Is Fidelis Care Medicaid or private insurance?
Fidelis Care is a private New York insurer, part of Centene, that administers public programs. Medicaid is the program; Fidelis is one of the companies that delivers it. A Fidelis card can therefore mean Medicaid, the Essential Plan, a child’s Child Health Plus, a marketplace plan or a Medicare plan, depending on what you qualified for.
The confusion is understandable. Fidelis grew out of a New York nonprofit tradition, it is the biggest Medicaid managed care plan in the state, and its name is printed on more Medicaid cards than any other. In the state Health Department’s 2024 plan profiles, Fidelis Care New York had 1,706,637 Medicaid managed care members, down 11% from 2023, and was one of five plans in the table listed as accredited. What Fidelis is and how to check your doctor.
Which Fidelis Care plans are Medicaid?
Fidelis’s own “Our Plans” list contains seven products. Four run on Medicaid eligibility; three do not, plus its Medicare line.
| Fidelis plan | What it is | Is it Medicaid? |
|---|---|---|
| Medicaid Managed Care | New York Medicaid delivered through Fidelis | Yes |
| HealthierLife (HARP) | A Health and Recovery Plan for Medicaid members with behavioral health needs | Yes |
| Medicaid Advantage Plus | A plan combining Medicare, Medicaid and long-term care | Medicaid and Medicare |
| Fidelis Care at Home (MLTC) | Managed long-term care for people who need care at home | Runs on Medicaid long-term care rules |
| New York Essential Plan | The state plan for adults just above the Medicaid line | No, a separate state program |
| Child Health Plus | Coverage for children under 19 | No, a separate state program |
| Ambetter from Fidelis Care | Qualified Health Plans on NY State of Health | No, marketplace insurance |
| Wellcare By Fidelis Care | Medicare Advantage and dual plans | No, Medicare (dual plans add Medicaid) |
What does Fidelis Care Medicaid cost and cover?
Fidelis describes its Medicaid Managed Care plan as comprehensive coverage with no copays for covered services and no monthly premium for those who qualify. Benefits include preventive care, dental and vision care, prescription drugs, emergency and ambulance services, hospital and outpatient care, and behavioral health services. You can enroll in any month; there is no open enrollment season for Medicaid.
Fidelis also reprints the 2026 Medicaid income ceilings from NY State of Health:
| Household size | Maximum yearly income, 2026 |
|---|---|
| 1 | $22,025 |
| 2 | $29,864 |
| 3 | $37,702 |
| 4 | $45,540 |
These are the lines for most adults; pregnant people and children qualify at higher incomes. All 2026 income limits.
As with every carrier, the benefit package is set by New York State. Choosing Fidelis does not buy better Medicaid benefits than another plan, and choosing another plan does not buy worse ones. What Fidelis controls is its network, its drug list and its customer service. Its distinguishing feature is reach: it operates across the whole state, which helps people who move between the city and upstate counties but does not guarantee density in your neighborhood. Compare Healthfirst, Fidelis, MetroPlus and EmblemHealth.
What is Ambetter from Fidelis Care?
Ambetter from Fidelis Care is the new name for Fidelis Care’s Qualified Health Plans: private marketplace insurance, not Medicaid. Fidelis offers it in Platinum, Gold, Silver, Bronze and Catastrophic levels, with an HSA-compatible Bronze option, through NY State of Health. Fidelis says you must enroll through NY State of Health to receive those benefits, and that the plans can also be bought off-exchange, directly from Fidelis.
Premiums, copays, coinsurance and deductibles vary by plan. The marketplace is where tax credits apply, and for 2027 the credit generally ends at 400% of the poverty level. For 2027 the state Department of Financial Services approved an average +8.0% rate change for Fidelis’s individual plans, filed under NY Quality Healthcare Corp, which had 72,116 members at filing. 2027 rates by insurer · How the marketplace works.
Open enrollment for 2027 marketplace coverage runs November 1, 2026 to January 31, 2027; enroll by December 15 for a January 1 start.
Is the Fidelis Essential Plan Medicaid?
No. The Essential Plan is a separate state program for adults 19 to 64 with income above the Medicaid line, up to 200% of the federal poverty level, $31,920 a year for one person in 2026. It costs $0 a month with no deductible but does not include long-term care. Fidelis is one of the carriers that delivers it. Fidelis Care Essential Plan.
Is Fidelis Care Medicare?
Fidelis’s Medicare plans are sold under the name Wellcare By Fidelis Care, including Medicare Advantage and “Medicare and Dual Advantage” plans for people who have both Medicare and Medicaid. If you are 65 or older and your card says Wellcare, you are on a Medicare plan. If you also have Medicaid, ask whether you are in a dual plan, because that changes who pays your cost sharing. Being dual eligible.
How do I know which Fidelis plan I have?
| Your situation | What to do |
|---|---|
| Card says Fidelis Care, no program shown | Call 1-888-343-3547 and ask for the exact plan name |
| Card says Ambetter from Fidelis Care | You are on a marketplace plan, not Medicaid |
| Card says Wellcare By Fidelis Care | You are on a Medicare plan; ask if it is a dual plan |
| You pay no premium and no copays | Most likely Medicaid Managed Care or the Essential Plan |
| A dentist asks “is Fidelis Medicaid?” | Give the full plan name so they check the right network |
| Your income rose above the Medicaid line | Report it to NY State of Health; you may move to the Essential Plan or Ambetter and keep Fidelis |
That last row is the practical advantage of a carrier that spans several programs: if your income crosses a threshold, staying with Fidelis can preserve your doctors even as the program changes. It does not always work, because networks can differ between a carrier’s Medicaid and marketplace products, so check each doctor under the new plan’s exact name. How to verify a provider.
What to say on the phone to Fidelis or a doctor’s office:
“My card says Fidelis Care. Is this Medicaid Managed Care, the Essential Plan, Child Health Plus, Ambetter or Wellcare? And is Dr. [name] in network for that exact plan and taking new patients?”
How do I join Fidelis Care Medicaid?
Apply for the program and choose Fidelis as your plan. Most people under 65 apply through NY State of Health, online or at 1-855-355-5777. Fidelis’s page also lets you call 1-888-FIDELIS (1-888-343-3547), TTY 711, visit a Fidelis Care office or request help through its “Get Help Finding Coverage” form. People 65 and older or applying on disability go through the city’s Human Resources Administration. Where to apply for Medicaid in NYC.
Questions people ask
Is Fidelis Care Medicaid?
Not by itself. Fidelis Care is an insurance company that runs Medicaid managed care plans in New York, plus the Essential Plan, Child Health Plus, Ambetter marketplace plans and Wellcare Medicare plans, which are not Medicaid.
Is Ambetter from Fidelis Care Medicaid?
No. Ambetter from Fidelis Care is the name of Fidelis’s Qualified Health Plans sold through NY State of Health. They charge premiums and deductibles, reduced by tax credits for many buyers.
Is Fidelis Care Medicaid or Medicare?
Both, depending on the plan. Fidelis Medicaid Managed Care is Medicaid; Wellcare By Fidelis Care plans are Medicare; Medicaid Advantage Plus and dual plans combine the two.
Does Fidelis Care Medicaid cost anything?
No monthly premium and no copays for covered services, for those who qualify, according to Fidelis.
Does Fidelis Care Medicaid cover dental?
Yes. Fidelis lists dental and vision care among Medicaid Managed Care benefits. Ask the plan for its dental directory before booking.
Can I switch from Fidelis to another Medicaid plan?
Yes. Medicaid is a year-round program, and you can change plans; the benefits stay the same, so compare networks and drug lists before you switch.
Sources
- Fidelis Care — Shop for a plan: our plans (checked 2026-10-29)
- Fidelis Care — Medicaid Managed Care (checked 2026-10-29)
- Fidelis Care — Ambetter from Fidelis Care Qualified Health Plans (checked 2026-10-29)
- Fidelis Care — Wellcare By Fidelis Care: Medicare and Dual Advantage (checked 2026-10-29)
- NYS Department of Health — Medicaid managed care plan profiles, eQARR 2024 (checked 2026-10-29)
- NYS Department of Financial Services — 2027 individual and small group rate actions (checked 2026-10-29)
More in Health Insurance Companies in New York: Who They Are and How They Differ
- Which Plans Actually Exist Where You Live — Which health plans are sold in your county? New York licenses them county by county, and NY State of Health publishes the list. Check it before you enroll.
- How to Verify a Provider Takes Your Plan — How to verify a provider takes your plan: directories are often wrong, so ask if they take your exact plan and accept new patients on it. Log every call.
- Fidelis Care: What to Know Before You Pick It — Fidelis Care offers Medicaid, Essential Plan and Child Health Plus statewide. Essential Plan benefits match other carriers; the network is what differs.
This page explains how the system works. It is not medical advice. More.