CompleteCare (HMO D-SNP)

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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
CompleteCare (HMO D-SNP)
Summary of Benefits (PDF)
Star Ratings
Healthfirst has Four-Star-Rated Medicare
Advantage Plans out of five stars in 2024
Eligible Age
18 or older
Eligible Service Areas
Reside within New York City's five boroughs (The Bronx, Kings (Brooklyn), New York (Manhattan), Queens, Richmond (Staten Island)), Nassau, Orange, Rockland, Sullivan and Westchester counties.
Other Eligibility Requirements
Must have evidence of Medicare Part A and Part B coverage and full Medicaid coverage.
Require nursing home level of care (as of the time of enrollment)
Have the ability, at the time of enrollment, of returning to or remaining in your home and community without danger to your health and/or safety
Require at least one of the following Community Based Long Term Care Services (CBLTCS) covered by the plan for more than 120 days from the effective date of enrollment
OTC Plus Card
$250 per month for over-the-counter (OTC) nonprescription drugs, health-related items, healthy foods, fitness equipment and activity trackers, and home utilities such as gas, oil, electric, water, and internet service
$0 copay
$0 copay for vision exams; $550 allowance for frames/lenses and contact lenses.
$0 copay for hearing exams and entry-level hearing aids
40 supplemental visits per year
Nurse Help Line Access
$0 copay
Telemedicine (Teladoc)
$0 copay
Fitness Program
$0 copay for access to the SilverSneakers network of fitness facilities, group exercise classes, classes held at parks and community locations, and at-home kits
Rides to Your Healthcare Providers
$0 transportation to/from your doctor for covered services
Costs & Benefits
CompleteCare (HMO D-SNP)
Medical Deductible
Maximum Out-of-Pocket
Your Annual Checkup
$0 copay
Primary Care Provider (PCP) Visit
$0 copay
Specialist Visit
$0 copay
Urgent Care
$0 copay
Emergency Room
$0 copay
$0 copay
Ambulatory Surgery Visit
$0 copay
Outpatient Facility
$0 copay
Inpatient Hospital Stay
$0 copay
Skilled Nursing Facility
$0 copay

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.

Generic Drugs
$0 copay
All Other Drugs
$0 copay

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 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 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).

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.

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.

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 January 18, 2024 @ 3:09 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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    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

    Learn More

Additional Plan Highlights

  • 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

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Frequently Asked

See All
  • What is an HMO D-SNP or SNP insurance plan? FAQ dropdown arrow
  • What can I purchase with the Healthfirst CompleteCare OTC Plus card? FAQ dropdown arrow
  • Where to buy OTC items with your OTC Plus card: FAQ dropdown arrow
  • What dental benefits are available with the Healthfirst CompleteCare plan? FAQ dropdown arrow
  • How can I save money on my healthcare costs? FAQ dropdown arrow
  • How do I access my pharmacy benefits? FAQ dropdown arrow

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


TTY English: 1-888-542-3821

TTY Español: 1-888-867-4132

Member Services


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.

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.