CompleteCare (HMO SNP)

The Healthfirst CompleteCare Plan is a Medicaid Advantage Dual-Eligible Special Needs plan that offers members the benefits of Original Medicare and Medicaid, plus prescription drug coverage, over-the-counter benefits, the SilverSneakers^® fitness program, and dental, vision, and hearing coverage. You’ll also get a Primary Care Manager who will manage your day-to-day needs, identify health concerns early, and adjust your care plan to help you stay in your home for as long as possible. 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 extra in-home care and long-term care services.

Plan Highlights:

Prescription drug coverage
Over-the-counter benefits
SilverSneakers^® fitness program
Comprehensive dental
Vision exams and eyeglasses
Hearing exams and hearing aids
Acupuncture

2020

CompleteCare (HMO SNP)

Summary of Benefits and Coverage (PDF)

Star Ratings

Four-Star-Rated Medicare Advantage Plan out of five stars in 2020

2020 Star Ratings

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

Comprehensive Formulary

Comprehensive Formulary (List of Covered Drugs)

English/Español/中文

Search for your prescription

Low Income Subsidy Premium Pricing

English Español 中文

Eligible Age

18 years or older

Eligible Service Areas

Within New York City’s five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), and Nassau and Westchester counties

Other Eligibility Requirements

Qualify as a full-benefit dual-eligible, entitled to both Medicare Parts A & B and have full benefits from New York State Medicaid

Require nursing home level of care (as of the time of enrollment)

Do not have End-Stage Renal Disease (ESRD) (permanent kidney disease requiring dialysis or a kidney transplant), except under certain limited circumstances

Have the ability, at the time of enrollment, to return to or remaining in your home and community without danger to your health and/or safety

Require care management and need at least one of covered by Medicaid Advantage Plus for more than 120 days from the effective date of enrollment

Over-the-Counter Benefit

$1,800 per calendar year ($150 per month) for over-the-counter (OTC) nonprescription drugs, health-related items and selected grocery items Over-the-Counter (OTC) Benefits

Dental

$0 copay

Vision

$0 copay

Hearing

$0 copay

Acupuncture

$0 copay for up to 35 acupuncture visits every year

$0 copay

Nurse Help Line Access

$0 copay

Fitness Program

$0 copay for access to the SilverSneakers^® network of fitness facilities and to group exercise classes, classes held at parks and community locations, and at-home kits

Free Rides

FREE transportation to/from your doctor or pharmacy for covered services (for full dual-eligible members)

Out-of-Network Coverage Rules

English Español 中文

Dental and Vision Quick Reference Guide

English Español 中文

More Plan Information

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., a not-for-profit corporation controlled by Healthfirst, Inc., and certified as a health maintenance organization under Article 44 of the New York State Public Health Law.

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

Healthfirst Medicare Plan, Inc. 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 January 31, 2020 @ 7:34 pm

H3359_MKT20_78_2020

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 isn’t a replacement for your Primary Care Provider (PCP). Your PCP should always be your first choice for care and for routine 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 the SilverSneakers network of fitness facilities and to group exercise classes, classes held at parks and community locations, and at-home kits.
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 usually 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)
- Personal medication list that lists 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 isn’t a replacement for your Primary Care Provider (PCP). Your PCP should always be your first choice for care and for routine 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 the SilverSneakers network of fitness facilities and to group exercise classes, classes held at parks and community locations, and at-home kits.
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 usually 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)
- Personal medication list that lists 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
- 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.

Learn about enrollment

1-877-237-1303

7 days a week, 8am—8pm

TTY English: 1-888-542-3821

TTY Español: 1-888-867-4132

Member Services

1-888-260-1010

7 days a week, 8am—8pm

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.

If you receive Medicaid and want to know whether you are eligible for a managed long-term care plan, you can call the Conflict-Free Evaluation and Enrollment Center (CFEEC) at 1-855-222-8350, Monday to Friday, 8:30am—8pm, and Saturday, 10am—6pm, to schedule a free evaluation.

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Individual & Family Plans

Individual & Family Plans

CompleteCare (HMO SNP)

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.

CompleteCare (HMO SNP)

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