Medicaid Managed Care

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)^*

2023

Medicaid Managed Care

Medicaid Managed Care

Covered Services

Star Ratings

The New York State of Health Marketplace rates insurance companies based on member experience, medical care, and health plan administration. The overall quality rating is based on a scale of one to five stars, with five stars being the highest and best rating.

Comprehensive Formulary

Comprehensive Formulary (List of Covered Drugs)

English

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?

Dental Cleanings

Pediatric – $0 copay

Adult - $0 copay

Vision Exams

Pediatric – $0 copay

Adult - $0 copay

Telemedicine ()

$0 copay

Costs & Benefits

Medicaid Managed Care

(Individual)

$200

For covered prescription drugs, the Maximum Out-of-Pocket limit is $50 per calendar quarter.

Your Annual Checkup

$0 copay

Retail Health Clinic

$0 copay

Urgent Care

$0 copay

Emergency Room

$0 copay

Ambulance

$0 copay

Surgeon

$0 copay

$0 copay per admission

Preventive Pediatric GuideEnglish
Women’s Preventive Services
Full List of Approved Preventive Services
Home Health Care Management and Residential Health Care Facility Services (Nursing Home)

English Español 中文

Prescriptions

(Tier 1)

$1 copay

(Tier 2)

$1 copay

(Tier 3)

$3 copay

Over-the-Counter (OTC) Nonprescription Drugs

$0.50 copay

English

Eligibility for Medicaid Plans

These plans are for low-income families, and for individuals under the age of 65, with the following household income

Medicaid Managed Care
Household Size	Maximum Household Income
1	$18,755
2	$25,268
3	$31,782
4	$38,295
5	$44,809
6	$51,323
7	$57,836
8	$64,350

^*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

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.

^*Telemedicine 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).
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.

Additional Benefits

24/7 Access to Telemedicine with Teladoc^*

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.

^*Telemedicine 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).
See better with Healthfirst Vision Benefits

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

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.

Frequently Asked
Questions

See All

Who is eligible to enroll?

We have plans for all ages, needs, and income levels. To see which Healthfirst plans are right for you, please use our plan recommendation tool or contact us.
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?

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.

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Support When You Need It

We’re happy to answer your questions.

Learn about enrollment

1-844-488-1486

Monday to Saturday, 8am–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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Need help choosing a plan?

Need help choosing a plan?

Medicaid Managed Care

Plan Highlights:

Additional Benefits

24/7 Access to Telemedicine with Teladoc^*

See better with Healthfirst Vision Benefits

Dental Care That Keeps You Smiling

Additional Benefits

24/7 Access to Telemedicine with Teladoc^*

See better with Healthfirst Vision Benefits

Dental Care That Keeps You Smiling

Frequently Asked
Questions

Support When You Need It

1-844-488-1486

1-866-463-6743

Can’t talk right now?

You are now navigating away from the Healthfirst website.

Medicaid Managed Care

Plan Highlights:

Plans

Eligibility for Medicaid Plans

Additional Benefits

24/7 Access to Telemedicine with Teladoc*

See better with Healthfirst Vision Benefits

Dental Care That Keeps You Smiling

Additional Benefits

24/7 Access to Telemedicine with Teladoc*

See better with Healthfirst Vision Benefits

Dental Care That Keeps You Smiling

Frequently Asked Questions

Support When You Need It

1-844-488-1486

1-866-463-6743

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