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.
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.$0 copay for covered preventive and comprehensive dental services; up to $2,500 maximum coverage per year
$0 copay for routine vision exams$0 for routine hearing exams
$0‒$1,475 copay per hearing aid
Plan covers one hearing aid per ear, per year
$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) Nurse Help Line Access 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 Primary Care Provider (PCP) Visit Specialist Visit Outpatient Lab Tests (including COVID-19) Retail Health Clinic Urgent Care Emergency Room Ambulatory Surgery Visit Outpatient Facility 20% coinsurance Inpatient Hospital Stay $450 copay per day for up to 5 days;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.
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.
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.
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).
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).
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.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.
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:
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 August 7, 2024 @ 11:12 am