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!
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:
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.
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).
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).
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.
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.
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:
Every year, Medicare evaluates plans based on a 5-star rating system.
Enroll online using the link above.
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 Federal civil rights laws. Healthfirst does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex as defined in 45 CFR § 92.101(a)(2).
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 May 22, 2025 @ 11:49 am
Y0147_MKT25_91 5128-24_M
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:
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.
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 us in person at one of our community offices
The following link will take you to Medicare.gov where you can enroll online.
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