Medicare & Long-Term Care Plans CompleteCare (HMO D-SNP)

This plan is made for those who need help with day-to-day activities like bathing and meal preparation and who want to stay in their home. The plan offers Medicare Advantage, Medicaid Managed Long-Term Care (MLTC) benefits, and prescription drug coverage combined. It also covers benefits that Original Medicare doesn't cover, like an OTC Plus card, eyeglasses, and wide-ranging support for caregivers.

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Plan highlights Costs and plan details Prescription drug beneifts Additional benefits Plan documents Helpful resources Frequently asked questions

Plan highlights

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Long-term care benefits, such as personal care aide services, adult day health center, social day center, and more

Dedicated Care Team to help you meet your care goals and live independently at home

$252/month OTC Plus card for over-the-counter (OTC) items, healthy foods, exercise equipment, activity trackers, home utilities (including gas, oil, electric, water, and internet service), and more1

Support for caregivers through Carallel®

Comprehensive dental, including dentures, crowns, root canals for $0

$0 copay for all other covered services, including free entry-level hearing aids

Costs and plan details

Premium
$0
Eligible Age
18 or older
Eligible Service Areas
Reside within New York City's five boroughs (The Bronx, Brooklyn, Manhattan, Queens, Staten Island), or in Nassau, Orange, Rockland, Sullivan, and Westchester counties.
Other Eligibility Requirements
Must have evidence of Medicare Part A and Part B coverage and full Medicaid coverage.

Require nursing home level of care (as of the time of enrollment)

Have the ability, at the time of enrollment, to return to or remain in your home and community without danger to your health and/or safety

Are in need of Community Based Long-Term Services and Supports (CBLTSS) for more than 120 days from the effective date of enrollment and meet the minimum needs requirements as follows:
  • At least limited assistance with physical maneuvering with more than two activities of daily living (ADL); or
  • Individuals with a dementia or Alzheimer’s diagnosis assessed as needing supervision with more than one ADL
Those continuously enrolled in a Managed Long-Term Care Plan (MLTC), Medicaid Advantage Plus Plan (MAP), and PACE as of August 2025 do not need to meet the minimum needs criteria.

If this is your first time receiving Community Based Long-Term Services and Supports (CBLTSS), you must contact the New York Independent Assessor Program (NYIAP) to find out if you are eligible. Call 1-855-222-8350 (TTY 1-888-329-1541), Monday to Friday, 8:30am–8pm; Saturday, 10am–6pm, except for designated state holidays.
OTC Plus Card
$252 per month allowance for over-the-counter (OTC) non-prescription drugs and health-related items, fitness equipment, and activity trackers. Eligible individuals can also use the allowance for healthy foods and home utilities such as gas, oil, electric, water, and internet service.1
Dental
$0 copay2
Vision
$0 copay for vision exams; $400 allowance per calendar year for frames/lenses and contact lenses.
Hearing
$0 copay for hearing exams and entry-level hearing aids
Acupuncture
$0 copay for up to 20 visits per year for chronic lower back pain and 40 supplemental visits per year for any condition, including chronic lower back pain
Telemedicine
$0 copay
Nurse Help Line Access
$0 copay
Support for Caregivers
$0

Members and their caregivers have access to unlimited, personalized support through Carallel®—at no cost.

This support includes one-on-one guidance from caregiving experts who will listen, understand, and help, providing practical advice on managing daily care, creating a safe home environment, and planning.

You’ll also receive help finding in-home care, senior housing options, and local programs. Plus, you’ll have access to support groups and a wide range of online resources—all designed to make caregiving easier and more manageable.

Learn more at myhf.org/caregiving.
Fitness Program
$0 copay for access to the SilverSneakers network of fitness facilities, group exercise classes, classes held at parks and community locations, and at-home kits
Your Annual Checkup
$0 copay
Primary Care Provider (PCP) Visit
$0 copay
Specialist Visit
$0 copay
Urgent Care
$0 copay
Emergency Room
$0 copay
Ambulance
$0 copay
Ambulatory Surgery Visit
$0 copay
Outpatient Facility
$0 copay
Inpatient Hospital Stay
$0 copay
Skilled Nursing Facility
$0 copay

Prescription drug benefits

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.

All Part D Drugs
$0 copay
Quantity Limits

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.

Additional benefits

24/7 access to telemedicine with Teladoc Health®

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 Health) 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).

24/7 access to care with the Nurse Help Line

Talk to a nurse any time—for a $0 copay. Get wellness advice and help finding a doctor.

Telemedicine (Teladoc Health) 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).

Urgent care center network

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.

SilverSneakers®

Get access to live classes and workshops taught by instructors trained in senior fitness, hundreds of workout videos in the SilverSneakers On-Demand™ online library, online fitness and nutrition tips, and their mobile app with digital workout programs.

Healthfirst Medication Therapy Management program

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:

  • Phone consultation with a licensed pharmacist to complete a Comprehensive Medication Review (CMR). The call will take about 30 to 60 minutes, and the pharmacist will answer any questions you may have. (A CMR is offered once each year, if you qualify.)
  • Medication Action Plan (MAP)
  • Medication recommendations may be sent to your provider from the MTM pharmacist, also known as Targeted Medication Review (TMR)
  • A list that shows all your medications

Plan documents

General plan information

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Prescription drug information

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  • List of Drugs Requiring Prior Authorization
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  • List of Drugs Requiring Step Therapy
See all plan documents Find member forms

Frequently asked questions

For individuals eligible for both Medicare and Medicaid, our Dual-Eligible Special Needs plans (D-SNPs) are designed to make Part D prescription drugs, healthy foods, and even home utilities more affordable!

Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage Plan that limit membership to people with specific diseases or characteristics. Medicare SNPs tailor their plan benefits, provider choices, and drug formularies to best meet the specific needs of the members they serve.

Our CompleteCare (HMO D-SNP) Medicare Advantage Prescription Drug plan is designed to help our members live better, healthier lives with Long Term Services and Supports (LTSS), a monthly OTC Plus card allowance that can be used for healthy foods,1 and more. Plus, there are no out-of-pocket costs for CompleteCare members.

With the Healthfirst CompleteCare (HMO D-SNP) Medicare Advantage Prescription Drug plan, you receive an OTC Plus card that can be used to pay for over-the-counter (OTC) non-prescription medicines and health-related items, healthy foods, exercise equipment and activity trackers, or even home utilities such as gas, oil, electric, water, and internet service.*

  • Visit participating retailers and farmers’ markets in your neighborhood
  • Shop at nationwide retailers in person such as Walgreens, Walmart, Rite Aid and more,
  • Shop online with no-cost delivery at https://www.conveyhfotc.com/login.

The Healthfirst CompleteCare (HMO D-SNP) plan covers preventive dental care such as yearly checkups, cleanings, and fluoride treatment. Plus, comprehensive dental care including dentures, crowns, root canals, and extractions.

Dental services must be medically necessary; limitations and exclusions apply.

There are no out-of-pocket costs for in-network covered services for CompleteCare members. Be sure to take advantage of your plan benefits, such as annual physical and dental checkups, to keep you healthy and identify potential health risks early.

  • Make sure you see an in-network doctor or facility for treatment to avoid surprise bills.
  • Visit an urgent care center for non-emergency issues such as colds or flu, sprains, and wounds.
  • Ask your in-network doctor or pharmacist for 90-day prescription refills.
  • Use your convenient 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.

Disclaimers

1Healthy foods and home utilities are special supplemental benefits for members enrolled in a Healthfirst dual-eligible special needs plan. To be eligible, you must have a chronic condition such as cardiovascular disorder, disabling mental health condition, diabetes, lung disorders, obesity, or another eligible condition not listed. Benefit eligibility is not based on your chronic condition alone.

2Dental 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 on January 1 of each year.

The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

Coverage is provided by Healthfirst Health Plan, Inc., which offers HMO plans with a Medicare contract and a contract with the NY State Medicaid program. Enrollment in Healthfirst Medicare Plan depends on contract renewal.

Plans contain exclusions and limitations.

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OTC items are subject to the plan’s list of eligible items and the plan’s participating network of retail, online, and utility providers.

No out-of-pocket costs for entry-level hearing aids. Eyewear allowance can only be used at participating retailers.

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

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

Telemedicine (Teladoc Health) 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).

SilverSneakers is a registered trademark of Tivity Health, Inc. © 2026 Tivity Health, Inc. All rights reserved.

The benefits mentioned are a part of special supplemental program for the chronically ill. Not all members qualify.

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Last update July 10, 2026 @ 11:08 am

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If you receive Medicaid and want to know whether you are eligible for a Managed Long-Term Care Plan, you can call the New York Independent Assessor (NYIA) formerly Conflict-Free Evaluation Enrollment Center (CFEEC) at 1-855-222-8350, TTY at 1-888-329-1541, Monday to Friday, 8:30am–8pm, and Saturday, 10am–6pm, to schedule your initial assessment.

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