Coordinated Benefits Plan (HMO)

The Healthfirst Coordinated Benefits Plan is a Medicare Advantage plan that offers the benefits of Original Medicare, plus dental, hearing, vision, transportation, SilverSneakers^® fitness program, and 24/7 access to care via phone or video chat 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 if you already have prescription drug coverage 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
Hearing exams and hearing aids
Vision exams and eyeglasses
Rides to your healthcare providers

2022

Coordinated Benefits Plan (HMO)

Summary of Benefits and Coverage (PDF)

Star Ratings

Healthfirst has Four-Star-Rated Medicare
Advantage Plans out of five stars in 2022

2022 Star Ratings

English/Español/中文

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

Eligible Age

65 or older

Eligible Service Areas

Reside within New York City’s five boroughs (The Bronx, Brooklyn, Manhattan, Queens, Staten Island) or Nassau county.

Other Eligibility Requirements

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

Enroll in and continue to pay for Medicare Part B

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

Annual Supplemental Physical Exam

$0 copay

Dental

$5 copay for covered preventive dental services; $5-150 copay for covered comprehensive dental services

Vision

$0 copay for routine vision exams

$0 copay for standard eyewear lenses and frames (upgraded frames available with copay)

Hearing

$0 for routine hearing exams

$500 allowance for hearing aids every year (for both ears combined)

Telemedicine ()

$0 copay

Nurse Help Line Access

$0 copay

Rides to your healthcare providers

$0 transportation to/from your doctor - 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.

Out-of-Network Coverage Rules

English Español 中文

Dental and Vision Quick Reference Guide

English Español 中文

Costs & Benefits

Coordinated Benefits Plan (HMO)

$7,550

Your Annual Checkup ()

$0 copay

$10 copay

$35 copay

Outpatient Lab Tests (including COVID-19)

$0 copay

Retail Health Clinic

$15 copay

Urgent Care

$35 copay

Emergency Room

$90 copay

Ambulance

$275 copay

Ambulatory Surgery Visit

20% of the cost of each visit

$403 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

$188 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.

You must continue to pay your Medicare Part B premium.

Coverage is provided by Healthfirst Health Plan, Inc. 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 1, 2021 @ 2:30 pm

Y0147_MKT22_56 1081-21_2022

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.
SilverSneakers

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.
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.
SilverSneakers

SilverSneakers
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.
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
- 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.

The following link will take you to Medicare.gov where you can enroll online.

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

SilverSneakers

Urgent Care Center Network

Additional Plan Highlights

24/7 Access to Telemedicine with Teladoc^*

24/7 Access to care with the Nurse Help Line

SilverSneakers

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?

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

SilverSneakers

Urgent Care Center Network

Additional Plan Highlights

24/7 Access to Telemedicine with Teladoc*

24/7 Access to care with the Nurse Help Line

SilverSneakers

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!

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