NJ FamilyCare

Medicaid

Our NJ FamilyCare plan is for children, parent or caretaker relatives, and adults without dependent children. It’s also for people who need extra support and care to live safely at home. You qualify based on income and health care needs. View the benefits below to see all that our plan offers.

This plan is available wherever you live in New Jersey.

More information on eligibility and enrollment can be found on the NJFamilyCare website.

Available ang planong ito sa lahat ng county.

Mga Pakinabang at Feature

Pangangalaga Habang Walang Sakit at Kapag May Sakit

Get the care you need to be at your best — or to get better if you are injured or sick. That includes:

  • Well Visits. Preventive checkups, shots and lab tests.
  • Therapy Services. Physical or other therapy to help you be your best.
  • Lab and X-rays. Lab tests, x-rays and diagnostic imaging are covered.
  • Shots and Vaccines. Routine shots to help keep you healthy.
  • Urgent Care. Immediate care for a sudden illness or injury.

Wala nang mas mahalaga pa sa kalusugan at kapakanan mo at ng iyong sanggol. That's why our plan benefits include:

  • Choice of Doctor. Find an OB-GYN you trust in our network.
  • Prenatal Visits. Care for you before your baby is born.
  • Healthy First Steps®. Extra support to help you and your baby stay healthy.
  • Choice of Birth Center. Pick from over 100 network hospitals across New Jersey.

Kung mayroon kang hika, diabetes o isa pang pangmatagalang kundisyon, maaasahan mo kami. Tinitiyak ng aming plano na nakukuha mo ang pangangalaga, suporta at mga serbisyong kailangan mo. Kabilang sa mga benepisyo ang:

  • Pamamahala sa kaso. Personal support from an experienced professional.
  • Diabetic Supplies. Insulin, needles and more ordered by your doctor.

Make sure your sight, teeth, speech and hearing are at their best. Kabilang sa mga benepisyo ang:

  • Vision. Routine exams and help paying for eyeglasses and contact lenses.
  • Dental. We cover cleanings, checkups and dental work.
  • Hearing. Tests, check-ups and hearing aids are covered (some limitations apply).

Understanding Dental Coverage - English Spanish

Get the medical care and equipment you need to recover safely at home. Benefits may include:

  • Kagamitan at Mga Supply. Ang medikal at pangkaligtasang kagamitan sa tahanan ay sinasaklaw.
  • Nurse Visits. Medical care to help you safely recover at home.
  • Chore Services. Isang taong tutulong sa iyong gawin ang mga utos, paglilinis o paglalaba.
  • Personal Care. Someone to help with dressing, bathing and feeding if needed.

Kung minsan, maaaring kailanganin mo ng kaunting karagdagang tulong sa paggamit ng iyong planong pangkalusugan. Para sa mga pagkakataong iyon, maaari kang umasa sa:

  • Interpreters. An interpreter can go with you to medical visits.
  • Mga Serbisyo sa Miyembro. Your benefit questions are answered 24/7.

The MLTSS program is focused on serving frail, elderly, and disabled individuals. This program combines traditional health care benefits (doctor visits, hospital stays, labs) and long term services and supports (providing help in home or community with daily living activities) such as:

  • Pamamahala sa Pangangalaga. Someone to get you the care and support needed.
  • Home and Vehicle Modifications. In-home medical and safety equipment are covered, plus needed modifications to a vehicle.
  • Home Meal Delivery. If you can't safely make meals, we'll provide them.
  • Mental Health & Addiction Services. Saklaw ang pagpapayo at iba pang mga panggagamot.
  • Personal Emergency Response System. Sends an urgent request for someone to help you.
  • Adult Day Care. Friendship and social activities in a safe setting.
  • Respite na Pangangalaga. Tulong sa tahanan upang makapagpahinga ang iyong caregiver.
  • Personal Care. Someone to help with dressing, bathing and dining.

Learn more about the MLTSS program here.

Adult Day Care

Companionship is important. Adult day care provides care and companionship for seniors who need extra help during the day.

Caregivers also benefit, knowing their loved one is well cared for and safe during the day.

Services will vary by the member's coverage type and may include:

  • Social connections and friendship.
  • Bathing and personal care.
  • Meals.

Caregiver Training*

For MLTSS members: Caring for a loved one or a friend is an act of love and devotion. It can also leave the caregiver emotionally and physically exhausted.

Our workshops teach:

  • Caregiving basics.
  • Healthy eating and help with eating.
  • Health insurance basics.
  • How to care for yourself while caring for a loved one.
  • Caring for a loved one with dementia or Alzheimer's disease.

Along with instruction, caregivers have an opportunity to socialize with others and build a network of support.

Care Management*

Do you or a loved one have a serious health problem or a high-risk pregnancy? If so, our care managers are in your corner. They will:

  • Explain medical terms in plain language.
  • Coordinate your doctor appointments.
  • Provide your care team with your medical records.

Your care manager will stay close by throughout the medical journey. He or she will:

  • Think beyond your immediate medical needs.
  • Make sure you have support at home, so you can focus on getting better.

Pagpili ng Doktor

You or your child gets a primary care provider (PCP) who is your main doctor. Use the Doctor Lookup tool to see if your doctor is in our network.

If you don't have a doctor, or if your doctor is not in our network, we can help you find a new one close to you.

Ang iyong PCP ay ang iyong pangunahing doktor para sa:

  • Pampigil na pangangalaga.
  • Panggagamot kung mayroon kang sakit o pinsala.
  • Mga referral sa mga espesyalista para sa ilang partikular na kundisyon.

Pagpili ng Birth Center

Mahalagang pumili ng ospital kung saan ka manganganak. That's why you can pick from 100 network hospitals across New Jersey.

We also encourage you to tour the hospital's birthing center. Nang sa gayon ay maging pamilyar ka rito. And you'll be more relaxed when you have your baby.

Community Transition Services*

For MLTSS members: We want to help you live in the place that is right for you. If needed, our plan will help cover the cost of moving from a nursing facility into your community.

Covered items can include:

  • Household goods.
  • Security deposit.
  • Utility deposit.
  • Your first week of food, as needed.

Chore Services

If you are having difficulty performing day-to-day household activities, chore services can step in. They can take on the routine tasks that may be hard for you to do on your own.

Services will vary by the member's coverage type and may include:

  • Running errands.
  • Paglilinis ng bahay.
  • Doing laundry.
  • Paghahanda ng mga pagkain.

Pangangalaga sa Ngipin

Routine exams and cleanings every six months help keep teeth and gums strong and healthy. If there is a dental problem that needs to be fixed, that's covered as well. If approved, the plan covers:

  • Crowns and bridges.
  • Dentures.
  • Oral surgery and root canals.

Understanding Dental Coverage - English Spanish

Diabetic Supplies

If you have diabetes, you may need insulin, needles, wipes and glucose strips. If medically necessary, we cover all that and more.

Ang aming plano ay may kasama ring mahuhusay na serbisyo upang tulungan kang mapamahalaan ang iyong diabetes, kabilang ang:

  • Classes on keeping diabetes in control.
  • Pag-coordinate sa pangangalaga ng doktor.
  • Pagpaplano sa pagkain at pagpili ng mga pagkain.

Mga Kagamitan at Supply

Ang iyong kalusugan at kaligtasan sa tahanan ay mahalaga.

Our plan covers medical equipment ordered by your doctor or case manager. Kabilang rito ang mga gamit tulad ng:

  • Mga kama sa ospital.
  • Oxygen tanks.
  • Wheelchairs or wheelchairs.

Pangangalaga sa Pandinig

Ang problema sa pandinig ay maaaring makaapekto sa iyong pang-araw-araw na pamumuhay sa maraming paraan. Kabilang sa aming plano ang mga serbisyo at suporta upang matulungang protektahan ang iyong pandinig.

Sinasaklaw namin ang:

  • Exams, therapy and tests.
  • Hearing aids and batteries.

Some limitations apply.

Healthy First Steps®

Maaari kang makatanggap ng tulong at pagpapayo mula sa iyong ina, mga tita, kapatid at kaibigang babae. Gayunpaman, magkakaiba ang bawat pagbubuntis. Susuportahan ka ng programang ito sa kabuuan ng iyong pagbubuntis.

Tutulungan ka naming:

  • Find a doctor for you and your baby.
  • Learn resources for nutrition, fitness and safety.
  • Get supplies, including breast pumps for nursing moms.

Home Meal Delivery*

For MLTSS members: Taking care of the basics, like cooking, can be hard to do yourself after an illness or sickness. That's why we'll bring nutritious meals to you to help you through tough times. You can get up to 1 meal delivered per day, if needed.

Pagkakaospital

Our plan pays for all expenses related to a hospital stay, so you can rest and heal.

Sinasaklaw ng aming plano ang:

  • Pangangalaga ng isang nurse.
  • Kwarto at matutuluyan.
  • Mga supply at kagamitan.
  • Panggagamot at mga therapy.
  • Mga diagnostic na pagsusuri at eksaminasyon.

At pagkalabas mo sa ospital, hindi ka mag-iisa. Titiyakin naming makakakuha ka ng follow-up na pangangalaga upang maipagpatuloy ang pagpapagaling sa tahanan.

Interpreters

Your doctor and you need to understand each other. Not speaking English well makes this difficult. We can arrange for a medical interpreter to be at your appointment.

We also have people at our phone centers who speak more than one language. Chances are, we have someone who speaks your language.

Lab and X-ray Services

Napakainam na malaman nang maaga pa lang kung ano ang problema.

  • Mga laboratoryo at pagsusuri.
  • Mga x-ray, scan at iba pang imaging.

We'll help you get the information needed to improve your health or be at your best.

Medicines

Our plan includes medicines and refills for prescriptions written by your doctor or specialist. Thousands of drugs are covered.

We also cover some over-the-counter medicines with a written order from your doctor.

And we make getting your medicine easy. You can fill your prescriptions at:

  • Local pharmacies in our network.
  • Services that deliver right to your door.

Mga Serbisyo para sa Miyembro

Sometimes you might need a little help understanding your health care options. With us, you have someone you can call 24/7. We'll answer your questions simply and completely.

Maaari ka rin naming tulungang humanap ng:

  • Mga doktor.
  • Mga parmasya.
  • Mga ospital o iba pang mga pasilidad na pangkalusugan.
  • Mga lokal na mapagkukunan.

Nurse Visits

Sometimes you may need continued care after you leave the hospital or urgent care center. If your health is at risk after a serious illness, surgery or injury, a nurse will visit you at home to:

  • Provide medical care for you.
  • Answer your questions and concerns.

Personal Care

Sometimes the basics are hard to do yourself after an illness or injury.

Services will vary by the member's coverage type and may include:

  • Dressing.
  • Bathing.
  • Feeding.

Mga Pagpapatingin Habang Nagbubuntis

A pregnancy is a journey you'll want to make with the help of friends, family and a pregnancy doctor, or OB-GYN.

Ang lahat ng iyong inirerekomendang pagpapatingin at pagpapasuri sa klinika habang nagbubuntis ay sinasaklaw.

Sa mga pagpapatinging ito, ang klinika ay:

  • Titiyaking malusog kayo ng iyong sanggol.
  • Ipapaliwanag kung ano ang dapat asahan sa bawat yugto ng iyong pagbubuntis.
  • Sasagutin ang iyong mga tanong.

Respite Care*

For MLTSS members: Mayroon ka bang mga kapamilya o kaibigan na nag-aalaga sa iyo sa tahanan? Kung mayroon, hinihiling naming suportahan sila sa kanilang pagsusumikap. That's why we provide respite care to give your caregivers a rest. Ang respite na pangangalaga ay nag-aalok sa mga caregiver ng pansamantalang bakasyon malayo sa kanilang mga mahal sa buhay na may karamdaman o mga espesyal na pangangailangan sa pangangalaga.

Shots and Vaccines

Routine shots help keep you healthy.

Sinasaklaw ng aming plano ang:

  • Recommended shots and vaccines.
  • Mga diagnostic na pagsusuri at eksaminasyon.

Therapy Services

Physical, occupational and speech therapy can help you recover from a serious injury or illness, or simply reach your full potential.

Our plan provides:

  • Occupational therapy.
  • Physical therapy.
  • Speech therapy.

Urgent Care

You may have an injury or sudden illness that is not life-threatening but needs immediate attention.

Our plan covers care at:

  • Mga center ng agarang pangangalaga.
  • Medical aid units.
  • Other walk-in clinics.

Pangangalaga sa Paningin

You'll get the care, eyeglasses and treatment that let you see life more clearly.

Kasama sa saklaw ang:

  • Routine exams.
  • Help with paying for eyeglasses and contact lenses.

This benefit is offered by March Vision.

Mga Pagpapatingin Habang Walang Sakit

Makakatulong sa iyo ang mga pagpapatingin habang walang sakit sa iyong doktor na manatiling malusog. These visits can catch health problems early, so they can be treated.

Kabilang sa mga serbisyong pang-iwas sa sakit ang:

  • Checkups for adults and children.
  • Well-baby care.
  • Care for women expecting a baby.
  • Routine shots and tests.
  • Mga mammogram.

There are no copayments for preventive care.

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