Medicare

Frequently Asked
Questions

• How do I qualify for the Healthfirst Increased Benefits Plan Medicare Advantage Prescription Drug plan?

  To receive the most benefits from the Healthfirst Increased Benefits Plan, you should be eligible for Extra Help, also known as Low Income Subsidy (LIS), which helps lower prescription drug costs, some or all of your prescription drug coverage (Part D) premiums, deductibles, coinsurance, and/or copayments. Note: If you have limited income, but aren’t on Medicaid, you may still qualify for Low Income Subsidy.

  People with Medicaid get Extra Help automatically when they enroll in Medicare. Those without Medicaid (who qualify for Extra Help) must enroll on their own through the Social Security Administration.

  Another financial assistance program is the Medicare Savings Program (MSP), which is a federally funded program for people with limited income and resources to help pay some or all of their Medicare premiums, deductibles, copayments, and coinsurance. MSP eligibility is based on your household income, with no limit to assets. For example, if you own your home and are single and making less than $2,200 a month (or married and making less than $3,000 a month) you can still qualify.

• What can I purchase with the Healthfirst Increased Benefits Plan OTC Plus card?

  With the Healthfirst Increased Benefits plan you receive a $100/quarter ($400/year) OTC Plus card that can be used to pay for over-the-counter (OTC) non-prescription drugs, health-related items, healthy foods, or even home utilities such as gas, oil, electric, water, and internet service.*

  *For members with Extra Help; members without Extra Help have $100/quarter ($400/year) for OTC and health-related items, exercise equipment, fitness trackers and wearables, and personal emergency response systems (PERS) only.

• Where to buy OTC items with the OTC Plus card:

  Use your OTC Plus card to save on over-the-counter and health-related items, healthy foods, and more. To buy, you can:

  • Visit participating local retailers and farmers’ markets in your neighborhood
  • Shop at nationwide retailers in person such as Walgreens, Walmart, and Rite Aid or
  • Shop online with no-cost delivery at ConveyHFOTC.com.
• What dental benefits are available with the Healthfirst Increased Benefits Plan?

  The Healthfirst Increased Benefits Plan (HMO) Medicare Advantage Prescription Drug plan offers dental coverage with no annual maximum and includes cleanings, exams, X-rays, in addition to complex care such as extractions, dentures, crowns, and more.

• How can I save money on my healthcare costs?

  Taking advantage of your plan benefits can help you save money on healthcare costs. To help you lower your overall health insurance costs, you should always:

  • Use your no-cost benefits, such as annual physical and dental checkups, to help 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 and Tier 1 $0 Preferred Generic Drugs whenever possible.

  Use your telemedicine benefit whenever you cannot see a healthcare provider in person.

• How do I use access my pharmacy benefits?

  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.