Healthfirst Signature (HMO) is a Medicare Advantage plan that gives you the flexibility to pick benefits that best suit your needs. This Medicare Advantage HMO plan offers the benefits of Original Medicare plus much more. For a $0 monthly premium, you will get access to benefits such as prescription drugs, dental, hearing, vision, the SilverSneakers® fitness program, 24/7 access to doctors care through phone or video chat, and more. In addition, you may choose one Choice Extras benefit upon enrollment. And you don’t need referrals to see in-network specialists. This plan is designed for people who do not qualify for programs like Extra Help (also known as Low Income Subsidy), Medicare Savings Programs (MSP), or Medicaid.

Plan Highlights:

  • Your pick of one Choice Extras benefit: OTC allowance or transportation
  • Comprehensive dental
  • No-cost preferred generic drugs
  • Vision exams and eyeglasses
  • Hearing exams and hearing aids
  • Acupuncture
Choose Plan Year
Premium
$0
Eligible Age
65 or older (or under 65 with certain disabilities)
Eligible Service Areas
Reside within New York City’s five boroughs (The Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Nassau, Orange, Rockland, Sullivan, and Westchester counties.
Other Eligibility Requirements
Qualify for Medicare Part A.
Enroll in and continue to pay for Medicare Part B
Medical Deductible
$0
Maximum Out-of-Pocket
$6,700
Choice Extra
$85 per quarter over-the-counter (OTC) card or 30 one-way trips to doctors for covered services
Annual Supplemental Physical Exam
$0 copay
Dental
$0 copay for covered preventive and comprehensive dental services; up to $2,500 maximum coverage per year
Vision
$0 copay for routine vision exams
$250 eyewear allowance every year towards one pair of glasses (lenses and frames)
Hearing
$0 for routine hearing exams
$0‒$1,475 copay per hearing aid
Plan covers one hearing aid per ear, per year
Nutrition Counseling
$0 copay for up to 6 counseling visits per year
Acupuncture
$0 copay for up to 20 visits per year for chronic lower back pain and 12 additional visits per year for any condition, including chronic lower back pain
Telemedicine (Teladoc)
$0 copay
Nurse Help Line Access
$0 copay
Meal Delivery
$0 copay for up to 84 meals delivered to your home for up to 28 days following a discharge from hospital to home or from a skilled nursing facility to home with a stay greater than two days, if recommended by a provider
Your Annual Checkup
$0 copay
Primary Care Provider (PCP) Visit
$0 copay
Specialist Visit
$30 copay
Outpatient Lab Tests (including COVID-19)
$0 copay
Retail Health Clinic
$15 copay
Urgent Care
$55 copay
Emergency Room
$125 copay
Ambulance
$275 copay
Ambulatory Surgery Visit
$240 copay
Outpatient Facility
0% for diagnostic colonoscopies and esophageal endoscopies
20% coinsurance for all other outpatient hospital services
Inpatient Hospital Stay
$430 copay per day for up to 5 days;
$0 copay per day after 5 days
Skilled Nursing Facility
$10 copay per day for up to 20 days;
$214 copay per day for days 21–100

Choice Extras benefits (OTC or non-emergent transportation)

Healthfirst Signature (HMO) offers enrollees a choice of one of two supplemental benefits upon enrollment: an allowance for over-the-counter (OTC) items, or non-emergent transportation to healthcare provider locations. Enrollees may choose only one of the two benefits and may not switch to another choice during the year.

  1. The OTC allowance is $85 per quarter toward approved OTC non-prescription drugs and/or health-related items at participating providers (retail locations and mail order) for enrollee’s personal use.
  2. The non-emergent transportation benefit option covers up to 30 one-way trips to an approved healthcare provider location, using a participating transportation provider arranged by Healthfirst’s transportation vendor at least two (2) days before the healthcare appointment. Prior authorization is required.

Prescription Drug Benefits

We want to help you get the most out of your Part D prescription drug benefits. Please refer to the formulary links below to see which medications fall under each tier. Please note that Healthfirst may add drugs to or remove them from the Medicare formulary during the year. You’ll receive notice when changes are made.

Deductible (Applies to Tiers 4‒5)
$590
Preferred Generic Drugs (Tier 1)
$0 copay, no deductible
Generic Drugs (Tier 2)
$15 copay for 30-day or 90-day supply, no deductible
Preferred Brand and Generic Drugs (Tier 3)
$47 copay for 30-day or 90-day supply, no deductible
Non-Preferred Drugs (Tier 4)
50% coinsurance for 30-day supply after deductible
Specialty Drugs (Tier 5)
25% of cost after deductible
Select Insulins
Maximum of $35 copay for 30-day supply, no deductible
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 Plan Highlights

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) 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) 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.

E8F603C3-4D94-4DCE-818B-75031FE268CE Created with sketchtool.

SilverSneakers®

Get access to live classes and workshops taught by instructors trained in senior fitness, 300+ 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

Learn More

Plan Documents

2025 Signature (HMO) Plan

General Plan Information
2025 Star Ratings: New York City & Nassau
2025 Star Ratings: Orange, Rockland, Sullivan & Westchester
Low Income Subsidy Pricing
Summary of Benefits
Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
List of Drugs Requiring Prior Authorization
List of Drugs Requiring Step Therapy
See all forms & documents

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.

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.

Healthfirst complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-305-0408 (TTY 1-888-867-4132).

注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電1-866-305-0408 (TTY 1-888-542-3821).

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.

Telemedicine (Teladoc) 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).

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.

SilverSneakers is a registered trademark of Tivity Health, Inc. © 2024 Tivity Health, Inc. All rights reserved.

Last update December 5, 2024 @ 8:44 am

Y0147_MKT25_91 5128-24_M

Premium
$0
Eligible Age
65 or older (or under 65 with certain disabilities)
Eligible Service Areas
Reside within New York City’s five boroughs (The Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Nassau, Orange, Rockland, Sullivan, and Westchester counties.
Other Eligibility Requirements
Qualify for Medicare Part A.
Enroll in and continue to pay for Medicare Part B
Medical Deductible
$0
Maximum Out-of-Pocket
$6,700
Choice Extra
$70 per quarter over-the-counter (OTC) card or 25 one-way trips to doctors for covered services
Annual Supplemental Physical Exam
$0 copay
Dental
$0 copay for covered preventive and comprehensive dental services; up to $2,500 maximum coverage per year
Vision
$0 copay for routine vision exams
$300 allowance every two years toward eyeglasses/contacts
Hearing
$0 for routine hearing exams
$0‒$1,475 copay per hearing aid
Plan covers one hearing aid per ear, per year
Nutrition Counseling
$0 copay for up to 6 counseling visits per year
Acupuncture
$0 copay for up to 20 visits per year for chronic lower back pain and 12 supplemental visits per year for any condition
Telemedicine (Teladoc)
$0 copay
Nurse Help Line Access
$0 copay
Meal Delivery
$0 copay for up to 84 meals delivered to your home for up to 28 days following a discharge from hospital to home or from a skilled nursing facility to home with a stay greater than two days, if recommended by a provider
Your Annual Checkup
$0 copay
Primary Care Provider (PCP) Visit
$0 copay
Specialist Visit
$35 copay
Outpatient Lab Tests (including COVID-19)
$0 copay
Retail Health Clinic
$15 copay
Urgent Care
$55 copay
Emergency Room
$100 copay
Ambulance
$275 copay
Ambulatory Surgery Visit
$240 copay
Outpatient Facility
20% coinsurance
Inpatient Hospital Stay
$450 copay per day for up to 5 days;
$0 copay per day after 5 days
Skilled Nursing Facility
$0 copay per day for up to 20 days;
$203 copay per day for days 21–100

Choice Extras benefits (OTC or non-emergent transportation)

Healthfirst Signature (HMO) offers enrollees a choice of one of two supplemental benefits upon enrollment: an allowance for over-the-counter (OTC) items, or non-emergent transportation to healthcare provider locations. Enrollees may choose only one of the two benefits and may not switch to another choice during the year.

  1. The OTC allowance is $70 per quarter toward approved OTC non-prescription drugs and/or health-related items at participating providers (retail locations and mail order) for enrollee’s personal use.
  2. The non-emergent transportation benefit option covers up to 25 one-way trips to an approved healthcare provider location, using a participating transportation provider arranged by Healthfirst’s transportation vendor at least two (2) days before the healthcare appointment. Prior authorization is required.

Prescription Drug Benefits

We want to help you get the most out of your Part D prescription drug benefits. Please refer to the formulary links below to see which medications fall under each tier. Please note that Healthfirst may add drugs to or remove them from the Medicare formulary during the year. You’ll receive notice when changes are made.

Deductible (Applies to Tiers 4‒5)
$250
Preferred Generic Drugs (Tier 1)
$0 copay, no deductible
Generic Drugs (Tier 2)
$10 copay for 30-day or 90-day supply, no deductible
Preferred Brand and Generic Drugs (Tier 3)
$47 copay for 30-day or 90-day supply, no deductible
Non-Preferred Drugs (Tier 4)
$100 copay for 30-day supply after deductible
Specialty Drugs (Tier 5)
26% of cost after deductible
Supplemental Drugs (Tier 6)
$5 copay for 30-day supply, no deductible
Select Insulins
Maximum of $35 copay for 30-day or 90-day supply, no deductible
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 Plan Highlights

24/7 Access to Telemedicine with Teladoc*

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) 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) 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.

E8F603C3-4D94-4DCE-818B-75031FE268CE Created with sketchtool.

SilverSneakers

Get access to live classes and workshops taught by instructors trained in senior fitness, 200+ 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

Learn More

Plan Documents

2024 Signature (HMO) Plan

General Plan Information
2024 Star Ratings: New York City & Nassau
2024 Star Ratings: Orange, Rockland, Sullivan & Westchester
Dental Benefit Guide
Low Income Subsidy Pricing
Summary of Benefits
Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
List of Drugs Requiring Prior Authorization
List of Drugs Requiring Step Therapy
See all forms & documents

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.

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.

Healthfirst complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-305-0408 (TTY 1-888-867-4132).

注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電1-866-305-0408 (TTY 1-888-542-3821).

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.

Telemedicine (Teladoc) 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).

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

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.

SilverSneakers is a registered trademark of Tivity Health, Inc. © 2023 Tivity Health, Inc. All rights reserved.

Last update December 5, 2024 @ 8:44 am

Y0147_MKT24_67 1102-23_M

Frequently Asked Questions test

An HMO plan is a type of Medicare Advantage plan that provides health care coverage exclusively from doctors, other healthcare providers, or hospitals in the plan’s network (except emergency care, out-of-area urgent care, or temporary out-of-area dialysis). With the Healthfirst Signature (HMO) Medicare Advantage Prescription Drug plan, you get access to a large network of top doctors and hospitals, convenient ways to get care 24/7, and many plan benefits that help you stay healthy, save money, and more. Plus, you don’t need referrals to see in-network specialists.

Healthfirst Signature (HMO) members may choose one of two Choice Extras benefit options, a quarterly OTC allowance or no-cost transportation. If you choose an OTC allowance as your Choice Extras benefit, you can use your OTC card to purchase approved over‑the‑counter (OTC) non‑prescription drugs and health‑related items from participating retailers.

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

  • Visit participating retailers in your neighborhood
  • Shop at nationwide retailers in person such as Walgreens, Walmart, and Rite Aid
  • Shop online with no-cost delivery at ConveyHFOTC.com

The Healthfirst Signature (HMO) Medicare Advantage Prescription Drug plan covers preventive dental care such as twice-yearly checkups, cleanings, and fluoride treatment. and more complex care such as extractions, dentures, crowns and more, all for $0 copay with participating network providers, up to $2,500 in dental services per year.

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 copay Preferred Generic Drugs whenever possible.
  • 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 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:

  • How you take the medicine (for example, pill or liquid)
  • Safety
  • Strength
  • Quality
  • How it works
  • How the medicine should be used

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.

Have questions about your plan? Looking to enroll?

Have questions or
ready to enroll?

We can help!

Support When You Need It

We’re happy to answer your questions. Our service center's hours are:

  • October through March, 7 days a week, 8am—8pm
  • April through September, Monday to Friday, 8am—8pm
Learn about enrollment 1-877-237-1303

TTY English: 1-888-542-3821

TTY Español: 1-888-867-4132
Member Services 1-855-771-1081
TTY English: 1-888-542-3821
TTY Español: 1-888-867-4132

Need help enrolling in a health plan?

Request a call and our sales team will call you within one business day.

You can also visit us in person at one of our community offices

The following link will take you to Medicare.gov where you can enroll online.

CMS Online Enrollment Center