More changes are coming to Medicare, and they will start to impact 2026 Medicare Advantage plans. We know the changes can be a bit confusing, and Healthfirst is here to help you.
Serving New Yorkers for more than 30 years, today Healthfirst helps two million members navigate the world of healthcare and makes it easy where we can. Let us help you understand the latest changes to Medicare and explain how they might affect you.
If you have any questions, please call us at one of the numbers below. Our team of Medicare specialists is here to help.
Beginning in 2026, Medicare will begin to have new eligibility requirements for enrollment in Dual-Eligible Special Needs (D-SNP) Plans. These are plans for those with both Medicare and Medicaid. The new requirements could mean some enrollees need to change plans for 2026.
How will this impact you?
If you do not have full Medicaid and would like to be screened to see if you qualify, call 1-866-889-2524.
Another change beginning in 2026 is new rules for some dual-eligible special needs plans (including the Healthfirst Life Improvement Plan and the Healthfirst Connection Plan) and OTC card benefits.
While all Healthfirst members can still use their OTC Plus card for over-the-counter items, Medicare members everywhere will now have to qualify to be able to use their OTC Card for food and utilities. These qualifications include having a chronic condition such as:*
If you are a current Healthfirst member as of October 1, 2025:
Healthfirst will review your prior claims to see if you have one of the qualifying conditions. Most Healthfirst members qualify.
If you will be a new Healthfirst member:
Once you become a Healthfirst member, you’ll need to give one of your doctors a Provider Attestation Form for them to complete, sign, and submit. The form simply states you have an eligible chronic condition. You can download the form here.
Another change beginning in 2026 is new rules for some dual-eligible special needs plans (including the Healthfirst Life Improvement Plan and the Healthfirst Connection Plan) and OTC card benefits.
While all Healthfirst members can still use their OTC Plus card for over-the-counter items, Medicare members everywhere will now have to qualify to be able to use their OTC Card for food and utilities. These qualifications include having a chronic condition such as:*
If you are a current Healthfirst member as of October 1, 2025:
Healthfirst will review your prior claims to see if you have one of the qualifying conditions. Most Healthfirst members qualify.
If you will be a new Healthfirst member:
Once you become a Healthfirst member, you’ll need to give one of your doctors a Provider Attestation Form for them to complete, sign, and submit. The form simply states you have an eligible chronic condition. You can download the form here.
Due to the changes from Medicare, you may see some increases in prescription drug copays and deductibles. Any changes will depend on the plan you are enrolled in and the medications you take, so it’s best to check your plan’s 2026 ANOC (Annual Notice Of Change) and your 2026 drug list for specific costs. You should also continue to speak to your doctor to ensure you are paying the lowest amount for your prescriptions.
Healthfirst is committed to making sure our members get all the savings they qualify for. Our Medicare Specialists are trained in the different savings programs offered by New York State and the federal government. When you call, we can see if you’re eligible to save and can even help you apply. These savings could help offset any potential cost increases you may see due to the Medicare changes. So be sure to call 1-866-889-2524.
Our specialists can work with you to find the best plan for you. We can also help you find any savings programs that you may qualify for, including Medicaid, Medicare Savings Program, Low-Income Subsidy, Extra Help, and more.
Whether you are already a Healthfirst member or shopping for a new plan, call one of our Medicare specialists today at 1-866-889-2524, and let’s check your eligibility.
*Healthy foods and home utilities are special supplemental benefits for members enrolled in a Healthfirst dual-eligible special needs plan. To be eligible, you must have a chronic condition such as cardiovascular disorder, disabling mental health condition, diabetes, lung disorders, obesity, or another eligible condition not listed. Benefit eligibility is not based on your chronic condition alone.
If you’d like to learn more about the new Medicare changes, or have questions, give us a call and we can help.
October to March, 7 days a week, 8am–8pm;
April to September, Monday to Friday, 9am–8pm
October to March, 7 days a week, 8am–8pm;
April to September, Monday to Friday, 8am–8pm
Many of the changes are outlined at the top of this page and include new rules for Dual-Eligible Special Needs (D-SNP) Plans.
That depends on which plan you have and whether you qualify for both Medicare and full Medicaid. If you have a Dual-Eligible Special Needs Plan, you may see changes. If you’re not sure, call Healthfirst and we can help.
While Healthfirst D-SNP members can still use their OTC Plus card for over-the-counter items, they will now have to qualify to be able to use their OTC card for food and utilities. Those qualifications include having certain chronic conditions, some of which are listed above.
Due to some of the changes from Medicare, you may see some increases in prescription drug copays and deductibles. Any changes will depend on the plan you are enrolled in and the medications you take, so it’s best to check your plan’s 2026 ANOC (Annual Notice Of Change) and your 2026 drug list for specific costs.
When your doctor prescribes a medicine, ask if there is a lower-cost alternative. In general, generic prescriptions tend to cost less and are usually the same as name-brand drugs in terms of active ingredients, strength, and effectiveness.
One good way to save on Medicare costs is to see if you qualify for a government savings program. Healthfirst Medicare Specialists, who are trained in the different savings programs offered by New York State and the federal government, can see if you’re eligible and help you apply. These savings could help offset any potential cost increases you may see due to the Medicare changes. Call 1-866-889-2524.
Our Medicare Specialists are happy to help you understand the changes and what they could mean for you.
Call us and let’s talk.