Signature (PPO)

Healthfirst Signature (PPO) gives you the flexibility to go out of network and visit any doctor or hospital in the U.S. that accepts Medicare. You also have a dedicated Member Services team that helps make healthcare easy for you. This 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 coverage, dental, hearing, vision, and the SilverSneakers^® fitness program. In addition, you have a $700/year Flex card that can be used for dental, vision, and hearing out-of-pocket costs. 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
$700/year Flex card for dental, vision, and hearing out-of-pocket costs
Dedicated member services team
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
Supplemental drug coverage for select prescription-strength vitamins and erectile dysfunction (ED) drugs

2023

Signature (PPO)

Summary of Benefits and Coverage (PDF)

Star Ratings

Not enough data available.^*

^*Some plans do not have enough data to rate performance.

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

Low Income Subsidy Premium Pricing

English Español 中文

Eligible Age

65 or older (or under 65 with )

Eligible Service Areas

Reside within New York City’s five boroughs (The Bronx, Brooklyn, Manhattan, Queens, and Staten Island) or Nassau county.

Other Eligibility Requirements

Qualify for Medicare Part A.

Enroll in and continue to pay for Medicare Part B.

In-Network

Out-of-Network

Flex Card

$700/year Flex card for dental, vision, and hearing out-of-pocket costs.

Annual Supplemental Physical Exam

$0 copay

$50 copay after your $1,000 plan deductible

Dental

Preventive $0 copayComprehensive $0 copay

$20 copay$0-$100

Plan pays up to $1,500 per year for both preventive and comprehensive dental combined.

Vision

$0 copay for routine vision exams

$250 allowance every two years toward eyeglasses/contacts

Hearing

$0 for routine hearing exams

$0‒$1,475 copay per hearing aid for up to two hearing aids per year

Nutrition Counseling

$0 copay

$50 copay after your $1,000 plan deductible

Nutrition Counseling is offered for up to six preventive counseling and/or risk factor reduction visits annually

Acupuncture for Chronic Lower Back Pain

$0 copay

$50 copay after your $1,000 plan deductible

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 ()

copay

$0 copay after your $1,000 plan deductible

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

Dental Quick Reference Guide

English Español 中文

Costs & Benefits

Signature (PPO)

In-Network

Out-of-Network

$1,000 per year for select medical services

$7,000

$11,000 annually for Medicare-covered services you receive from both in-network and out-of-network providers.

$0 copay

$50 copay after your $1,000 plan deductible

$45 copay

$60 copay after your $1,000 plan deductible

Outpatient Lab Tests (including COVID-19)

$0 copay

50% coinsurance after your $1,000 plan deductible

Retail Health Clinic

$15 copay

50% coinsurance after your $1,000 plan deductible

Urgent Care

$60 copay for urgently needed services both in the U.S. and worldwide

Emergency Room

$95 copay for emergency care both in the U.S. and worldwide

Ambulance

$275 copay per one-way trip

Ambulatory Surgery Visit

$240 copay

50% coinsurance after your $1,000 plan deductible

20% coinsurance

50% coinsurance after your $1,000 plan deductible

$502 copay per day for days 1‒3;$0 copay per day for days 4 and beyond

40% coinsurance per stay after your $1,000 plan deductible

Skilled Nursing Facility

$0 copay per day for days 1‒20; $196 copay per day for days 21‒100

50% coinsurance per stay after your $1,000 plan deductible

Out-of-Network Care Quick Reference Guide

English
Español
中文

Out-of-Area Coverage Quick Reference Guide

English
Español
中文

Prescriptions

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.

(Applies to Tiers 4‒5)

$250

(Tier 1)

$0 copay, no deductible

(Tier 2)

$10 copay for 30-day or 90-day supply, no deductible

(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

(Tier 5)

26% of cost after deductible

Supplemental Drugs (Tier 6)

$10 copay for 30-day supply, no deductible

Select Insulins

$35 copay for 30-day or 90-day supply, no deductible

(List of Covered Drugs)

English/Español/中文

List of Drugs Requiring

English

List of Drugs Requiring

English

More Information: 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 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.

Out-of-network healthcare services may have higher costs. Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

Some dental services must be medically necessary to be covered; limitations and exclusions apply. No out-of-pocket costs for entry-level hearing aids. Eyewear allowance can be used at participating retailers.

Coverage is provided by Healthfirst Health Plan, Inc. or Healthfirst Insurance Company, Inc. Plans contain exclusions and limitations.

Healthfirst Health Plan, Inc. offers PPO plans that contract with the Federal Government. Enrollment in Healthfirst Medicare Plan depends on contract renewal.

Healthfirst Medicare Plan, Inc. 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).

Last update August 17, 2023 @ 10:13 am

Y0147_MKT23_90 0816-22_2023

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.
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 late-night and weekend hours, often with faster service at a lower cost than the emergency room (ER). 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.
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

Additional Plan Highlights

24/7 Access to Telemedicine with Teladoc^*

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

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.
Urgent Care Center Network

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 late-night and weekend hours, often with faster service at a lower cost than the emergency room (ER). 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.
SilverSneakers

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
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

Frequently Asked
Questions

See All

Can I save money on my healthcare costs?
Taking advantage of your 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 checkups, to help keep you healthy and identify potential risks early.
- Make sure you see an in-network doctor or facility 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
- Choose 90-day prescription refills and Tier 1 $0 copay Preferred Generic Drugs whenever possible
- Use your telemedicine benefit if it’s included with your health plan
How do I use my coverage at the pharmacy?

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.
Do generic drugs work as well as brand name drugs?
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.

Support When You Need It

We’re happy to answer your questions.

Learn about enrollment

1-877-237-1303

7 days a week, 8am—8pm

TTY English: 1-888-542-3821

TTY Español: 1-888-867-4132

Member Services

1-833-350-2910

7 days a week, 8am—8pm

TTY English: 1-833-350-2910

TTY Español: 1-888-867-4132

Can’t talk right now?

Request a callback and we’ll get back to 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

I am^*

First Name^*

Last Name^*

Phone Number^*

Email Address^*

Home Zip Code^*

By checking this box, I authorize Healthfirst to contact me about Healthfirst products and services using the information provided above by automated means, including email, phone, or text. Message & data rates may apply. Submitting this form does not obligate me to enroll in a plan, affect my current enrollment, or enroll in a Healthfirst plan.

Need help choosing a plan?

Need help choosing a plan?

Signature (PPO)

Plan Highlights:

Additional Plan Highlights

24/7 Access to Telemedicine with Teladoc^*

24/7 Access to care with the Nurse Help Line

Urgent Care Center Network

SilverSneakers

Healthfirst Medication Therapy Management Program

Additional Plan Highlights

24/7 Access to Telemedicine with Teladoc^*

24/7 Access to care with the Nurse Help Line

Urgent Care Center Network

SilverSneakers

Healthfirst Medication Therapy Management Program

Frequently Asked
Questions

Support When You Need It

1-877-237-1303

1-833-350-2910

Can’t talk right now?

You are now navigating away from the Healthfirst website.

Signature (PPO)

Plan Highlights:

Additional Plan Highlights

24/7 Access to Telemedicine with Teladoc*

24/7 Access to care with the Nurse Help Line

Urgent Care Center Network

SilverSneakers

Healthfirst Medication Therapy Management Program

Additional Plan Highlights

24/7 Access to Telemedicine with Teladoc*

24/7 Access to care with the Nurse Help Line

Urgent Care Center Network

SilverSneakers

Healthfirst Medication Therapy Management Program

Frequently Asked Questions

Support When You Need It

1-877-237-1303

1-833-350-2910

Can’t talk right now?

We look forward to helping you!

You are now navigating away from the Healthfirst website.

Sent!

Something went wrong

24/7 Access to Telemedicine with Teladoc^*

24/7 Access to Telemedicine with Teladoc^*

Frequently Asked
Questions