• Healthfirst offers Medicare Advantage plans to select counties in New York state, including New York City.
  • Most plans offered are HMOs that don’t require a referral for in-network providers.
  • Some Healthfirst plans are Special Needs Plans, which are offered to those who are eligible for both Medicare and Medicaid.

Healthfirst is a private insurance company that offers Medicare Advantage plans in New York state. The company currently has more than 1.6 million members enrolled in its various health plans.

Read on to find out more about the Medicare Advantage plans that Healthfirst offers to residents who live in certain areas of New York.

Healthfirst currently offers Medicare Advantage plans only in New York state. Covered cities include New York City and those on Long Island, as well as Orange, Rockland, Sullivan, and Westchester counties.

If you’re curious whether Healthfirst offers a Medicare Advantage plan in your area, you can use Medicare’s plan finder tool.

Healthfirst offers several types of Medicare Advantage plans. Availability will depend on where you live. Let’s go over each type of plan and what it offers.

Healthfirst Medicare Advantage HMO plans

A Health Maintenance Organization (HMO) is a common approach for Medicare Advantage plans. Under an HMO plan, you’ll usually seek care from your plan’s network of providers.

If you choose an out-of-network provider, you may have to pay more or the service may not be covered.

Healthfirst’s Medicare Advantage plans are HMO plans. They don’t require a referral from your primary care doctor if you want to see an in-network specialist.

Here’s an overview of each of Healthfirst’s HMO plans.

Coordinated Benefits Plan (HMO)

This HMO plan has a $0 monthly premium but does not include prescription drug coverage. Healthfirst recommends this plan if you have other prescription drug coverage. This could be through an employer, union, or another insurance source.

The plan provides all the benefits of original Medicare (parts A and B), plus:

Increased Benefits Plan

This HMO plan is for those who qualify for Extra Help, a program that helps people who have Medicare pay for prescription drugs. Benefits associated with this plan include all the coverage of the Coordinated Benefits Plan, plus:

  • prescription drug coverage
  • over-the-counter (OTC) allowance of $15 per month for the purchase of OTC items (approved non-prescription drugs and health-related items)
  • acupuncture coverage

65 Plus Plan

This $0 monthly HMO Advantage plan is for those who would like Healthfirst coverage and aren’t enrolled in Extra Help, a Medicare savings program, or Medicaid. Aside from the basic coverage, added benefits are similar to those in the Increased Benefits Plan.

Signature HMO

This $0 monthly premium Medicare Advantage plan includes and access to a specially-trained member services team to help you with your healthcare choices. The plan provides all the benefits of the 65 Plus Plan, plus:

  • Choice Extra over-the-counter (OTC) allowance of $35 per quarter in the form of a Healthfirst OTC card with your pre-funded monthly amount
  • nutrition counseling of up to six sessions per year

Healthfirst Medicare Special Needs Plans

Healthfirst offers two Special Needs Plans (SNPs). These are HMO plans specifically designed for those who qualify for both Medicare and Medicaid. Here are some details about Healthfirst’s two SNP options.

Healthfirst Life Improvement Plan

This is a plan for subscribers who are eligible for both Medicare and Medicaid or are eligible for cost-sharing assistance from Medicaid. The Life Improvement Plan is an HMO that doesn’t require you to get referrals to see in-network specialists.

Some of the plan’s major offerings include:

  • prescription drug coverage
  • dental
  • hearing exams and hearing aids
  • vision exams plus eyeglasses
  • over-the-counter medication benefit of $1,740 per calendar year ($145 per month)
  • SilverSneakers fitness program
  • acupuncture
  • routine transportation (nonemergency)
  • meal delivery

Eligible service areas for this plan include those within New York City, as well as Nassau, Orange, Sullivan, and Westchester counties.

CompleteCare

This HMO plan is also for subscribers who are eligible for Medicare and Medicaid. The plan offers a primary care manager. This is a point person who acts as a manager for your day-to-day health needs. This manager also helps identify health concerns for those who need in-home care and long-term medical care services.

Benefits associated with this plan include all of the coverage in the Healthfirst Life Improvement Plan, plus adult day healthcare and home care.

Most Medicare Advantage plans through Healthfirst offer Part D coverage. But Healthfirst doesn’t offer separate Medicare Part D plans. This means your Part D coverage will be bundled into your plan instead.

Healthfirst plans that have Part D coverage include:

  • Increased Benefits Plan (HMO)
  • 65 Plus Plan (HMO)
  • CompleteCare (HMO SNP)
  • Life Improvement Plan (HMO SNP)
  • Signature (HMO)

If you wish to purchase a separate prescription drug plan, you can do so from another company.

Healthfirst Medicare Advantage plans offer the traditional coverage under original Medicare, plus additional services. You can refer to the specific plan’s information regarding costs for these services. Some are offered with $0 copayment.

Healthfirst plans include the following:

Preventive care and exams

Original Medicare doesn’t cover some of the medical services that you might consider essential. Healthfirst plans may offer some of them, including:

  • dental
  • hearing and hearing aids
  • vision and eyeglasses

Other benefits

Some Healthfirst programs also offer additional benefits, such as:

  • SilverSneakers fitness program
  • transportation to medical appointments
  • acupuncture

The following are some examples of Healthfirst’s Medicare Advantage plans and their costs in different locations for 2021.

Healthfirst Coordinated Benefits Plan (HMO) Healthfirst Increased Benefits Plan (HMO)Healthfirst 65 Plus Plan (HMO), Central Bronx Healthfirst Life Improvement Plan (HMO SNP), White PlainsHealthfirst Complete Care (HMO SNP), Manhattan
Monthly premium with drug coverage$0 (no drug coverage with this plan)$0$0$0$0
Health plan deductible per year$0$0$0$0$0
Drug deductible per yearN/A$0 or $92$350
for
tier 2–5
prescription drugs
$0 or $92$0
In-network out-of-pocket max$7,550$0$6,700$3,450$3,400
Primary doctor copay per visit$10$0$10$0$0
Specialist copay per visit$35$40$45$0$0

These are just some examples of available Healthfirst plans by ZIP code. You can use Medicare’s compare plan tool to find out more about each of these plans and the costs in your area.

Medicare Advantage, or Part C, is an alternative to original Medicare (Part A and Part B) where a private insurance company contracts with Medicare to provide your health benefits.

You may prefer a Medicare Advantage plan if you’d like extra coverage for things that traditional Medicare doesn’t cover, such as prescription drug benefits or vision, dental, and other services.

Medicare Advantage plans aren’t uniform — they usually vary by company and region. This is because the plan typically contracts with providers and healthcare organizations in your area to become “in network,” which helps them offer cost savings to you.

While some Medicare Advantage plans have a monthly premium, others do not. You may still pay your Medicare Part B premium, however, depending on the Medicare Advantage plan you choose.

Medicare Part D is the portion of Medicare that covers prescription drugs. If you’re 65 years old or over, you’re required to have some form of prescription drug coverage. This can be through Medicare Advantage or a separate prescription drug plan.

Each Part D plan has a formulary. This is a listing of medications the plan covers. Medicare requires each formulary to cover at least two medications in major categories, such as those prescribed to treat hypertension, hyperlipidemia, or diabetes.

If a medication isn’t on a plan’s formulary, it will likely be more expensive for you. Some people ask their doctor if it’s possible to switch to a medication that is on their plan’s formulary as a way to save money.

Healthfirst offers several Medicare Advantage plans to those living in certain areas of New York state. The plans largely use an HMO model and also include SNPs for those who need long-term care or are also enrolled in Medicaid.

You can visit Medicare.gov or call Medicare at 800-MEDICARE (800-633-4227) to find out more about available Medicare Advantage plans.

This article was updated on November 19, 2020, to reflect 2021 Medicare information.

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