BackCompleteCare (HMO D-SNP)
The Healthfirst CompleteCare plan is a Medicare Advantage Dual-Eligible Special Needs (HMO D-SNP) plan that offers members the benefits of Original Medicare and Medicaid, plus prescription drugs; dental, vision, and hearing; an OTC Plus card; the SilverSneakers® fitness program; and more. You’ll also get a Care Team, led by a Registered Nurse or a Licensed Social Worker, that will help you coordinate the services you need to stay healthy. And you don’t need referrals to see in-network specialists. This plan is designed for people who have both Medicare and full Medicaid and need in-home care and long-term care services.
Plan Highlights:
- Prescription drug coverage
- Comprehensive dental
- Vision exams and eyeglasses
- Hearing exams and hearing aids
- OTC Plus card for OTC, non-prescription drugs and health-related items, healthy foods, exercise equipment, fitness trackers, and home utilities such as gas, oil, electric, water, and internet service
- SilverSneakers fitness program
- Acupuncture
- Long-term care benefits (i.e. Care Management Team, personal care services)
- 2024
- 2023
Healthfirst will cover Non-Emergency Medicaid-covered transportation provided that it is included as a Managed Long Term Care benefit by the New York State Department of Health.
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.
Healthfirst Health Plan, Inc. is an HMO plan with a Medicare contract and a contract with the New York Medicaid program. Enrollment in Healthfirst Medicare Plan depends on contract renewal.
Coverage is provided by Healthfirst Health Plan, Inc., which offers HMO plans with a Medicare contract and a contract with the NY State Medicaid program. Enrollment in Healthfirst Medicare Plan depends on contract renewal.
OTC items are subject to the plan’s list of eligible items and the plan’s participating network of retail, online, and utility providers.
No out-of-pocket costs for entry-level hearing aids. Eyewear allowance can only be used at participating retailers.
EyeMed is contracted with Healthfirst to provide vision benefits to its members.
Dental services must be medically necessary to be covered; limitations and exclusions apply.
SilverSneakers is a registered trademark of Tivity Health, Inc.© 2020 Tivity Health, Inc. All rights reserved.
The benefits mentioned are a part of special supplemental program for the chronically ill. Not all members qualify.
Healthfirst complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
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Last update October 18, 2023 @ 4:43 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.
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).
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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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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.
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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
Additional Plan Highlights
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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
Frequently Asked
Questions
See All
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What is an HMO D-SNP or SNP insurance plan?
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What can I purchase with the Healthfirst CompleteCare OTC Plus card?
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Where to buy OTC items with your OTC Plus card:
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What dental benefits are available with the Healthfirst CompleteCare plan?
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How can I save money on my healthcare costs?
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How do I access my pharmacy benefits?
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
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.
If you receive Medicaid and want to know whether you are eligible for a Managed Long-Term Care Plan, you can call the New York Independent Assessor (NYIA) formerly Conflict-Free Evaluation Enrollment Center (CFEEC) at 1-855-222-8350, TTY at 1-888-329-1541 , Monday to Friday, 8:30am-8pm, and Saturday, 10am-6pm, to schedule your initial assessment.
We look forward to helping you!
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