65 Plus Plan (HMO)

The Healthfirst 65 Plus Plan is a Medicare Advantage plan that offers the benefits of Original Medicare, plus prescription drug coverage, dental, hearing, vision, acupuncture, the SilverSneakers^® fitness program, 24/7 access to care via phone or video chat, and the Nurse Help Line. And 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 doctor visits
Comprehensive dental
Hearing exams and hearing aids
Vision exams and eyeglasses
Acupuncture

2023

65 Plus Plan (HMO)

Summary of Benefits and Coverage (PDF)

Star Ratings

2023 Star Ratings

English Español 中文

Every year, Medicare evaluates plans based on a 5-star rating system.

Low Income Subsidy Premium Pricing

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Eligible Age

65 or older (or under 65 with )

Eligible Service Areas

Reside within New York City’s five boroughs (The Bronx, Brooklyn, Manhattan, Queens, and Staten Island), or 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

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

$150 allowance for eyeglasses/contacts every year

Hearing

$0 for routine hearing exams

$0‒$1,475 copay per hearing aid for up to two hearing aids 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 ()

$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.

Dental Quick Reference Guide

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Costs & Benefits

65 Plus Plan (HMO)

$8,300

Your Annual Checkup

$0 copay

$30 copay

Outpatient Lab Tests (including COVID-19)

$0 copay

Retail Health Clinic

$15 copay

Urgent Care

$45 copay

Emergency Room

$95 copay

Ambulance

$275 copay

Ambulatory Surgery Visit

$200 copay

20% of the cost for each outpatient hospital visit

$560 copay per day for up to 4 days; $0 copay per day after 4 days

Skilled Nursing Facility

$0 copay per day for up to 20 days; $196 copay per day for days 21‒100

Prescriptions

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. Please note that Healthfirst may add drugs to or remove them from its Medicare formulary during the year. You will receive notice when changes are made.

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

(Applies to Tiers 4‒5)

$250

(Tier 1)

$0 copay, no deductible

(Tier 2)

$10 copay for 30-day or 90-day supply, no deductible

(Tier 3)

$47 copay for 30-day or 90-day supply, after deductible

Non-Preferred Drugs (Tier 4)

$100 copay for 30-day supply after deductible

(Tier 5)

26% of cost after deductible

Supplemental Drugs (Tier 6)

$10 copay for 30-day or 90-day supply, no deductible

Select Insulins

$35 copay for 30-day or 90-day supply, no deductible

(List of Covered Drugs)

English/Español/中文

List of Drugs Requiring

English

List of Drugs Requiring

English

More Information: Medicare Coverage Decisions, Appeals, and Complaints

This information is not a complete description of benefits. Contact the plan for more information. Benefits, premiums, and/or copayments/coinsurance may change 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. or Healthfirst Insurance Company, Inc. Plans contain exclusions and limitations.

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

Some dental services must be medically necessary to be covered; limitations and exclusions apply.

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

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).

Last update March 27, 2023 @ 10:02 am

Y0147_MKT23_90 0816-22_2023

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.
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 late-night and weekend hours, often with faster service at a lower cost than the emergency room (ER). 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.
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

Additional Plan Highlights

24/7 Access to Telemedicine with Teladoc^*

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

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.
Urgent Care Center Network

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 late-night and weekend hours, often with faster service at a lower cost than the emergency room (ER). 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.
SilverSneakers

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
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

Frequently Asked
Questions

See All

Can I save money on my healthcare costs?
Taking advantage of your benefits can help you save money on healthcare costs. To help you lower your overall health insurance costs, you should always:
- Use your no cost benefits, such as annual checkups, to help keep you healthy and identify potential risks early.
- Make sure you see an in-network doctor or facility for treatment to avoid out-of-pocket costs
- Visit an urgent care center for non-emergency issues such as colds or flu, sprains, and wounds
- Choose 90-day prescription refills and Tier 1 $0 copay Preferred Generic Drugs whenever possible
- Use your telemedicine benefit if it’s included with your health plan
How do I use my coverage at the pharmacy?

Pharmacy benefits are different for each Healthfirst health insurance plan. Please check your plan’s formulary for more information on which pharmacy medicines and other items are covered.

Healthfirst has partnered with CVS Caremark to bring you a personal prescription drug account that will give you 24/7 access to important drug benefit information and tools that will make getting your prescription drugs easier. Click here to create your account or log in.
Do generic drugs work as well as brand name drugs?
Yes. Generics are the same as brand name drugs in many ways:
- How you take the medicine (for example, pill or liquid)
- Safety
- Strength
- Quality
- How it works
- How the medicine should be used
This is required by the U.S. Food and Drug Administration (FDA). The difference is that generic drugs usually cost much less than brand name drugs. Not all brand name drugs are available as generic versions.

To find out more about a specific drug, you can use our drug search tool.

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

1-877-237-1303

TTY English: 1-888-542-3821

TTY Español: 1-888-867-4132

Member Services

1-888-260-1010

TTY English: 1-888-542-3821

TTY Español: 1-888-867-4132

Can’t talk right now?

Request a callback and we’ll get back to 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

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Need help choosing a plan?

Need help choosing a plan?

65 Plus Plan (HMO)

Plan Highlights:

Additional Plan Highlights

24/7 Access to Telemedicine with Teladoc^*

24/7 Access to care with the Nurse Help Line

Urgent Care Center Network

SilverSneakers

Healthfirst Medication Therapy Management Program

Additional Plan Highlights

24/7 Access to Telemedicine with Teladoc^*

24/7 Access to care with the Nurse Help Line

Urgent Care Center Network

SilverSneakers

Healthfirst Medication Therapy Management Program

Frequently Asked
Questions

Support When You Need It

1-877-237-1303

1-888-260-1010

Can’t talk right now?

You are now navigating away from the Healthfirst website.

65 Plus Plan (HMO)

Plan Highlights:

Additional Plan Highlights

24/7 Access to Telemedicine with Teladoc*

24/7 Access to care with the Nurse Help Line

Urgent Care Center Network

SilverSneakers

Healthfirst Medication Therapy Management Program

Additional Plan Highlights

24/7 Access to Telemedicine with Teladoc*

24/7 Access to care with the Nurse Help Line

Urgent Care Center Network

SilverSneakers

Healthfirst Medication Therapy Management Program

Frequently Asked Questions

Support When You Need It

1-877-237-1303

1-888-260-1010

Can’t talk right now?

We look forward to helping you!

You are now navigating away from the Healthfirst website.

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24/7 Access to Telemedicine with Teladoc^*

24/7 Access to Telemedicine with Teladoc^*

Frequently Asked
Questions