This Medicare Advantage Prescription Drug plan is for those who may qualify for additional financial assistance (such as Extra Help, Medicare Savings Programs, or Medicaid), which help you pay your drug costs, deductibles, and copays. Our 65 Plus (HMO) plan offers a $0 monthly plan premium for hospital and medical coverage, plus dental, vision and hearing—more than what Original Medicare offers!

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
Choose Plan Year
Premium
$0
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.
Medical Deductible
$0
Maximum Out-of-Pocket
$9,350
Annual Supplemental Physical Exam
$0 copay
Dental
$0 copay for covered preventive and comprehensive dental services; up to $2,000 maximum coverage per year1
Vision
$0 copay for routine vision exams, including refraction
$200 eyewear allowance every year for contact lenses or one pair of glasses (lenses and frames)
Hearing
$0 for routine hearing exams
$0‒$1,475 copay per hearing aid
Plan covers one hearing aid per ear, per year
Acupuncture
$0 copay for up to 20 visits per year for chronic lower back pain and 12 additional visits per year for any condition, including chronic lower back pain
Telemedicine (Teladoc)
$0 copay
Nurse Help Line Access
$0 copay
Rides to Your Healthcare Providers
$0 copay transportation to/from your doctor or pharmacy for covered services—up to 10 one-way trips per year
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.
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
$110 copay
Ambulance
$275 copay
Ambulatory Surgery Visit
0% for diagnostic colonoscopies and esophageal endoscopies
$200 copay for each ambulatory surgery center visit
Outpatient Facility
0% for diagnostic colonoscopies and esophageal endoscopies
20% coinsurance for all other outpatient hospital services
Inpatient Hospital Stay
$460 copay per day for up to 5 days;
$0 copay (days 6-999)
Skilled Nursing Facility
$0 copay per day for up to 20 days;
$214 copay per day for days 21‒100

Prescription Drug Benefits

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. Also, Tier 5 Specialty Drugs are only available for a 30-day supply.

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

Deductible (Applies to Tiers 4‒5)
$590
Preferred Generic Drugs (Tier 1)
$0 copay, no deductible
Generic Drugs (Tier 2)
$15 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)
50% coinsurance for 30-day supply after deductible
Specialty Drugs (Tier 5)
25% of cost after deductible
Select Insulins
Maximum of $35 copay for 30-day supply, no deductible
Quantity Limits

For safety and cost reasons, plans may limit the amount of a prescription drug they cover over a certain period of time. For example, most people who are prescribed heartburn medication take one tablet a day for four weeks. Therefore, a plan may cover only an initial 30-day supply of the heartburn medication. The quantity allowed is listed after the QL symbol in your formulary and may be read as “units per days’ supply.” If your prescription for any of these medications exceeds the maximum quantity listed, you and your doctor will need to request a formulary exception.

Additional Plan Highlights

24/7 Access to Telemedicine with Teladoc® Health*

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).

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.

**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).

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.

E8F603C3-4D94-4DCE-818B-75031FE268CE Created with sketchtool.

SilverSneakers®

Get access to live classes and workshops taught by instructors trained in senior fitness, 300+ workout videos in the SilverSneakers On-Demand online library, online fitness and nutrition tips, and their mobile app with digital workout programs.

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

Plan Documents

2025 65 Plus (HMO) Plan

General Plan Information
Low Income Subsidy Pricing
Summary of Benefits
Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
List of Drugs Requiring Prior Authorization
List of Drugs Requiring Step Therapy
See all forms & documents

1Dental services must be medically necessary; limitations and exclusions apply.

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.

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.© 2024 Tivity Health, Inc. All rights reserved.

Modivcare and Medical Answering Services provide the covered transportation services under your plan.

Last update October 2, 2024 @ 11:22 am

Y0147_MKT25_91 5128-24_M

Premium
$0
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.
Medical Deductible
$0
Maximum Out-of-Pocket
$8,850
Annual Supplemental Physical Exam
$0 copay
Dental
$0 copay for covered preventive and comprehensive dental services; up to $2,000 maximum coverage per year
Vision
$0 copay for routine vision exams, including refraction
$150 allowance for eyeglasses/contacts every year
Hearing
$0 for routine hearing exams
$0‒$1,475 copay per hearing aid
Plan covers one hearing aid per ear, per year
Acupuncture
$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.
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
Ambulance
$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

Prescription Drug Benefits

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)
$250
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
Quantity Limits

For safety and cost reasons, plans may limit the amount of a prescription drug they cover over a certain period of time. For example, most people who are prescribed heartburn medication take one tablet a day for four weeks. Therefore, a plan may cover only an initial 30-day supply of the heartburn medication. The quantity allowed is listed after the QL symbol in your formulary and may be read as “units per days’ supply.” If your prescription for any of these medications exceeds the maximum quantity listed, you and your doctor will need to request a formulary exception.

Additional Plan Highlights

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).

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.

**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).

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.

E8F603C3-4D94-4DCE-818B-75031FE268CE Created with sketchtool.

SilverSneakers

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.

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

Plan Documents

2024 65 Plus (HMO) Plan

General Plan Information
The Healthfirst 65+ Plan is rated a Four-Star-Rated Medicare Advantage Plan in 2024
Every year, Medicare evaluates plans based on a 5-star rating system.
2024 Star Ratings
Dental Benefit Guide
Low Income Subsidy Pricing
Summary of Benefits
Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
List of Drugs Requiring Prior Authorization
List of Drugs Requiring Step Therapy
See all forms & documents

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 October 2, 2024 @ 11:22 am

Y0147_MKT24_67 1102-23_M

Frequently Asked Questions

A Health Maintenance Organization (HMO) is a type of health insurance plan that gives you access to care from a network of doctors and hospitals in a specific service area. HMOs usually don't cover out-of-network care, except in emergencies, and may require you to live or work in its service area to be eligible for coverage. These plans often provide integrated care and focus on prevention and wellness. (Source: HealthCare.gov)

Healthfirst 65 Plus offers $0 copay for covered preventive and comprehensive dental services, including dentures, crowns, root canals, and extractions—with a $2,000 maximum coverage per year.1

1Dental services must be medically necessary; limitations and exclusions apply.

There are many ways Healthfirst members can save on their healthcare costs, including:

  • Generic prescription drugs
  • No-cost delivery options for prescriptions (mail and home delivery)
  • Medicare Savings Program
  • Elderly Pharmaceutical Insurance Coverage (EPIC) Program and Extra Help
  • Healthfirst Pharmacy Team (exclusively for Healthfirst Medicare Advantage plan members)
  • Help from community resources
  • And more

Visit our help with pharmacy costs page for more information. If you qualify for Medicare and Medicaid, you can save even more on your healthcare costs!

You can get your prescriptions filled at any pharmacy in the Healthfirst network. Find a pharmacy that's convenient for you.

Want your medications delivered to you? Ask your pharmacy if they offer delivery service. If they do not, Caremark Mail Order will deliver to your mailbox.

Learn more in our pharmacy benefits section.

Generic drugs are approved by the Food and Drug Administration (FDA) to be just as safe and effective as brand-name drugs. They both have the same active ingredients, but generic drugs usually cost a lot less. This means you can save money on your prescriptions and still get the same benefits as you would from brand-name medication. Talk to your doctor about whether generic medications are right for you.

Have questions about your plan? Looking to enroll?

Have questions or
ready to enroll?

We can help!

Support When You Need It

We’re happy to answer your questions. Our service center's hours are:

  • October through March, 7 days a week, 8am—8pm
  • April through September, Monday to Friday, 8am—8pm
Learn about enrollment 1-877-237-1303

TTY English: 1-888-542-3821

TTY Español: 1-888-867-4132
Medicare Member Services 1-888-260-1010
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