Fidelis Care is a Medicaid health plan, not Medicaid itself
Fidelis Care is a private insurance company that contracts with your state to deliver Medicaid coverage. When you enroll in Fidelis Care, you are choosing one specific plan to manage your Medicaid benefits — the state still pays for your coverage, but Fidelis handles your claims, doctor network, and day-to-day customer service.
Think of it this way: Medicaid is the program that funds your coverage. Fidelis Care is one of several companies your state hired to run that program. Other states use different companies, and even within your state, you may have multiple plans to choose from. Fidelis operates in New York, New Jersey, and Arizona, so whether it is an option for you depends on where you live.
The main difference between Fidelis and other Medicaid plans is their provider network — which doctors, hospitals, and specialists accept their insurance — and how they manage referrals and prior authorizations. Some people prefer Fidelis because their doctor is in the network; others switch because their doctor is not.
Key Takeaways
- Fidelis Care is a private company contracted to deliver Medicaid benefits in New York, New Jersey, and Arizona, not a separate program you apply for.
- You choose Fidelis Care during your Medicaid enrollment or annual renewal, and you can switch to a different plan during open enrollment if Fidelis does not meet your needs.
- Your Medicaid coverage and benefits are the same whether you use Fidelis or another plan — the difference is which doctors and hospitals are in the network.
- Fidelis offers specialized plans for seniors (Fidelis Medicare Advantage) and people with disabilities, so the plan you choose depends on your age and health status.
How Fidelis Care fits into your Medicaid enrollment
When you first become Medicaid-may be able to access, you do not automatically get Fidelis Care. Instead, you choose a plan during the enrollment process. Your state's Medicaid office will send you a list of available plans in your area, and Fidelis is usually one option among several.
If you do not actively choose a plan, your state may assign you to one automatically — sometimes that is Fidelis, sometimes it is not. You can change your selection at any time during your first 90 days of Medicaid coverage, and then once a year during open enrollment (usually November through January). If Fidelis is not the right fit, you can switch to another plan without losing your Medicaid coverage.
The enrollment process itself happens through your state's Medicaid office or through a website like New York's mybenefits.ny.gov. Fidelis does not enroll you directly — the state does, and then Fidelis becomes your plan administrator once you are assigned.
What Fidelis covers and what it does not
Fidelis covers the same Medicaid benefits your state requires: doctor visits, hospital stays, emergency care, prescription drugs, mental health services, and preventive care. The scope of coverage does not change based on which plan you choose — Medicaid law sets the minimum, and all plans must meet it.
Where plans differ is in details: which pharmacies are in-network, how much you pay for a specialist visit, whether you need a referral to see a specialist, and how quickly you can get an appointment. Some Fidelis plans also include dental or vision coverage, depending on your state and your specific plan type.
If you need a service that Fidelis does not cover, you can appeal the denial or ask your doctor to request a prior authorization. Fidelis must follow state and federal rules about what they can refuse — they cannot deny coverage for a service that Medicaid requires them to cover just because they want to save money.
Fidelis plans for different age groups and needs
Fidelis offers several types of plans depending on your situation. If you are under 65 and may be able to access for regular Medicaid, you would enroll in Fidelis Care (their standard plan). If you are 65 or older, you may be offered Fidelis Medicare Advantage, which combines Medicare and Medicaid coverage into one plan — this is only available if you may have access to for both programs.
Fidelis also runs specialized plans for people with disabilities and chronic conditions. These plans may include care coordination, meaning a nurse or social worker helps you manage your health and connects you to services you need. The specific plans available depend on your state and your circumstances.
When you enroll or renew, the enrollment materials will list which plans you are may be able to access for. If you are unsure which plan fits your situation, you can call your state's Medicaid office or Fidelis directly to ask questions before you choose.
How to switch plans or get help with Fidelis
If you enroll in Fidelis and later realize it is not working for you — your doctor is not in the network, you are having trouble reaching customer service, or you found a plan you prefer — you can switch during open enrollment. You do not need Fidelis's permission to leave; you simply select a different plan through your state's Medicaid office.
If you have an urgent problem with Fidelis (a claim was denied, you cannot reach them, or you need care immediately), you can file a complaint with your state's Medicaid office or your state's Department of Insurance. Both agencies have the power to investigate and require Fidelis to fix the problem.
For day-to-day questions about your coverage, your member ID card, or how to find a doctor in the network, you can call Fidelis's customer service number, which is printed on your member card. Wait times vary, but most calls are answered within 15 to 30 minutes during business hours.
Fidelis versus other Medicaid plans in your state
Your state likely offers multiple Medicaid plans, and Fidelis is one of them. Other common plans include Empire BlueCross BlueShield, Healthfirst, Molina Healthcare, and regional plans specific to your area. Each plan has a different network of doctors and hospitals, different customer service quality, and different specialty services.
The best way to compare is to check which of your current doctors are in each plan's network. If your primary care doctor is in Fidelis but your specialist is not, you may want to choose a different plan. Your state's Medicaid office usually provides a comparison tool or a phone line where you can ask which doctors are in each plan.
You are not locked into Fidelis — if you switch to another plan and later want to come back to Fidelis, you can do that during the next open enrollment. The only restriction is that you can usually only change plans once per year (except during your first 90 days of Medicaid coverage).
Frequently Asked Questions
Do I have to pay Fidelis to use my Medicaid coverage?
No. Fidelis is paid by your state's Medicaid program, not by you. You do not pay a premium, and you should not pay Fidelis directly for anything. If someone claiming to represent Fidelis asks you for money, that is a scam.
What happens to my coverage if Fidelis leaves my state?
If Fidelis stops operating in your state, your state will notify you and automatically move you to another plan. Your Medicaid coverage does not end — you simply switch to a different plan administrator. The state handles the transition and gives you time to find new doctors if needed.
Can I use Fidelis if I move to a different state?
Fidelis only operates in New York, New Jersey, and Arizona. If you move to a different state, you will need to enroll in your new state's Medicaid program and choose from the plans available there. You can apply for Medicaid in your new state as soon as you move.
How do I know if my doctor accepts Fidelis?
You can search Fidelis's online provider directory on their website, or call their customer service number to ask. You can also call your doctor's office directly and ask if they accept Fidelis Medicaid. It is worth checking before you enroll, because switching plans mid-year is only possible during open enrollment.
What if Fidelis denies a treatment my doctor says I need?
You have the right to appeal any denial. You can ask your doctor to submit a written request for a prior authorization, or you can file an appeal yourself through Fidelis. If Fidelis denies the appeal, you can file a complaint with your state's Medicaid office, which can investigate whether the denial was legal.