Coordinated Benefits Plan (HMO)

The Healthfirst Coordinated Benefits Plan is a Medicare Advantage plan that offers members all the benefits of Original Medicare, plus dental, hearing, vision, routine transportation, and 24/7 access to care with Teladoc^© and the Nurse Help Line. And you don’t need referrals to see in-network specialists. This plan may be right for you if you don’t need prescription drug coverage because you have it through an employer, union, or other source.

This plan does not include prescription drug coverage under Part D. If you’re a member of another Medicare Advantage plan or standalone Medicare prescription drug plan (Part D) and you join this plan, you’ll be disenrolled from the other Medicare Advantage or Medicare Part D plan.

Plan Highlights:

Comprehensive dental
Vision exams and eyeglasses
Hearing exams and hearing aids
Routine transportation

2020
2019

Coordinated Benefits Plan (HMO)

Summary of Benefits and Coverage (PDF)

Star Ratings

English/Español/中文

Eligible Age

65 or older

Eligible Service Areas

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

Other Eligibility Requirements

Qualify for Medicare Part A (you are 65 or older, or under 65 with certain disabilities)

Enroll in and continue to pay for Medicare Part B

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

Already have dependable coverage through an employer, union, or other source (not including standalone Medicare Prescription Drug Plans)

Dental

$5 copay

Vision

$0 copay

Hearing

$35 copay

$0 copay

Nurse Help Line Access

$0 copay

Free Rides

FREE transportation to/from your doctor or pharmacy — up to 8 one-way trips per year

Out-of-Network Coverage Rules

English Español 中文

Dental and Vision Quick Reference Guide

English Español 中文

More Plan Information

Benefits & Costs

Coordinated Benefits Plan (HMO)

$6,700

Your Annual Checkup ()

$0 copay

$10 copay

$35 copay

Urgent Care

$35 copay

Emergency Room

$90 copay

Ambulance

$225 copay

Ambulatory Surgery Visit

20% of the cost of each visit

$310 copay per day for up to six days

$0 per day after six days

Skilled Nursing Facility

$0 per day for up to 20 days

$172 copay for days 21 - 100

More Information: Medicare Coverage Decisions, Appeals, and Complaints

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., Healthfirst PHSP, Inc., and/or Healthfirst Insurance Company, Inc. (together, “Healthfirst”). Plans contain exclusions and limitations.

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 October 10, 2019 @ 6:06 pm

H3359_MKT20_59_2019
H3359_MKT20_78_2020

Coordinated Benefits Plan (HMO)

Summary of Benefits and Coverage (PDF)

Star Ratings

Star Ratings coming soon

Eligible Age

65 or older

Eligible Service Areas

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

Other Eligibility Requirements

Qualify for Medicare Part A (you are 65 or older, or under 65 with certain disabilities)

Enroll in and continue to pay for Medicare Part B

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

Already have dependable coverage through an employer, union, or other source (not including standalone Medicare Prescription Drug Plans)

Dental

$5 copay

Vision

$0 copay

Hearing

$35 copay

$0 copay

Nurse Help Line Access

$0 copay

Free Rides

FREE transportation to/from your doctor or pharmacy — up to 8 one-way trips per year

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

New in 2020!
SilverSneakers^® 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.

Out-of-Network Coverage Rules

English Español 中文

Dental and Vision Quick Reference Guide

English Español 中文

More Plan Information

Benefits & Costs

Coordinated Benefits Plan (HMO)

$6,700

Your Annual Checkup ()

$0 copay

$10 copay

$35 copay

Urgent Care

$35 copay

Emergency Room

$90 copay

Ambulance

$225 copay

Ambulatory Surgery Visit

20% of the cost of each visit

$380 copay per day for up to 5 days

$0 per day after 5 days

Skilled Nursing Facility

$0 per day for up to 20 days

$178 copay for days 21–100

More Information: Medicare Coverage Decisions, Appeals, and Complaints

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., Healthfirst PHSP, Inc., and/or Healthfirst Insurance Company, Inc. (together, “Healthfirst”). Plans contain exclusions and limitations.

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 October 10, 2019 @ 6:06 pm

H3359_MKT20_59_2019
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.

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.

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
Why should I choose Healthfirst?

Healthfirst is a not-for-profit community organization sponsored by some of the most prestigious and nationally recognized hospitals and medical centers in New York. With more than a million members and growing, Healthfirst has been serving communities in New York City for more than 25 years. With access to thousands of doctors and specialists, you’re sure to find the service you need nearby. Each of our community offices is fully staffed with representatives who can answer questions—in many different languages—about our health insurance plans and programs, whether you’re a member or not.
How can I enroll in a Healthfirst plan?

The easiest way to enroll in a Healthfirst plan is to contact us. Our sales reps can guide you to the best plan for you and ease the enrollment process.

To learn more about our Healthfirst plans or find the one that’s right for you, use our plan recommendation 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.

You can also visit us in person at one of our community offices.

CMS Online Enrollment Center

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Individual & Family Plans

Individual & Family Plans

Coordinated Benefits Plan (HMO)

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

Additional Plan Highlights

24/7 Access to Telemedicine with Teladoc^*

24/7 Access to care with the Nurse Help Line

Urgent Care Center Network

Frequently Asked
Questions

Support When You Need It

1-877-237-1303

1-888-260-1010

Can't talk right now?

Sent!

You are now navigating away from the Healthfirst website.

Coordinated Benefits Plan (HMO)

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

Additional Plan Highlights

24/7 Access to Telemedicine with Teladoc*

24/7 Access to care with the Nurse Help Line

Urgent Care Center Network

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!

Sent!

You are now navigating away from the Healthfirst website.

Sent!

Something went wrong

24/7 Access to Telemedicine with Teladoc^*

24/7 Access to Telemedicine with Teladoc^*

Frequently Asked
Questions