below 138% FPL
Seniors 65 and older	Income and asset limits apply; long-term care rules differ
People with disabilities	Must meet NY Medicaid disability and income criteria
Pregnant women & children	Expanded income thresholds apply

Note: Income limits are updated annually. Contact NY State of Health or your local Department of Social Services to confirm current figures.

Fidelis Medicaid Income Limits (New York, 2026)

For a single adult in New York, the general Medicaid income limit is approximately $1,732 per month (138% FPL). For seniors applying for long-term care Medicaid, the rules are more complex and involve both income and asset limits — these are evaluated separately from standard Medicaid.

If your income is slightly above the limit, you may still qualify through the NY Medicaid Excess Income (spend-down) program, which allows you to deduct medical expenses to meet eligibility.

What Does Fidelis Medicaid Cover?

Fidelis Care covers a broad range of services for Medicaid members, including:

• Primary and preventive care — doctor visits, annual physicals, vaccinations
• Specialist visits — referrals to cardiologists, neurologists, orthopedic doctors, and more
• Prescription medications — covered through the Fidelis formulary
• Hospital care — inpatient stays, outpatient procedures, emergency services
• Mental health and substance use services — therapy, psychiatric care, addiction treatment
• Dental and vision — routine exams, cleanings, eyeglasses
• Long-term care — nursing home care, in-home personal care, assisted living (for eligible seniors)
• Non-emergency medical transportation — rides to and from medical appointments
• Maternity and newborn care — prenatal visits, labor and delivery, postpartum care

Fidelis Care for Seniors: What to Know

For seniors in New York, Fidelis Care plays an important role in filling the gaps that Medicare doesn’t cover. If you are 65 or older and qualify for both Medicare and Medicaid, Fidelis can act as your Medicaid plan — covering Medicare premiums, copays, and services like long-term home care that Medicare excludes.

Seniors enrolled in Fidelis Medicaid also have access to care coordination services — a dedicated care manager who helps schedule appointments, manage medications, and connect you with community support services.

How to Apply for Fidelis Medicaid

You cannot apply directly to Fidelis Care — you must first be approved for Medicaid, then choose Fidelis as your managed care plan. Here’s the process:

1. Apply for Medicaid — In New York, apply through NY State of Health online, by phone, or at your local Department of Social Services office.
2. Get approved — Once your Medicaid application is reviewed and approved, you will be able to choose a managed care plan.
3. Choose Fidelis Care — Select Fidelis Care as your health plan. You’ll receive a welcome packet explaining your benefits, how to find a doctor, and how to use your coverage.
4. Start using your benefits — Find an in-network Fidelis provider and begin accessing care. You can also contact Fidelis member services with any coverage questions.

Fidelis Care NJ: Is It Available in New Jersey?

Yes — Fidelis Care has a presence in New Jersey through Fidelis Care NJ, offering Medicaid managed care plans to eligible New Jersey residents. The eligibility process in NJ runs through NJ FamilyCare, which is New Jersey’s Medicaid program. Residents apply through NJ’s Division of Medical Assistance and Health Services.

What This Means for You

If you live in New York or New Jersey and have limited income, Fidelis Care Medicaid could provide comprehensive health coverage at little or no cost — including services that Medicare alone does not cover, such as long-term home care, dental, and vision.

The most important first step is confirming your Medicaid eligibility through your state. Once approved, choosing Fidelis Care as your managed care plan gives you access to one of New York’s largest and most established Medicaid networks.