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 Community Based Long Term Services and Supports (CBLTSS) like home care and personal care to stay in their homes and communities.
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. You will receive notice when changes are made.
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. Please note that Tier 5 Specialty Drugs are only available for a 30-day supply.
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.
*Healthy foods/groceries and home utilities are special supplemental benefits. To be eligible for these benefits, you must have one of the following chronic conditions: cardiovascular disorder, disabling mental health condition, diabetes, lung disorders, or obesity. There are other eligible conditions not listed. Your chronic condition alone cannot guarantee eligibility for these benefits. All applicable eligibility requirements must be met before the benefits are provided.
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.
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.
Plans contain exclusions and limitations.
Healthfirst complies with applicable Federal, state and local 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).
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.
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.
The benefits mentioned are a part of special supplemental program for the chronically ill. Not all members qualify.
Modivcare and Medical Answering Services provide the covered transportation services under your plan.
Last update March 19, 2025 @ 4:42 pm
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For individuals eligible for both Medicare and Medicaid, our Dual-Eligible Special Needs plans (D-SNPs) are designed to make Part D prescription drugs, healthy foods and even home utilities more affordable!
Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage Plan that limit membership to people with specific diseases or characteristics. Medicare SNPs tailor their plan benefits, provider choices, and drug formularies to best meet the specific needs of the members they serve.
Our CompleteCare (HMO D-SNP) Medicare Advantage Prescription Drug plan is designed to help our members live better, healthier lives with Long Term Services and Supports (LTSS), a monthly OTC Plus card allowance that can be used for healthy foods, and more. Plus, there are no out-of-pocket costs for CompleteCare members.
With the Healthfirst CompleteCare (HMO D-SNP) Medicare Advantage Prescription Drug plan, you receive a $280/month ($3,360/year) OTC Plus card that can be used to pay for over-the-counter (OTC) non-prescription medicines and health related items, healthy foods, exercise equipment and activity trackers, or even home utilities such as gas, oil, electric, water, and internet service.*
The Healthfirst CompleteCare (HMO D-SNP) plan covers preventive dental care such as yearly checkups, cleanings, and fluoride treatment. Plus, comprehensive dental care including dentures, crowns, root canals, and extractions.
Dental services must be medically necessary; limitations and exclusions apply.
There are no out-of-pocket costs for in-network covered services for CompleteCare members. Be sure to take advantage of your plan benefits, such as annual physical and dental checkups, to keep you healthy and identify potential health risks early.
Pharmacy benefits are different for each Healthfirst health insurance plan. Please check your plan’s formulary for more information on which prescription 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.
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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.
