The Healthfirst Connection Plan is a Medicare Advantage Dual-Eligible Special Needs (HMO D-SNP) plan that works directly with your existing Medicaid coverage and offers members the benefits of Original Medicare and Medicaid, and more, such as prescription drugs, OTC Plus card, SilverSneakers® fitness program, 24/7 access to care via phone or video chat and more. Plus, you don’t need referrals to see in-network specialists.
Please call Member Services at 1-888-260-1010 for more information on this plan.
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 fall under each tier. Healthfirst may add drugs to or remove them from its Medicare formulary during the year. You will receive notice when changes are made.
Please note that for Tier 1-4 Drugs, you may receive up to a 90-day supply, but for Tier 5 Drugs, you may only receive up to a 30-day supply.
Depending on your level of Extra Help, you have to pay only the following for your prescription drugs:
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.
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 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 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).
Dental services must be medically necessary; limitations and exclusions apply. No out-of-pocket costs for entry-level hearing aids. Eyewear allowance can only be used at participating retailers.
OTC items are subject to the plan’s list of eligible items and the plan’s participating network of retail, online, and utility providers.
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.
DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.
EyeMed® is contracted with Healthfirst to provide vision benefits to its members.
Modivcare and Medical Answering Services provide the covered transportation services under your plan.
Last update September 25, 2024 @ 7:46 am
Y0147_MKT25_91 5128-24_M
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 fall under each tier. Healthfirst may add drugs to or remove them from its Medicare formulary during the year. You will receive notice when changes are made.
Depending on your level of Extra Help, you have to pay only the following for your prescription drugs (up to a 90-day supply):
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, 200+ 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:
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. and Healthfirst PHSP, 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 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).
Dental services must be medically necessary; limitations and exclusions apply. No out-of-pocket costs for entry-level hearing aids. Eyewear allowance can only be used at participating retailers.
OTC items are subject to the plan’s list of eligible items and the plan’s participating network of retail, online, and utility providers.
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.
DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.
EyeMed® is contracted with Healthfirst to provide vision benefits to its members.
Last update September 25, 2024 @ 7:46 am
Y0147_MKT24_67 1102-23_M
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:
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.
Yes. Generics are the same as brand name drugs in many ways:
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.
Have questions about your plan? Looking to enroll?
Have questions or
ready to enroll?
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 our Virtual Community Office to connect with a local Healthfirst representative or to find a community office near you.
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.
