Medicaid Managed Care

Medicaid Managed Care provides important health benefits for a $0 monthly premium and low or $0 copays. This NY State Medicaid plan is for qualified low-income families and individuals.

Plan Highlights:

  • 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)**
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
Deductible (individual)
$0
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.

EFA092C3-2461-4D39-89BB-2D795C6E9CD6 Created with sketchtool.

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

    2026 Medicaid Managed Care

    General Plan Information
    The Healthfirst Medicaid Managed Care Plan earned a Five-Star rating in 2025
    Medicaid Managed Care and CHPlus insurers’ quality ratings are measured on a five-star scale from indicators chosen by the New York State Department of Health (NYSDOH). These ratings are published on the NYSDOH public website.
    Covered Services
    Full List of Approved Preventive Services
    Prescription Drug Information
    Medicaid NYRx pharmacy program
    Prescription Cost
    Find member forms
    See all plan documents

    Helpful Resources

    NY State of Health
    Preventive Pediatric Guide
    Vaccine Recommendations
    Women’s Preventive Services
    Fairness Hearing Notice for Class Action Against the State Regarding CDPAP

    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).

    DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.

    EyeMed® is contracted with Healthfirst to provide vision benefits to its members.

    Eligible Age
    No age eligibility requirement
    Eligible Service Areas
    Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, and 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
    Deductible (individual)
    $0
    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
    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.

    EFA092C3-2461-4D39-89BB-2D795C6E9CD6 Created with sketchtool.

    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

      2025 Medicaid Managed Care

      General Plan Information
      The Healthfirst Medicaid Managed Care Plan is rated a 5-Star-Rated Plan in 2025
      Medicaid Managed Care and CHPlus insurers’ quality ratings are measured on a five-star scale from indicators chosen by the New York State Department of Health (NYSDOH). These ratings are published on the NYSDOH public website.
      Covered Services
      Full List of Approved Preventive Services
      Prescription Drug Information
      Medicaid NYRx pharmacy program
      Prescription Cost
      Find member forms
      See all plan documents

      Helpful Resources

      NY State of Health
      Preventative Pediatric Guide
      Vaccine Recommendations
      Women’s Preventive Services
      Fairness Hearing Notice for Class Action Against the State Regarding CDPAP

      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.
      Healthfirst complies with Federal civil rights laws. Healthfirst does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex as defined in 45 CFR § 92.101(a)(2).
      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)。

      **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).

      DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.

      EyeMed® is contracted with Healthfirst to provide vision benefits to its members.

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

      Frequently Asked Questions

      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

      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

      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

      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

      Support When You Need It

      We’re happy to answer your questions

      Learn about enrollment 1-844-488-1486

      Monday to Saturday, 9am–6pm

      TTY English: 1-888-542-3821

      TTY Español: 1-888-867-4132
      Member Services 1-866-463-6743

      Monday to Friday, 8am–6pm

      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.

      You can also go to the NY State of Health website to view your choices, or call the NY State of Health customer service center at 1-855-355-5777.

      Have questions about your plan? Looking to enroll?

      Have questions or
      ready to enroll?

      We can help!