Healthfirst Medicare Advantage plans provide all the benefits and services that Original Medicare does, plus a whole lot more—for less. We offer a variety of plans to meet your needs, with benefits such as prescription drug coverage; over-the-counter allowance; dental, hearing, and vision benefits; the SilverSneakers® fitness program; 24/7 access to care via phone or video chat; and the option to go out of network for care. With Healthfirst Medicare Advantage plans, you can enjoy enhanced coverage and added convenience for your healthcare needs.
Healthfirst Long-Term Care plans provide health benefits that help you (or your loved one) remain at home and independent for as long as possible. We offer plans that combine hospital, medical, and prescription drug coverage with long-term care benefits, as well as a stand-alone managed long-term care plan option. With Healthfirst Long-Term Care plans, you’ll have access to a care management team, which includes a primary care manager and other support staff who will help you develop your own personal care plan centered around your care goals and coordinate the services you need. Together, they will help you (or your loved one) with your day-to-day needs and coordinate care with you, your doctor, and your family.
Healthfirst offers a variety of plans designed to meet your unique needs. See below for plan details or call us for more information.
The amount you must pay in covered expenses each year before your plan or program pays anything for certain covered services. The deductible may not apply to all services. There may be different deductibles for different services (e.g., medical vs. pharmacy). Not all plans require deductibles. This is separate from a monthly premium payment. Example: If your deductible is $500, you need to spend $500 for covered healthcare services within one year before your plan or program will start paying for your health services. Your deductible resets once every year.
A federal program to help people with limited income and resources pay Medicare prescription drug program costs like premiums, deductibles, and coinsurance.
The amount you must pay monthly, quarterly, or twice a year to be covered by a health insurance plan or program.
SilverSneakers is a Medicare fitness program that uses exercise and social opportunities to promote well-being among seniors.
This Medicare Advantage Prescription Drug plan is for those who want the flexibility to go out of network and visit any doctor and hospital in the U.S. that accepts Medicare. In addition to a $0 monthly plan premium, prescription drug coverage, and copays as low as $0, it offers dental and vision benefits with no additional premium and a Flex card that can be used for dental, vision, and hearing out-of-pocket costs.
This Medicare Advantage Prescription Drug plan is for those who want the flexibility to pick a benefit that best suits their needs. It is a $0 premium plan that provides a choice of supplemental benefits (OTC card or transportation), prescription drug coverage, and low or no copays, with more than what Original Medicare offers.
This Medicare Advantage Prescription Drug plan is for those who qualify for Extra Help (also known as Low Income Subsidy (LIS), which helps to lower prescription drug costs. It offers a $0 monthly plan premium,* prescription drug coverage, an OTC Plus card, and low or no copays.
*If you qualify for Extra Help, your monthly premium will be $0. If you lose Extra Help, your monthly premium may be $36.10.
This Medicare Advantage Prescription Drug plan is for those who are eligible for Medicare and who are also receiving full Medicaid benefits or cost-sharing assistance from Medicaid. It offers a $0 monthly plan premium, $0 for most covered prescription drugs, an OTC Plus card, and low or no copays.
This Medicare Advantage Prescription Drug plan is for those who are eligible for Medicare and who are also receiving full Medicaid benefits or cost-sharing assistance from Medicaid. It offers a $0 monthly plan premium, OTC Plus card, prescription drug coverage, and low or no copays.
Learn about Coverage Decisions, Appeals, and Complaints for Medicare Plan Members
You also have the option to submit complaints/grievances directly through Medicare.gov
The Inflation Reduction Act is a prescription drug law will help people with Medicare save money on their prescription drugs. Here’s how the new law benefits you:
Finding a Medicare Advantage plan that works for you depends on your needs (e.g., if you need long term care, health coverage outside of NY, or want to save on OTC items, etc.), and your budget. It can be complicated so we would recommend that you talk to one of our Medicare Advantage plan specialists for free guidance. There’s no obligation to enroll. We can help you find out if you qualify for financial assistance, and even help you apply.
A Health Maintenance Organization (HMO) is a type of Medicare Advantage Plan (Part C) offered by a private insurance company, such as Healthfirst. When you have an HMO, you generally must get your care and services from doctors, other health care providers, and hospitals in the plan's network, except emergency care, out-of-area urgent care, and temporary out-of-area dialysis. A HMO D-SNP is an HMO Medicare Advantage plan for dual-eligible special needs plan. That means these plan members are eligible for both Medicare and Medicaid. There are eligible for extra plan benefits and savings.
Extra Help (also known as the Low Income Subsidy “LIS”) is a program to help pay Part D (Medicare prescription drug coverage) costs for beneficiaries with limited income and resources. This financial assistance helps to reduce or eliminate the beneficiary's Part D premium, and significantly lower their cost-sharing for covered drugs. Beneficiaries are eligible for Extra Help if they have:
Call us to learn if you qualify for Extra Help and how you can apply. (aging.ny.gov )
To enroll in a Healthfirst Medicare Advantage plan (Part C), you must meet the following requirements:
You can become eligible for Medicare Part A and Part B when you turn 65 or if you've received disability benefits from the Social Security Administration or Railroad Retirement Board for 24 months. You may also be eligible for Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (Lou Gehrig's disease).
Healthfirst is New York’s largest not-for-profit health insurer, offering high-quality, affordable plans to fit every life stage, including Medicaid plans, Medicare Advantage plans, and long-term care plans. We’ve been serving communities in New York City for more than 30 years, and now we have close to 2 million members and growing. Our members have access to a large network of healthcare providers, including thousands of doctors and specialists. Want to talk to us in person? Our community offices are conveniently located throughout the five boroughs, Long Island, Westchester and Orange County, and is fully staffed with representatives who can answer questions—in many different languages—about our health insurance plans and benefits, whether you’re a member or not.
We’re happy to answer your questions. Our service center's hours are:
Request a call and our sales team will call you within one business day.
You can also visit our Virtual Community Office to connect with a local Healthfirst representative or to find a community office near you.
100 Church Street, New York, NY 10007
If you receive Medicaid and want to know whether you are eligible for a managed long-term care plan, you can call the New York Independent Assessor (NYIA) formerly Conflict-Free Evaluation Enrollment (CFEEC) at 1-855-222-8350, Monday to Friday, 8:30am–8pm, and Saturday, 10am–6pm, to schedule their initial assessment.
Coverage is provided by Healthfirst Health Plan, Inc., Healthfirst PHSP, Inc., and/or Healthfirst Insurance Company, Inc. (together, “Healthfirst”). Healthfirst Medicare Plan has HMO and PPO plans with a Medicare contract. Our SNPs also have contracts with the NY State Medicaid program. Enrollment in Healthfirst Medicare Plan depends on contract renewal..
Coverage for Senior Health Partners Managed Long-Term Care Medicaid Plan is provided by Healthfirst PHSP, Inc.
Healthfirst complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-305-0408 (TTY 1-888-867-4132). 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-866-305-0408 (TTY 1-888-542-3821).
Plans above reflect amounts after Extra Help or Medicaid secondary coverage has been applied.
This information is not a complete description of benefits. Contact the plan for more information. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.
Dental services must be medically necessary; limitations and exclusions apply.
OTC items are subject to the plan’s list of eligible items and the plan’s participating network of retail, online, and utility providers.
Plans vary by service area. Out-of-network healthcare services may have higher costs. Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
SilverSneakers is a registered trademark of Tivity Health, Inc.© 2024 Tivity Health, Inc. All rights reserved.
DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.
EyeMed® is contracted with Healthfirst to provide vision benefits to its members.
Modivcare and Medical Answering Services provide the covered transportation services under your plan.
Last update September 27, 2024 @ 1:08 pm
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