The Healthfirst Connection Plan is a Medicare Advantage Dual-Eligible Special Needs (HMO D-SNP) plan that works directly with your existing Healthfirst Medicaid plan 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. This plan is designed only for current members of a Healthfirst Medicaid plan.

Please call Member Services at 1-888-260-1010 for more information on this plan.

Plan Highlights:

  • Prescription drug coverage
  • OTC Plus card for OTC and health-related items, healthy foods, and home utilities (gas, water, electric, oil, and internet service)
  • Comprehensive dental (through your Healthfirst Medicaid plan)
  • Hearing exams and hearing aids (through your Healthfirst Medicaid plan)
  • Vision exams and eyeglasses (through your Healthfirst Medicaid plan)
  • SilverSneakers fitness program
Enrollment Period

Only members with Healthfirst Medicaid Managed Care or Personal Wellness Plan will be enrolled when they reach Medicare eligibility.

Eligible Age
65 or older (or under 65 with certain disabilities)
Eligible Service Areas
Reside within New York City’s five boroughs (The Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Nassau, Suffolk, Orange, Rockland, Sullivan, and Westchester counties.
Other Eligibility Requirements
Qualify for Medicare Part A (you are 65 or older, or under 65 with certain disabilities) and Part D.
Enroll in and continue to pay for Medicare Part B. Medicaid covers Medicare Part B premiums for dual-eligible members with full Medicaid coverage.
Are newly eligible for Medicare and currently enrolled in Healthfirst's Medicaid Managed Care or Personal Wellness Plans.
Medical Deductible
Maximum Out-of-Pocket
OTC Plus Card
$285 per quarter OTC Plus card for OTC non-prescription drugs and health-related items, healthy foods, fitness equipment, activity trackers, and home utilities (including internet services)
$0 copay; covered under Healthfirst Medicaid
$0 copay; covered under Healthfirst Medicaid
$0 copay; covered under Healthfirst Medicaid
$0 copay for up to 20 acupuncture visits for chronic lower back pain
Telemedicine (Teladoc)
$0 copay
Nurse Help Line Access
$0 copay
Meal Delivery
$0 copay for up to 84 meals delivered to your home for up to 28 days following a discharge from hospital to home or from a skilled nursing facility to home with a stay greater than two days, if recommended by a provider.
Your Annual Checkup
$0 copay
Primary Care Provider (PCP) Visit
$0 copay
Specialist Visit
$0 copay
Outpatient Lab Tests (including COVID-19)
$0 copay
Retail Health Clinic
$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

Prescription Drug Benefits

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):

Preferred Generic Drugs (Tier 1)
$0 copay
Generic Drugs (Tiers 2-5) (including brand drugs treated as generic)
$0 copay or
$1.55 copay or
$4.50 copay
All Other Drugs
$0 copay or
$4.60 copay or
$11.20 copay
Quantity Limits

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.

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 (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).

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).

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.

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

Plan Documents

2024 Connection Plan

General Plan Information
Summary of Benefits
Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
List of Drugs Requiring Prior Authorization
List of Drugs Requiring Step Therapy
See all forms & documents

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 July 15, 2024 @ 9:31 am

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Frequently Asked Questions

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 and Tier 1 $0 copay Preferred Generic Drugs whenever possible
  • Use your telemedicine benefit if it’s included with your health plan

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:

  • 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. 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 1-877-237-1303

TTY English: 1-888-542-3821

TTY Español: 1-888-867-4132
Medicare Member Services 1-888-260-1010
TTY English: 1-888-542-3821
TTY Español: 1-888-867-4132

Need help enrolling in a health plan?

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.