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Signature (PPO)

Healthfirst Signature (PPO) is a Medicare Advantage Prescription Drug plan that gives you the flexibility to go out of network and visit any doctor or hospital in the U.S. that accepts Medicare for medical care. This Medicare Advantage PPO plan offers the benefits of Original Medicare, plus much more. For a $0 monthly premium, you will get access to benefits such as prescription drug coverages, dental, hearing, vision, and the SilverSneakers® fitness program. In addition, you have a Flex card that can be used for dental, vision, hearing out-of-pocket costs, and more!  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:

  • A broad network of providers, plus the flexibility to go out of network to visit the provider of your choice
  • Flex card for dental, vision, and hearing out-of-pocket costs, as well as exercise equipment, activity trackers, and Personal Emergency Response Systems (PERS) (2025 plan feature)
  • No-cost preferred generic drugs
  • Preventive and comprehensive dental with no additional premium
  • Vision exams and eyeglasses with no additional premium
  • Hearing exams and hearing aids
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Plan Documents
Choose Plan Year
2025 2024
In-Network
Out-of-Network
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, Suffolk, Rockland 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
In-Network $5,000 annually for Medicare‑covered services received from in‑network providers
Out-of-Network
$8,000 annually for Medicare‑covered services received from both in‑network and out‑of‑network providers
Flex Card
$725/year Flex card for dental, vision, and hearing out-of-pocket costs, fitness equipment, activity trackers, and Personal Emergency Response Systems (PERS).
Annual Supplemental Physical Exam
In-Network $0 copay
Out-of-Network $50 copay
Dental
In-Network Preventive $0 copay
Comprehensive $0 copay
Out-of-Network $0‒$20 copay
$0‒$100 copay
Plan pays up to $1,500 per year for both preventive and comprehensive dental combined.
Vision
$0 copay for routine vision exam, including refraction
$250 eyewear allowance every year for contact lenses or 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
In-Network $0 copay
Out-of-Network $50 copay
Nutrition Counseling is offered for up to six preventive counseling and/or risk factor reduction visits annually
Acupuncture for Chronic Lower Back Pain
In-Network $0 copay
Out-of-Network $50 copay
Acupuncture is offered 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
Primary Care Provider (PCP) Visit
In-Network $0 copay
Out-of-Network $50 copay
Specialist Visit
In-Network $35 copay
Out-of-Network $60 copay
Outpatient Lab Tests (including COVID-19)
In-Network $0 copay
Out-of-Network $60 copay
Retail Health Clinic
In-Network $15 copay
Out-of-Network $60 copay
Urgent Care
$45 copay
Emergency Room
$125 copay
Ambulance
$275 copay
Ambulatory Surgery Visit
In-Network 0% for diagnostic colonoscopies and esophageal endoscopies
$240 copay for each ambulatory surgery center visit
Out-of-Network 30% coinsurance
Outpatient Facility
In-Network 0% coinsurance for diagnostic colonoscopies and esophageal endoscopies
20% coinsurance for all other outpatient hospital services
Out-of-Network 30% coinsurance
Inpatient Hospital Stay
In-Network $325 copay per day for days 1‒5;
$0 copay per day for days 6-999 and beyond
Out-of-Network 40% coinsurance per stay
Skilled Nursing Facility
In-Network $10 each day for days 1‒20
$214 each day for days 21-100
Out-of-Network 50% coinsurance per stay

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.
Please also note that Tier 5 Specialty Drugs are only available for a 30-day supply

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

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 (PPO) Plan

General Plan Information
2025 Star Ratings

Every year, Medicare evaluates plans based on a 5-star rating system.

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
Find member forms
See all plan documents

Helpful Resources

CMS Online Enrollment Center
Disenrollment Rights and Responsibilities
Healthfirst Medication Therapy Management Program
Medicare Coverage Decisions, Appeals and Complaints

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 Insurance Company, Inc., which offers a PPO plan that contracts 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).

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).

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

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

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

Last update December 16, 2024 @ 1:29 pm

Y0147_MKT25_91 5128-24_M

In-Network
Out-of-Network
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, Suffolk, Rockland 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
In-Network $5,000 annually for Medicare‑covered services received from in‑network providers
Out-of-Network
$8,000 annually for Medicare‑covered services received from both in‑network and out‑of‑network providers
Flex Card
$700/year Flex card for dental, vision, and hearing out-of-pocket costs.
Annual Supplemental Physical Exam
In-Network $0 copay
Out-of-Network $50 copay
Dental
In-Network Preventive $0 copay
Comprehensive $0 copay
Out-of-Network $0‒$20 copay
$0‒$100 copay
Plan pays up to $1,500 per year for both preventive and comprehensive dental combined.
Vision
$0 copay for routine vision exam, including refraction
$250 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
In-Network $0 copay
Out-of-Network $50 copay
Nutrition Counseling is offered for up to six preventive counseling and/or risk factor reduction visits annually
Acupuncture for Chronic Lower Back Pain
In-Network $0 copay
Out-of-Network $50 copay
Acupuncture is offered 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
Primary Care Provider (PCP) Visit
In-Network $0 copay
Out-of-Network $50 copay
Specialist Visit
In-Network $40 copay
Out-of-Network $60 copay
Outpatient Lab Tests (including COVID-19)
In-Network $0 copay
Out-of-Network $60 copay
Retail Health Clinic
In-Network $15 copay
Out-of-Network $60 copay
Urgent Care
$55 copay
Emergency Room
$100 copay
Ambulance
$275 copay
Ambulatory Surgery Visit
In-Network $240 copay
Out-of-Network 30% coinsurance
Outpatient Facility
In-Network 20% coinsurance
Out-of-Network 30% coinsurance
Inpatient Hospital Stay
In-Network $350 copay per day for days 1‒6;
$0 copay per day for days 7-999 and beyond
Out-of-Network 40% coinsurance per stay
Skilled Nursing Facility
In-Network $10 each day for days 1‒20
$203 each day for days 21-100
Out-of-Network 50% coinsurance per stay

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

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 (PPO) Plan

General Plan Information
2024 Star Ratings

Every year, Medicare evaluates plans based on a 5-star rating system.

Dental Benefit Guide
Low Income Subsidy Pricing
Out-of-Area Coverage Quick Reference Guide
Out-of-Network Care Quick Reference Guide
Summary of Benefits
Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
List of Drugs Requiring Prior Authorization
List of Drugs Requiring Step Therapy
Find member forms
See all plan documents

Helpful Resources

CMS Online Enrollment Center
Disenrollment Rights and Responsibilities
Healthfirst Medication Therapy Management Program
Medicare Coverage Decisions, Appeals and Complaints

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 Insurance Company, Inc., which offers a PPO plan that contracts 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).

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).

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

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

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

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

Last update December 16, 2024 @ 1:29 pm

Y0147_MKT24_67 1102-23_M

Frequently Asked Questions

See All

A Preferred Provider Organization (PPO) plan offers access to both in-network and out-of-network providers. With our Healthfirst Signature (PPO) Medicare Advantage Prescription Drug plan, you can access our large network of doctors and hospitals for low cost-sharing, or choose to visit any doctor and hospital in the U.S. that accepts Medicare for medical care.

The Healthfirst Signature (PPO) Medicare Advantage Prescription Drug plan includes a yearly Flex card allowance that can be used to pay for out-of-pocket dental, vision, and hearing costs as well as exercise equipment, fitness trackers and wearables, and personal emergency response systems (PERS). Plan members can use it toward an extra pair of glasses, premium hearing aids, or out-of-network dental care. Original Medicare does not offer the Flex card.

The Healthfirst Signature (PPO) Medicare Advantage Prescription Drug plan covers preventive dental care such as twice-yearly checkups, cleanings, fluoride treatment, and more complex care such as extractions, dentures, crowns, and more—all for $0 copay with participating network providers; $0–$100 copay per service for out-of-network dental care, and with up to $1,500 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 first for treatment to avoid out-of-pocket costs.
  • 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 fills 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.

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 1-888-260-2910
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

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Links to non-Healthfirst websites are provided for your convenience only. Healthfirst is not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.