The Healthfirst Increased Benefits Plan (HMO) is a Medicare Advantage Prescription Drug plan ideal for people who qualify for Extra Help (also known as Low Income Subsidy [LIS], which helps lower prescription drug costs) and/or a Medicare Savings Program (MSP), which helps pay for some Medicare premiums, copays, or coinsurance. This plan offers the benefits of Original Medicare plus prescription drugs, dental, hearing, vision, an OTC Plus card, transportation, the SilverSneakers® fitness program, and more. And you don’t need referrals to see in-network specialists.
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 are covered. 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 Tier 5 Specialty Drugs are only available for a 30-day supply.
Depending on your level of Extra Help, these 30-day supply costs may not apply:
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 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 that contract with the Federal Government. Enrollment in Healthfirst Medicare Plan depends on contract renewal.
Plans contain exclusions and limitations.
Healthfirst complies with applicable Federal, state and local rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
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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).
DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.
EyeMed® is contracted with Healthfirst to provide vision benefits to its members.
SilverSneakers is a registered trademark of Tivity Health, Inc.© 2024 Tivity Health, Inc. All rights reserved.
Modivcare and Medical Answering Services provide the covered transportation services under your plan.
Last update January 31, 2025 @ 10:03 am
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To receive the most benefits from the Healthfirst Increased Benefits Plan, you should be eligible for Extra Help, also known as Low Income Subsidy (LIS), which helps lower prescription drug costs, some or all of your prescription drug coverage (Part D) premiums, deductibles, coinsurance, and/or copayments. Note: If you have limited income, but aren’t on Medicaid, you may still qualify for Low Income Subsidy.
People with Medicaid get Extra Help automatically when they enroll in Medicare. Those without Medicaid (who qualify for Extra Help) must enroll on their own through the Social Security Administration.
Another financial assistance program is the Medicare Savings Program (MSP), which is a federally funded program for people with limited income and resources to help pay some or all of their Medicare premiums, deductibles, copayments, and coinsurance. MSP eligibility is based on your household income, with no limit to assets. For example, if you own your home and are single and making less than $2,200 a month (or married and making less than $3,000 a month) you can still qualify.
With the Healthfirst Increased Benefits Plan you receive a quarterly allowance that can be used to pay for over-the-counter (OTC) non-prescription drugs and health-related items, exercise equipment, activity trackers, and personal emergency response systems (PERS). If you qualify for Extra Help from Medicare (Low Income Subsidy), you can also use the card for healthy foods and home utilities, such as gas, oil, electric, water, internet service.
Use your OTC Plus card to save on over-the-counter and health-related items, healthy foods, and more. To buy, you can:
The Healthfirst Increased Benefits Plan (HMO) Medicare Advantage Prescription Drug plan offers dental coverage with no annual maximum and includes cleanings, exams, X-rays, in addition to complex care such as extractions, dentures, crowns, and more.1
Taking advantage of your plan benefits can help you save money on healthcare costs. To help you lower your overall health insurance costs, you should always:
Use your telemedicine benefit whenever you cannot see a healthcare provider in person.
Pharmacy benefits are different for each Healthfirst health insurance plan. Please check your plan’s formulary for more information on which prescription 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.
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