Medicaid Managed Care

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A Medicaid plan with a $0 monthly plan premium and low or no copays for doctor visits, lab tests, prescription drugs, hospitalization, urgent care, emergency care, maternity, dental, vision, hearing, wellness, and more. Sponsored by New York State, this plan is for qualified low-income families and individuals under 65.

Plan Highlights:

  • No-cost annual checkups
  • Hospital, emergency room, retail health clinic, and urgent care visits
  • Prescription and over-the-counter nonprescription drug coverage*
  • 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
  • NEW - Institution for Mental Disease (IMD) In Lieu of Service (ILS)
  • 24/7 access to care with telemedicine (Teladoc)*
  • 2021
Medicaid Managed Care
Summary of Benefits and Coverage (PDF)
Comprehensive Formulary
Premium
$0
Eligible Age
Under 65
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
Dental Cleanings
Pediatric – $0 copay
Adult - $0 copay
Vision Exams
Pediatric – $0 copay
Adult - $0 copay
Telemedicine (Teladoc)
$0 copay
Costs & Benefits
Contact Us Tier
Medicaid Managed Care
Deductible (Individual)
$0
Maximum Out-of-Pocket (Individual)
$200
Your Annual Checkup (Preventive Care)
$0 copay
Primary Care Provider (PCP) Visit
$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 per admission
Prescriptions
Generic Drugs (Tier 1)
$1 copay
Brand Name Preferred (Tier 2)
$1 copay
Brand Name Non-Preferred (Tier 3)
$3 copay
Over-the-Counter (OTC) Nonprescription Drugs
$0.50 copay
Covered Prescription Drugs (Formulary) English

*Some copays may apply.

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

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

Additional Benefits

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    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.

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    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.

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    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.

Additional Benefits

  • 24/7 Access to Telemedicine with Teladoc*

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  • See better with Healthfirst Vision Benefits

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  • Dental Care That Keeps You Smiling

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Frequently Asked
Questions

See All
  • Who is eligible to enroll? FAQ dropdown arrow
  • Why should I choose Healthfirst? FAQ dropdown arrow
  • How can I enroll? FAQ dropdown arrow

Support When You Need It

We're happy to answer your questions.

Learn about enrollment

1-844-488-1486

Monday to Friday, 9am–8pm

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

Can’t talk right now?

Request a callback and we’ll get back to 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’s website to view your choices, or call the NY State of Health customer service center at 1-855-355-5777.

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