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What’s covered?
This is NJ FamilyCare (Medicaid) coverage. As a member, you'll enjoy benefits and services that can help you reach your health goals. To learn more, check our list of covered services:
Or check your member handbook:
The Aetna Better Health® difference
You deserve to be as healthy as you can be. That’s why we offer the support and tools you need to be your healthiest, bringing together what matters most to your health. It’s care you can trust. And experience you can count on — with extra benefits that go beyond your standard health coverage.
Healthcare Central
Want to talk with us in person? Come see us at our Healthcare Central Store. It’s our Medicaid (NJ FamilyCare) Guidance Center in Newark, NJ. You can stop by to get answers to your questions face-to-face. We’ll be there to guide you through your benefits and more.
Maternity care
Are you pregnant or planning to have a baby? We can help you get the care you need. Whether you need help choosing a provider, learning about childbirth classes or getting healthy food, we're here for you.
No-cost smartphone
It’s important to stay in contact with your health care team. And to be able to receive health tips and reminders by text. Need a smartphone? You can get one through Assurance Wireless® Lifeline at no cost to you. Your smartphone will include services, like:
- Unlimited texts
- 1,000 talk minutes
- 4.5 GB of data each month, all on the T-Mobile Network
To see if you’re eligible for Assurance Wireless, go to Apply for your smartphone.
Benefits in your plan
Learn about all your plan benefits, from vision and mental health to pharmacies, family planning and rides. You can learn more about all these topics in your member handbook.
We take care of the whole you. That means you’re covered if you need to see a specialist, have an emergency or plan to start a family. We also offer a wide range of preventive care and vaccinations. You can start by finding a provider today.
A healthy smile goes a long way. Dental care is part of your overall health. That’s why you should see your dentist every six months. We work with LIBERTY Dental Plan to provide you with dental and oral health care. So you can protect your smile and stay healthy.
Going to routine eye exams is an easy way to keep your eyes bright and healthy. We work with MARCH® Vision Care to offer you these covered services:
One routine eye exam every year
One pair of glasses or contact lenses every two years
You don’t need a referral to see a provider in the network. Just be sure to show your member ID card at every appointment.
To learn more about your vision benefits, contact MARCH Vision Care. Just call 1-844-686-2724 (TTY: 1-877-627-2456). Or reach out to Member Services at 1-855-232-3596 (TTY: 711).
Find a provider
Visit the MARCH Vision Care website
Make sure to look for providers who have “Medicaid” listed under the name column.
Use our provider search tool
We make it easy for you to get the medicine you need to feel better. You may have a copay when you see your medicine on our preferred drug list (PDL)/formulary. This is a list of medications we cover. Don’t see yours on the list? Ask your provider to find a similar medicine. And you can fill your prescription at any pharmacy in our network.
Your mental health is part of your overall health. If you need help with mental health or a substance use disorder, we’re here for you. We offer behavioral health treatment to our members who need some extra care. We’ll also connect you with local resources for more support.
Help in a crisis
Call 988 if you have a behavioral health emergency. This is the new number for the National Suicide Prevention Lifeline. Do you have thoughts of harming yourself or someone else? Their trained counselors can help you, 24 hours a day, 7 days a week. You can also chat online with a counselor through their Lifeline Chat service.
Or call our crisis line at 1-855-232-3596 (TTY: 711). Then, choose option 9.
You can use any hospital for emergency care, even if it isn’t in our network. Just show your member ID card.
Do you need help getting care? Our care management team is here for you. Care managers are nurses and social workers who understand your health conditions and help connect you to the right care. A care manager can help you learn more about your health, find a ride to your appointments and more.
Some diseases call for a little extra care. Our disease management program can help you. Our care managers can help you manage chronic conditions like asthma, diabetes, chronic obstructive pulmonary disease (COPD) and more.
Are you expecting a child? We’ll help you stay healthy during your pregnancy. Our programs can help you get the care and services you need. And you can earn rewards for making healthy choices.
You can read more about pregnancy and newborn services on our website. Or call Member Services.
We’ll help you get birth control counseling and supplies. You can see any in-network or out-of-network provider. Any family planning care that you get is private. You can call Member Services to choose a family planning provider. Or you can read more about family planning.
If you have no way to get to the hospital during an emergency, call 911. We cover ambulance rides on the ground in a medical emergency for all members.
You can also get rides to provider visits through Medicaid Fee-For-Service.
To learn more, you can call ModivCare (formerly LogistiCare) at 1-866-527-9933 (TTY 1-866-288-3133). Be sure to schedule rides at least two business days in advance.
When you call to schedule your ride, make sure to have this info ready:
Name of the provider
Address
Phone number
Appointment time
Type of ride needed (e.g., regular car, wheelchair van)
If you have any problems with the services, just call the ModivCare Complaint Hotline at 1-866-333-1735.
The Personal Preference Program (PPP) offers you greater control, flexibility, and freedom. You can choose who provides your care, what type of care you want and need, when you want care to be provided and where the care will be provided.
More information on the Personal Preference Program (PDF)
If you have any questions, please email ABHNJPPP@AETNA.com
For more information and additional resources, visit:
Self-directed services are home and community-based services that help you or a loved one with personal care needs maintain independence. Self-directed services allow for personal choice in what services will best meet personal needs, who will deliver those services, and when and where services are provided within program guidelines.
The New Jersey Personal Preference Program (PPP) offers a way for NJ FamilyCare/Medicaid members, who qualify for the Personal Care Assistant (PCA) service, to remain in their home, active in their community, and does not require the use of a home health care agency.
PCA services are non-emergent, health related tasks delivered under NJ FamilyCare. Tasks include help with activities of daily living (ADLs) and instrumental activities of daily living (iADLs) essential to the member's health and comfort, such as bathing, dressing, meal preparation, and light housekeeping.
You will work with a financial consultant (FC) to develop a monthly budget, through which you will decide on the services you need and the individuals and/or agencies you wish to hire to provide the identified services. If you are cognitively impaired or unable to make decisions on your own, you can choose an authorized representative to assist you.
The PPP provides fiscal management services to assist you with the financial aspects of the program. The managed care organization (MCO) contracts with a financial intermediary. The financial intermediary (FI) is responsible for providing you help to setup and manage payroll responsibilities, acting as your bookkeeping service for processing time sheets, withholding and submitting accurate tax payments, and issuing paychecks for your workers.
The PPP requires greater individual responsibility, but in return, offers you greater control, flexibility and choice over the services you receive.
Why Choose the personal preference program?
PPP allows you to:
- Select the home care services that best suit your needs
- Hire workers, including trusted individuals like friends, relatives, or neighbors
- Plan services according to your individual needs
- Enjoy greater independence and control over your life
Eligibility:
- NJ FamilyCare eligible. You can apply for NJ FamilyCare at your local County Social Service Agency or online
- Approved for Personal Care Assistant Services (PCA) and need PCA services for a minimum of at least six months
To qualify for PCA services, recipients must:
- Have NJ FamilyCare/ Medicaid
- Obtain a doctor’s order, prescription to receive the service (do not have to be permanently disabled).
- Live in a community-based residence, such as a private home, apartment, rooming house, boarding home or group home, skill development home, supervised apartment or other congregate living program where personal care is not provided as part of the service package included in the living arrangement.
- Have a documented need for hands-on personal care.
For further information or to begin application process
Contact Member services at 1-855-232-3596
- Remain on the line when asked if you are a healthcare provider
- Respond "no" when asked if you are a MLTSS member
- Remain on hold to speak to a Member Services Representative
Aetna Assure Premier Plus (D-SNP) at 1-844-362-0934 (Spanish dial 8)
MLTSS Members: contact your care manager or the Care Manager Line at 833-346-0122
Resources
NJ Department of Human Services Personal Preference Program
More information on the Personal Preference Program (PDF)
Population health management programs
These programs can help you live your healthiest life possible. We have special programs and services to help you get the care you need. And prevent health issues in the future.
Managed long-term services and supports (MLTSS)
Managed long-term services and supports (MLTSS)
Do you need extra support for long-term care? We’ll help you get the services you need so you can feel better. If you meet the state’s guidelines for needing a higher level of care, you may qualify for MLTSS benefits. You can get them from the comfort of your home or an assisted living home. We cover these MLTSS benefits:
Skilled nursing facility services (91+ days)
Personal care services
Self-directed personal help services
Community first choice option
Home- and community-based services
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Fee-For-Service
There are some services that you can get from Fee-For-Service. We don’t cover them, but NJ FamilyCare pays for them directly. You’ll need to show both your Aetna Better Health of New Jersey ID card and NJ FamilyCare card at the visit.
If you have a NJ FamilyCare C or D plan, you may have to pay a copay at your visit. All services must be medically necessary. And your provider may need prior approval before you can get some services.
If you need these services, let us know and we’ll help get you get connected. Just call your primary care physician (PCP). Or reach out to Member Services at 1-855-232-3596 (TTY: 711) to get started.
Be sure to check out the full list of covered services English (PDF) | Spanish (PDF), including those under Fee-For-Service (FFS).
Other language and format needs
We provide interpreter services free of charge during any service or grievance process. This includes American Sign Language and real-time oral interpretation. If you need something translated into a language other than English, just call us. We can also provide materials in other formats, too. Like braille, audio CD or large print. And if you need an interpreter for your medical visit, you can call us at 1-855-232-3596 (TTY:711). Be sure to call 48 hours before your visit.
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