Plan highlights

Star rating

No-cost annual checkups

Hospital, emergency room, retail health clinic, and urgent care visits

Maternity coverage, plus your newborn is automatically enrolled in Medicaid

Hearing, vision, and dental coverage

Transportation to and from doctor appointments for covered services^*

Physical, occupational, and speech therapy

Health and wellness programs

In Lieu of Service (ILS): Psychiatric Admissions

24/7 access to care with telemedicine (Teladoc)^**

Costs and plan details

Deductible (individual)

Eligible Age

No age eligibility requirement

Eligible Service Areas

Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), on Long Island, and in Westchester, Orange, Rockland, and Sullivan counties

Other Eligibility Requirements

Meet the Medicaid Managed Care income requirements. Not sure if you’re eligible?
Find out now

Maximum Out-of-Pocket (individual)

$0
For maximum out-of-pocket pharmacy copay information, visit NYRx, the Medicaid Pharmacy Program

Your Annual Checkup

$0 copay

Primary Care Provider (PCP) Visit

$0 copay

Maternity Care

$0 copay

Dental Cleanings

Pediatric – $0 copay
Adult – $0 copay

Vision Exams

Pediatric – $0 copay
Adult – $0 copay

Telemedicine (Teladoc)

$0 copay

Specialist Visit

$0 copay

Retail Health Clinic

$0 copay

Urgent Care

$0 copay

Emergency Room

$0 copay

Ambulance

$0 copay

Surgeon

$0 copay

Outpatient Facility

$0 copay

Inpatient Hospital Stay

$0 copay

Additional benefits

24/7 Access to Telemedicine with Teladoc

Talk to a doctor any time—for a $0 copay. Connect with board-certified doctors through video chat or phone for prescriptions, help diagnosing and treating non-emergency conditions, and more. Access to dermatologists is also available.

See better with Healthfirst vision benefits

Taking care of your eyes doesn’t just mean having clear vision. An annual eye exam can help detect a number of health risks, such as diabetes, thyroid disease, high blood pressure, and other conditions. Healthfirst has made it easy for our members to take advantage of this often overlooked preventive service by providing access to comprehensive vision care.

Dental care that keeps you smiling

Healthfirst believes that providing you with good dental care is important to your overall healthcare. Covered services include regular and routine dental services such as preventive dental checkups, cleanings, X-rays, fillings, and other services to check for any changes or abnormalities that may require treatment and/or follow-up care for you. You do not need a referral from your PCP to see a dentist.

In Lieu of Services (ILS)

ILS are services or settings that are not covered by Medicaid but are medically appropriate substitutes for covered services or settings.

Covered ILS Benefit: Psychiatric Admissions
You have covered care options than can be used instead of Inpatient Psychiatric services available in some hospitals.

The alternative care option is a short-term intensive stay in a private Institution for Mental Disease (IMD) licensed by OMH, available only at the following four facilities in the Healthfirst service area:

Four Winds Hospital (Westchester)
Gracie Square Hospital (NYC)
Brunswick Hospital Center (Long Island)
South Oaks Hospital (Long Island)

Plan documents

General plan information

•

Covered Services
- View PDF:
- English

Full list of approved preventive services

Prescription drug information

Medicaid NYRx drug look-up Medicaid NYRx benefits and coverage See all plan documents Find member forms

Helpful resources

NY State of Health Recommendations for Preventive Pediatric Health Care Vaccine recommendations Women's preventive services guidelines

Fairness Hearing Notice for Class Action Against the State Regarding CDPAP
- View PDF:
- English
- Español

Learn about Social Care Networks

Frequently asked questions

What does Medicaid cover in New York?

Medicaid covers the essential benefits you need to stay healthy, including:

$0 annual checkups
Hospital, emergency room, urgent care, and retail health clinic visits
Maternity coverage for you and your newborn
Hearing, vision, and dental care
24/7 access to care with telemedicine
Over-the-counter nonprescription drug coverage

Is Healthfirst Medicaid or Medicare?

Both! Healthfirst offers health plans for all ages, needs, and incomes, including:

Medicare Advantage Plans
Managed Long-Term Care Plans
Medicaid Managed Care
Child Health Plus
Essential Plans
Marketplace Plans

What are the eligibility requirements for Medicaid?

Medicaid is for many low-income New York residents, including:

Pregnant women and infants
Children under the age of 19
Parents and caretaker relatives of dependent children
Adults 19 years of age and over who are not pregnant and not eligible for Medicare

How do I apply for Medicaid?

Call Healthfirst at 1-844-488-1486 (TTY 1-888-542-3821) or schedule an appointment
Apply through the NY State of Health online or by phone at 1-855-355-5777 (TTY 1-800-662-1220)
Get free help from a trained and certified Enrollment Assistor or Broker

Where can I find covered COVID-19 and flu vaccinations for my child?

Keep your child safe by getting them vaccinated. Healthfirst Medicaid Managed Care members under age 19 are covered for both COVID-19 and flu vaccines. To get your child vaccinated, reach out to their doctor, a public health clinic, or your county’s health department. Your child can also get vaccinated at a pharmacy enrolled in both NYRx (the NYS Medicaid Pharmacy program) and in the Vaccines for Children program. Always call first to make sure that the vaccines are ready for your child.

To find a vaccine provider, see the links below.

Resources

Disclaimers

See details

The benefit information provided is a brief summary, not a complete description, of benefits. For more information, contact the plan.

Coverage is provided by Healthfirst PHSP, Inc.
Plans contain exclusions and limitations.

ATENCIÓN: Dispone de servicios de asistencia lingüística y otras ayudas, gratis. Llame al 1-866-305-0408 (TTY: 1-888-867-4132).

请注意：您可以免费获得语言协助服务和其他辅助服务。请致电 1-866-305-0408 (TTY: 1‑888‑542‑3821)。

*Medical Answering Services provide the covered transportation services under your plan.

**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).

Medicaid Managed Care
Household Size	Maximum Household Income
1	$22,025
2	$29,864
3	$37,702
4	$45,540
5	$53,379
6	$61,217
7	$69,056
8	$76,894

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