We know Medicare changes can be a bit confusing, and Healthfirst is here to help you.
Serving New Yorkers for more than 30 years, today Healthfirst helps two million members navigate the world of healthcare and makes it easy where we can. Let us help you understand the latest changes to Medicare and explain how they might affect you.
If you have any questions, please call us at one of the numbers below. Our team of Medicare specialists is here to help.
You may have heard about changes coming January 1, 2027, for Medicaid recipients that will require recertification every six months and establish new work requirements for those able to work.
These changes do NOT apply to Medicare Dual members who are 65 and older.
However, if you do receive a letter from New York State, it’s important you take whatever action is required.
If you are a Medicare Dual member under 65 and you are affected, you can turn to Healthfirst for help. We can connect you with our recertification partner, SPS Community Solutions. They can help you complete any recertification paperwork and even submit the forms for you. This service is provided at no cost to you. If you need assistance, call 1-844-559-4219 (TTY 711, 1-888-812-0147), Monday to Friday, 9am–5pm.
In 2027 there will be new, stricter rules for OTC Plus card benefits offered by dual-eligible special needs plans.
While all Healthfirst members can still use their OTC Plus card for over-the-counter items, Medicare members everywhere will now have to meet the latest requirements to be able to use their OTC Plus card for food and utilities.* These qualifications include having a chronic condition such as:
If you are a current Healthfirst member:
Healthfirst will review your prior claims to see if you have one of the qualifying conditions. Most Healthfirst members qualify.
If you do qualify, you don’t have to do a thing. Your OTC Plus card will be programmed so you may use it to purchase food and utilities, in addition to over-the-counter items.
If you don’t automatically qualify, you'll receive a letter from Healthfirst. If you believe you have a chronic condition, we’ll need one of your doctors to complete a Provider Attestation Form stating that you have one of the eligible chronic conditions listed. Download the form here.
If you will be a new Healthfirst member:
Once you become a Healthfirst member, you’ll need to give one of your doctors a Provider Attestation Form for them to complete, sign, and submit. The form simply states you have an eligible chronic condition. You can download the form here.
You may see some increases in prescription drug copays and deductibles. Any changes will depend on the plan you are enrolled in and the medications you take, so it’s best to check your plan’s 2027 ANOC (Annual Notice Of Change) and your 2027 drug list for specific costs. You should also continue to speak to your doctor to ensure you are paying the lowest amount for your prescriptions.
An easy way to manage your prescriptions is with the new prescription search function of the Healthfirst NY Mobile App. Simply log in and click on “Manage Prescriptions”.
There you can:
Healthfirst is committed to making sure our members get all the savings they qualify for. Our Medicare Specialists are trained in the different savings programs offered by New York State and the federal government. When you call, we can see if you’re eligible to save and can even help you apply. These savings could help offset any potential cost increases you may see due to the Medicare changes. So be sure to call 1-866-889-2524.
Our specialists can work with you to find the best plan for you. We can also help you find any savings programs that you may qualify for, including Medicaid, Medicare Savings Program, Low-Income Subsidy, Extra Help, and more.
Whether you are already a Healthfirst member or shopping for a new plan, call one of our Medicare specialists today at 1-866-889-2524 and let’s check your eligibility.
While all Healthfirst members can still use their OTC Plus card for over-the-counter items, Medicare members everywhere will now have to meet the latest requirements to be able to use their OTC Plus card for healthy food and utilities. These qualifications include having certain chronic conditions. For more information, see above.
Depending on the plan you’re enrolled in and the medications you take, you may see some increases in prescription drug copays and deductibles. It’s best to check your plan’s 2027 ANOC (Annual Notice of Change) and your 2027 drug list for specific costs.
When your doctor prescribes a medicine, ask if there is a lower-cost alternative. In general, generic prescriptions tend to cost less and are usually the same as name-brand drugs in terms of active ingredients, strength, and effectiveness.
Also, give us a call and we can see if you qualify for any prescription drug savings programs.
One good way to save on Medicare costs is to see if you qualify for a government savings program. For example, if your income is less than $2,494 a month for a single person or $3,375 for a married couple, you may qualify for a Medicare Savings Program that can help pay your monthly premium. Our Healthfirst Medicare Specialists are trained to find any New York State or federal government savings programs that you may be eligible for and help you apply. Call 1-866-889-2524.
These changes do NOT apply to Medicare Dual members who are 65 and older. However, if you do receive a letter from New York State, it’s important you take whatever action is required.
If you would like to learn more about the new Medicare changes, or have questions, give us a call and we can help. We can also see if you are eligible for any savings programs and even help you apply.
TTY 1-888-542-3821
7 days a week, 8am–8pm (October to March)
Monday to Friday, 8am–8pm (April to September)
TTY 1-888-542-3821
7 days a week, 8am–8pm (October to March)
Monday to Friday, 8am–8pm (April to September)
*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.