The Healthfirst Connection Plan is a Medicare Advantage Dual-Eligible Special Needs (HMO D-SNP) plan that offers members the benefits of Original Medicare and more, such as prescription medications, an OTC Plus card, dental, hearing, vision, transportation, the SilverSneakers® fitness program, 24/7 access to care via phone or video chat, and more. Plus, you don’t need referrals to see in-network specialists. This plan is designed for people who have Medicare and receive cost-sharing assistance from Medicaid.
$45/month OTC Plus card for over-the-counter (OTC) items, exercise equipment, and activity trackers. If eligible, you can also use the card for healthy foods, home utilities, and more*
Copays as low as $0 for covered prescription drugs
16 no-cost, one-way trips per year to in-network doctors for covered services
Comprehensive dental, including dentures, extractions, crowns, root canals, and more for $01
Routine vision and hearing exams, $250/year allowance for unlimited eyeglasses or contact lenses, and hearing aids for as low as $0
We want to help you get the most out of your Part D prescription drug benefits. To confirm that your drugs are covered and to see which medications fall under each tier, use the Healthfirst prescription drug search tool or view the Connection Plan (HMO D-SNP) formulary. Healthfirst may add drugs to or remove them from its Medicare formulary during the year. We will notify you when we make changes.
Please note that for Tier 1–4 Drugs, you may receive up to a 90-day supply, but for Tier 5 Drugs, you may only receive up to a 30-day supply.
Depending on your level of Extra Help, you have to pay only the following for your prescription drugs:
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.
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 virtual dermatologists and mental health services is also available.
Talk to a nurse any time—for a $0 copay. Get wellness advice and help finding a doctor.
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.
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.
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:
Being a Qualified Medicare Beneficiary (QMB) means you get help paying for Medicare. But how that connects to plans like Healthfirst Connection Plan isn’t always clear.
The QMB program is one of the highest levels of support available through the Medicare Savings Program in New York. It’s designed for people with lower incomes who have Medicare but need help with out-of-pocket healthcare costs.
If you qualify as a QMB, you typically receive help with:
This could mean big savings on most Medicare-related costs.
How QMB connects to Medicare Advantage plans
Being a Qualified Medicare Beneficiary may also make you eligible for a plan designed just for your needs.
In New York, many QMBs qualify for a Dual Eligible Special Needs Plan (D-SNP) like the Healthfirst Connection Plan. These plans are built to work alongside your Medicaid benefits and help coordinate your care.
Why this matters
Understanding your QMB status is important because it can mean:
If you have both Medicare and Medicaid and receive QMB-level assistance, you may be able to get more out of your health plan than you realize.
Choosing a Medicare plan is about finding coverage that fits your health needs, your budget, and how you prefer to receive care.
The Healthfirst Connection Plan (HMO D-SNP) is designed specifically for people in New York who have both Medicare and Medicaid and may offer a cheaper and simpler way to manage their healthcare.
This plan may be a good fit if you:
Unlike Original Medicare, which separates hospital, medical, and drug coverage, a Dual Eligible Special Needs Plan brings these elements together—and aligns them with your Medicaid benefits.
That can mean:
A more connected approach to care
As a member, the biggest perk of a Dual Eligible Special Needs Plan isn’t just cost savings—it’s simplicity. When your coverage is coordinated, it can be easier to:
If you’re eligible for both Medicare and Medicaid in New York, Healthfirst Connection Plan can help you make the most of your benefits.
*These 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.
1Dental 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.
You must continue to pay your Medicare Part B premium (unless your Part B premium is paid by Medicaid or another third party).
Coverage is provided by Healthfirst Health Plan, Inc., which offers HMO plans that contract with the Federal Government. Enrollment in Healthfirst Medicare Plan depends on contract renewal.
Plans contain exclusions and limitations.
No out-of-pocket costs for entry-level hearing aids. Eyewear allowance can only be used at participating retailers.
OTC items are subject to the plan’s list of eligible items and the plan’s participating network of retail, online, and utility providers.
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.
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.
Last update October 6, 2026 @ 2:14 pm
Y0147_MKT27_49 26-5421_M
$55/month with the OTC Plus card for over-the-counter (OTC) items, healthy foods, home utilities, personal emergency response systems (PERS), exercise equipment, activity trackers, and more.*
Copays as low as $0 for covered prescription drugs
18 no-cost, one-way trips per year to in-network doctors for covered services
Comprehensive dental, including dentures, extractions, crowns, root canals, and more for $0**
Routine vision and hearing exams, $250/year allowance for eyeglasses or contact lenses, and hearing aids for as low as $0
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 fall under each tier. Healthfirst may add drugs to or remove them from its Medicare formulary during the year. You will receive notice when changes are made.
Please note that for Tier 1–4 Drugs, you may receive up to a 90-day supply, but for Tier 5 Drugs, you may only receive up to a 30-day supply.
Depending on your level of Extra Help, you have to pay only the following for your prescription drugs:
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.
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).
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).
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.
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.
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:
Taking advantage of your benefits can help you save money on healthcare costs. To help lower your overall health insurance costs, you should always:
Pharmacy benefits are different for each Healthfirst health insurance plan. Please check your plan’s formulary for more information on which pharmacy 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.
Yes. Generics are the same as brand name drugs in many ways:
This is required by the U.S. Food and Drug Administration (FDA). The difference is that generic drugs usually cost much less than brand-name drugs. Not all brand-name drugs are available as generic versions.
To find out more about a specific drug, you can use our drug search tool.
*These 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.
1Dental 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.
You must continue to pay your Medicare Part B premium (unless your Part B premium is paid by Medicaid or another third party).
Coverage is provided by Healthfirst Health Plan, Inc., which offers HMO plans that contract with the Federal Government. Enrollment in Healthfirst Medicare Plan depends on contract renewal.
Plans contain exclusions and limitations.
No out-of-pocket costs for entry-level hearing aids. Eyewear allowance can only be used at participating retailers.
OTC items are subject to the plan’s list of eligible items and the plan’s participating network of retail, online, and utility providers.
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.
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.
Last update October 6, 2026 @ 2:14 pm
Y0147_MKT27_49 26-5421_M
Monday to Friday, 8am–8pm
We can help you enroll by phone, video chat, or in person.
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.