A New Jersey FIDE SNP plan covers all Part A and Part B Medicare benefits, NJ FamilyCare Medicaid benefits, Medicare Part D prescription drug benefits, Managed Long Term Services and Supports (MLTSS) and Behavioral Health benefits in one health plan, with one identification card, and no premiums or copays for medical services or prescription drugs. These benefits and services are available for New Jersey residents who live in the plan's service area and have both Medicare and full Medicaid benefits.
No, but you need to fill out a Renewal application every year to maintain your NJ FamilyCare Medicaid coverage. Call NJ FamilyCare at 1-800-701-0710 (TTY 1-800-701-0720) to find out your renewal date or to ask for a renewal form.
We try to give you the best health care experience we can. You can file a complaint (grievance) online if you’re unhappy with the service you got from us or one of our providers.
You also have the right to ask for an appeal or “reconsideration” if we denied services or payment you believe we should have covered.
If you want to choose or change your PCP, just call 1-844-362-0934 (TTY: 711). We’re here 8 AM to 8 PM, 7 days a week.
You can also choose a PCP on our secure Member Portal. Your PCP must be part of our provider network. Try the Find a provider tool to find PCPs in your area. If you don’t choose a PCP, we'll choose one for you in our network.
You’ll get a new member ID card with the name of your PCP.
Our network providers bill the plan directly for your covered services and drugs – you should not receive a bill. If you get a bill for medical care or drugs you have received, you should save the bill and immediately contact the plan.
You should not pay the bill. We will review the bill and decide whether the services and drugs should be covered.
If you have additional questions, call Member Services at 1-844-362-0934 (TTY: 711), 8 AM to 8 PM, 7 days a week.
If you think you need to go to the ER when your PCP isn’t available:
Call us at 1-844-362-0934 (TTY: 711). Choose the option for our 24-hour nurse advice. The nurse can help you decide if you need to go to the ER or urgent care.
Call 911 or go to the closest hospital if you’re having an emergency.
If your drug isn’t on our Drug List, you can:
Ask your provider for a similar one that is on the list
Ask your provider to request an exception to cover this drug
Quantity limits are set for different reasons. Some drugs have a maximum limit or a maximum dose for safety reasons. Clinical staff review and set limits.
We do make exceptions in some cases. Ask your Provider to contact us. We’ll review the information from your Provider and make a decision.
You can still get care if one of these authorities declares a state of disaster or emergency in your area:
Governor of your state
U.S. Secretary of Health and Human Services
President of the United States
If you can’t use a network provider in a disaster: Your plan allows you to get care from out-of-network providers.
If you can’t use a network pharmacy in a disaster: You may be able to get your prescription drugs at an out-of-network pharmacy.
Need to learn more about getting care in a disaster? Just check your Evidence of Coverage.
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