65 Plus Plan (HMO)

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The Healthfirst 65 Plus (HMO) plan is a Medicare Advantage Prescription Drug plan that offers the benefits of Original Medicare, plus prescription drugs, dental, hearing, vision, the SilverSneakers® fitness program, 24/7 access to care via phone or video chat, and more. Plus, you don’t need referrals to see in-network specialists. This plan is designed for people who do not qualify for programs like Extra Help (also known as Low Income Subsidy), Medicare Savings Programs (MSP), or Medicaid.

Plan Highlights:

  • No-cost preferred generic drugs
  • Low-cost 90-day prescriptions
  • Low-cost doctor visits
  • Comprehensive dental
  • Hearing exams and hearing aids
  • Vision exams and eyeglasses
  • Acupuncture
  • 2024
65 Plus Plan (HMO)
Summary of Benefits (PDF)
Star Ratings
Healthfirst has Four-Star-Rated Medicare
Advantage Plans out of five stars in 2024
Eligible Age
65 or older (or under 65 with certain disabilities)
Eligible Service Areas
Reside within New York City’s five boroughs (The Bronx, Brooklyn, Manhattan, Queens, and Staten Island), and Nassau county.
Other Eligibility Requirements
Qualify for Medicare Part A.
Enroll and continue to pay for Medicare Part B.
Annual Supplemental Physical Exam
$0 copay
$0 copay for covered preventive and comprehensive dental services; up to $2,000 maximum coverage per year
$0 copay for routine vision exams, including refraction
$150 allowance for eyeglasses/contacts every year
$0 for routine hearing exams
$0‒$1,475 copay per hearing aid
Plan covers one hearing aid per ear, per year
$0 copay for up to 20 visits per year for chronic lower back pain and 12 supplemental visits per year for any condition
Telemedicine (Teladoc)
$0 copay
Nurse Help Line Access
$0 copay
Meal Delivery
$0 copay for up to 84 meals delivered to your home for up to 28 days following a discharge from hospital to home or from a skilled nursing facility to home with a stay greater than two days, if recommended by a provider.
Costs & Benefits
65 Plus Plan (HMO)
Medical Deductible
Maximum Out-of-Pocket
Your Annual Checkup
$0 copay
Primary Care Provider (PCP) Visit
$0 copay
Specialist Visit
$25 copay
Outpatient Lab Tests (including COVID-19)
$0 copay
Retail Health Clinic
$15 copay
Urgent Care
$45 copay
Emergency Room
$100 copay
$275 copay
Ambulatory Surgery Visit
$200 copay
Outpatient Facility
20% coinsurance
Inpatient Hospital Stay
$450 copay per day for up to 5 days; $0 copay per day after 5 days
Skilled Nursing Facility
$0 copay per day for up to 20 days;$203 copay per day for days 21‒100

We want to help you get the most out of your Part D prescription drug benefits. Please refer to the formulary below to see which medications are covered. Healthfirst may add drugs to or remove them from its Medicare formulary during the year. We will notify you when we make the change.

Depending on your level of Extra Help, these costs may not apply:

Deductible (Applies to Tiers 4‒5)
Preferred Generic Drugs (Tier 1)
$0 copay, no deductible
Generic Drugs (Tier 2)
$10 copay for 30-day or 90-day supply, no deductible
Preferred Brand and Generic Drugs (Tier 3)
$35 copay for 30-day or 90-day supply, no deductible
Non-Preferred Drugs (Tier 4)
$100 copay for 30-day supply after deductible
Specialty Drugs (Tier 5)
26% of cost after deductible
Supplemental Drugs (Tier 6)
$5 copay for 30-day, no deductible
Select Insulins
Maximum of $35 copay for 30-day supply, no deductible

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. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

You must continue to pay your Medicare Part B premium.

Coverage is provided by Healthfirst Health Plan, Inc., which offers HMO plans that contract with the Federal Government. Enrollment in Healthfirst Medicare Plan depends on contract renewal.

Plans contain exclusions and limitations.

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).

No out-of-pocket costs for entry-level hearing aids. Eyewear allowance can only be used at participating retailers.

Dental services must be medically necessary; limitations and exclusions apply.

DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.

EyeMed® is contracted with Healthfirst to provide vision benefits to its members.

Telemedicine (Teladoc) and the Nurse Help Line are not replacements for your primary care provider (PCP). Your PCP should always be your first choice for care (both in-person and virtual visits).

SilverSneakers is a registered trademark of Tivity Health, Inc.© 2023 Tivity Health, Inc. All rights reserved.

Last update January 18, 2024 @ 3:18 pm

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Additional Plan Highlights

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    24/7 Access to Telemedicine with Teladoc*

    Talk to a doctor any time—for a $0 copay. Visit with board-certified doctors through video chat or phone for prescriptions, treatment of non-emergency health issues, and more. Access to dermatologists is also available.

    *Telemedicine (Teladoc) isn’t a replacement for your primary care provider (PCP). Your PCP should always be your first choice for care (both in-person and virtual visits).

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    24/7 Access to care with the Nurse Help Line

    Talk to a nurse any time—for a $0 copay. Get wellness advice and help finding a doctor.

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    Urgent Care Center Network

    Get the care you need when you need it at an urgent care center in our network – no appointment needed. Urgent care centers offer convenient late-night and weekend hours. Visit an in-network urgent care center to get help with non-emergency health issues like earache, upset stomach, and sprains; for wounds that need stitches; and more.

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    Get access to live classes and workshops taught by instructors trained in senior fitness, 200+ workout videos in the SilverSneakers On-Demand online library, online fitness and nutrition tips, and their mobile app with digital workout programs.

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    Healthfirst Medication Therapy Management Program

    The Healthfirst Medication Therapy Management (MTM) program is an in-depth, one-on-one review of all your medications (prescription drugs, over-the-counter nonprescription drugs, and herbal and nutritional supplements). The goal is to help you get the most from your medications. Services include:

    • Phone consultation with a licensed pharmacist to complete a Comprehensive Medication Review (CMR). The call will take about 30 to 60 minutes and the pharmacist will answer any questions you may have. (A CMR is offered once each year, if you qualify.)
    • Medication Action Plan (MAP)
    • Medication recommendations may be sent to your provider from the MTM pharmacist, also known as Targeted Medication Review (TMR)
    • A list that shows all your medications

    Learn More

Additional Plan Highlights

  • 24/7 Access to Telemedicine with Teladoc*

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  • 24/7 Access to care with the Nurse Help Line

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  • Urgent Care Center Network

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  • SilverSneakers

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  • Healthfirst Medication Therapy Management Program

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Frequently Asked

See All
  • Can I save money on my healthcare costs? FAQ dropdown arrow
  • How do I use my coverage at the pharmacy? FAQ dropdown arrow
  • Do generic drugs work as well as brand name drugs? FAQ dropdown arrow

Support When You Need It

We’re happy to answer your questions. Our service centers hours are:

  • October through March, 7 days a week, 8am—8pm
  • April through September, Monday to Friday, 8am–8pm

Learn about enrollment


TTY English: 1-888-542-3821

TTY Español: 1-888-867-4132

Member Services


TTY English: 1-888-542-3821

TTY Español: 1-888-867-4132

Need help enrolling in a health plan?

Request a call and our sales team will call you within one business day.

You can also visit us in person at one of our community offices.

The following link will take you to Medicare.gov where you can enroll online.

CMS Online Enrollment Center