Medicare and NJ FamilyCare: How Dual Coverage Works
How Medicare and NJ FamilyCare, New Jersey's Medicaid program, work together for people 65 and older or on disability: 2026 income limits, what each pays, dual-eligible plans and how to apply.
NJ FamilyCare is New Jersey's Medicaid program. People who have both Medicare and NJ FamilyCare are called dual eligible. Medicare pays first, and NJ FamilyCare can pick up Medicare premiums and cost-sharing and add benefits Medicare does not cover, such as dental and eyeglasses. For people 65 and older, blind or disabled, the state's Aged, Blind, Disabled (ABD) programs are the route in: in 2026 the New Jersey Care Special Medicaid program covers people with income up to $1,330 a month single and resources up to $4,000. This guide explains the programs, the limits, the plan choices that open up and how to apply.
The NJ FamilyCare Aged, Blind, Disabled programs
The ABD programs give medical coverage to people 65 or older and to people determined blind or disabled by Social Security or by the State of New Jersey, when their income and resources are not enough to meet the cost of care. You must live in New Jersey and be a citizen or qualified immigrant; the state's brochure notes an adult must have Legal Permanent Residence status for at least five years.
Covered benefits include doctor and specialist visits, hospital care, prescriptions, lab tests and X-rays, mental health and substance use care, rehabilitative care, dental and eyeglasses, and long-term services and supports for people who qualify.
| Program | Income, single | Income, couple | Resources, single / couple |
|---|---|---|---|
| SSI (Supplemental Security Income), which brings full ABD benefits automatically | $1,025.25 | $1,516.35 | $2,000 / $3,000 |
| Medicaid Only (no SSI, but under the SSI standards) | $1,025.25 | $1,516.35 | $2,000 / $3,000 |
| New Jersey Care Special Medicaid Programs (up to 100% of the federal poverty level) | $1,330 | $1,804 | $4,000 / $6,000 |
| Long-term services and supports, if clinically eligible | $2,982 | Not listed | $2,000 single |
Source: NJ FamilyCare Aged, Blind, Disabled Programs (2026 brochure).
Who pays first when you have both
Medicare is your primary coverage. Your doctor or hospital bills Medicare first, then NJ FamilyCare pays what it covers. With full NJ FamilyCare, the state often pays your Part B premium and Medicare cost-sharing as well, and Medicaid coverage qualifies you automatically for Extra Help with Part D (Medicare.gov).
Use doctors, hospitals and pharmacies that accept both Medicare and NJ FamilyCare, and show both cards at every visit.
Medicare Savings Programs: help even if you do not qualify for full coverage
Many people are over the ABD limits but still qualify for a Medicare Savings Program, which pays Medicare costs without full NJ FamilyCare benefits. For 2026, New Jersey lists yearly income limits of $15,960 single for QMB (which pays premiums and Medicare cost-sharing), $19,152 for SLMB and $21,546 for QI (which pay the Part B premium), with assets under $9,950 single or $14,910 married. Our guide to Extra Help and Medicare Savings Programs in New Jersey walks through them.
Drug coverage when you are dual eligible
When you have Medicare, your prescriptions are covered through Medicare Part D, not NJ FamilyCare. Because full NJ FamilyCare brings Extra Help, you pay no Part D deductible, and in 2027 no more than $5.80 for generics or $14.40 for brand-name drugs, with lower amounts for some full Medicaid members (CMS CY2027 Rate Announcement).
For 2027, two New Jersey basic standalone drug plans, Wellcare Classic and Humana Basic Rx Plan, are priced below the $36.28 low-income premium amount, so they cost $0 a month with full Extra Help (CMS 2027 Landscape). Note that New Jersey's PAAD program is not available to people who receive Medicaid.
Dual-eligible Special Needs Plans
A dual-eligible Special Needs Plan (D-SNP) is a Medicare Advantage plan built only for people who have both Medicare and Medicaid. It covers Medicare hospital, medical and drug benefits, and it is designed to coordinate with your NJ FamilyCare benefits.
For 2027, Camden County has 13 Special Needs Plans, 5 of them dual-eligible (CMS 2027 Landscape, via THE BRAIN). Which ones you can join depends on your level of NJ FamilyCare coverage, so Jackie checks your eligibility letter before comparing them.
| Plan group | Number of plans |
|---|---|
| Medicare Advantage plans, excluding Special Needs Plans | 41 |
| Special Needs Plans, all types | 13 |
| Dual-eligible Special Needs Plans | 5 |
| Chronic condition Special Needs Plans | 5 |
| Institutional Special Needs Plans | 3 |
Source: CMS Medicare Advantage and Part D Landscape, contract year 2027 (New Jersey counties).
Long-term services and supports (MLTSS)
Long-term services and supports are extra help for people who need assistance with three or more activities of daily living, such as moving around, dressing, bathing or eating. They can be provided in a nursing home, an assisted living setting or at home, with services such as personal care, home-delivered meals and care management. In New Jersey these are delivered through Managed Long Term Services and Supports (MLTSS).
You must be both clinically eligible, decided by the Division of Aging Services, and financially eligible, decided by your county welfare agency. In 2026 a person who is clinically eligible qualifies at a higher income limit of $2,982 a month with resources up to $2,000. If income is over the limit, a Qualified Income Trust can hold the excess. The financial review includes a five-year look-back at accounts and transfers, so you must disclose all income and resources from the past five years.
Another option for some people is PACE, the Program of All-Inclusive Care for the Elderly, which the state notes is only available in certain counties. Your county Office on Aging can tell you whether PACE serves your area.
How to apply
- All the ABD programs use one application. Apply online, print and mail the application, or apply through your County Social Service Agency (county welfare agency). The state says an in-person interview is not required to apply.
- For help with the application, call NJ FamilyCare at 1-800-356-1561.
- In Camden County, the Camden County Board of Social Services is at (856) 225-8800. Other South Jersey numbers: Burlington (609) 261-1000, Gloucester (856) 582-9200, Cumberland (856) 691-4600, Atlantic (609) 348-3001, Cape May (609) 886-6200, Salem (856) 299-7200, Ocean (732) 349-1500. Union County: (908) 558-2288.
- If the state cannot verify your information electronically, it may ask for proof of identity, age, citizenship, income and what you own. Answer any letter quickly: missing a deadline can lead to a denial.
- The application packet includes an estate recovery notice and a short explainer. Estate recovery is the state's program for recovering certain Medicaid costs from an estate after death; read the notice so you know how it applies before you sign.
What Jackie checks for you
If you have, or might qualify for, NJ FamilyCare, Jackie reviews these before any plan comparison:
- Your level of help: full NJ FamilyCare, or a Medicare Savings Program only. That decides which plans you can join.
- Whether a 2027 dual-eligible Special Needs Plan in your county includes your doctors and hospitals.
- Whether your drug plan is one of the New Jersey basic plans with a $0 premium under full Extra Help.
- Whether a Medigap policy you pay for is still worth keeping, since NJ FamilyCare and QMB pick up the same costs.
Questions to ask
- Do I have full NJ FamilyCare benefits or a Medicare Savings Program only?
- Will the state pay my Part B premium, and from what month?
- Which of my doctors accept both Medicare and NJ FamilyCare?
- If I need help at home later, how do I start the clinical review for MLTSS?
The bottom line
If you are 65 or older or on disability with limited income and savings, NJ FamilyCare can work alongside Medicare: the state can pay your premiums and cost-sharing, Extra Help lowers drug costs, and dual-eligible Special Needs Plans coordinate both. Apply online, by mail or through your county, or call 1-800-356-1561. Then let Jackie compare the 2027 plans open to you, at no cost, by phone, Zoom or in person: (856) 727-4221.
Want to go through this with someone?
Jackie Layser will go through your doctors, your prescriptions and your real numbers by phone, Zoom or in person, and explain plainly what we found. Solutions You Can Count On.
Prefer to talk it through? Book a no-cost consultation by phone, Zoom or in person, and find official Medicare forms and publications on our Resources page.
Sources
- NJ FamilyCare Aged, Blind, Disabled Programs (2026 brochure), NJ Division of Medical Assistance and Health Services (NJ FamilyCare)
- NJ FamilyCare: Aged, Blind, Disabled program information and application, NJ Division of Medical Assistance and Health Services (NJ FamilyCare)
- NJ Medicare Savings Programs (2026 income and asset limits), NJ Division of Aging Services
- Medicare Savings Programs, Medicare.gov (CMS)
- CY2027 Medicare Advantage and Part D Rate Announcement, Centers for Medicare & Medicaid Services
- CMS Part D Landscape, contract year 2027 (New Jersey PDP region 04), Centers for Medicare & Medicaid Services
- CMS Medicare Advantage and Part D Landscape, contract year 2027 (New Jersey counties), Centers for Medicare & Medicaid Services
- NJ county welfare agencies (boards of social services), New Jersey Department of Human Services
- NJ County Offices on Aging (Area Agencies on Aging and ADRC), NJ Division of Aging Services
Please note: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. Garden State Medicare Solutions is not connected with or endorsed by the United States government or the federal Medicare program. Medicare has neither endorsed nor reviewed this information.