Healthfirst are an insurance company who offer Medicare Advantage plans in specific areas of New York state.
Having been in operation for longer than 25 years, Healthfirst offer various healthcare plans, including Medicare Advantage and Medicaid plans, as well as individual and group plans.
They offer their services in various locations across New York state.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare Advantage, or Medicare Part C, is an alternative to original Medicare (Part A and Part B). Private insurance companies offer Medicare Advantage plans, which may be region-specific.
All Medicare Advantage plans must offer the same coverage as original Medicare, but they often provide additional benefits for hearing, visual, and dental care. However, a person enrolled in a Medicare Advantage plan will still pay the Medicare Part B premium.
According to the Kaiser Family Foundation (KFF), around 34% of Medicare-eligible people are enrolled in a Medicare Advantage plan.
There are several types of Medicare Advantage plan. The most common ones include:
- Health Maintenance Organization (HMO) plans: Around 62% of people with Medicare Advantage plans have an HMO plan, according to the KFF. The plans include in-network providers, and a person will need to get a doctor’s referral to see a specialist.
- Preferred Provider Organization (PPO) plans: The KFF estimate that 31% of people with Medicare Advantage plans have a PPO plan. Unlike HMO plans, PPO plans generally pay at least some portion for the use of out-of-network providers. As a result, PPO plans may have a higher monthly premium than HMOs.
- Special Needs Plans (SNPs): These plans are only available to people with certain medical conditions, those who live in long-term care facilities, and those who may be eligible for both Medicare and Medicaid.
Learn more about the pros and cons of Medicare Advantage here.
Healthfirst are a nonprofit insurance company offering Medicare Advantage plans to Medicare-eligible individuals in certain areas of New York state.
According to the company’s website, Healthfirst have 1.6 million members, as well as over 40,000 in-network providers and more than 80 hospitals, participating in their health plans.
Healthfirst offer several Medicare Advantage plans. The table below shows some details for the company’s Medicare Advantage plans, including their premiums, copays, out-of-pocket costs, and availability by location.
| Plan | Premium | Primary care copay | Specialist care copay | Maximum out-of-pocket amount | Locations available |
|---|---|---|---|---|---|
| Signature (HMO) | $0 | $10 | $45 | $7,550 for in-network providers | Manhattan, The Bronx, Queens, Westchester County, Kings County, and Nassau County |
| 65 Plus Plan (HMO) | $0 | $10 | $45 | $7,550 for in-network providers | New York City and Nassau County |
| Increased Benefits Plan (HMO) | $0–$42.30, depending on Extra Help level | $0 | $40 | $7,550 for in-network providers | New York City, Nassau County, Rockland County, Westchester County, Orange County, and Sullivan County |
| Life Improvement Plan (HMO SNP) | $0 | $0 | $0 | $3,450 for in-network providers | New York City, Nassau County, Westchester County, Orange County, Rockland County, and Sullivan County |
| Complete Care (HMO SNP) | $0 | $0 | $0 | $3,450 for in-network providers | New York City, Nassau County, Westchester County, Orange County, Rockland County, and Sullivan County |
| Coordinated Benefits Plan (HMO) | $0 | $10 | $35 | $7,550 for in-network providers | New York City and Nassau County |
Managed care options
All of Healthfirst’s Medicare Advantage plans are managed care plans in the HMO category. A person with an HMO plan will choose a primary care doctor, and this doctor will help manage their care.
Healthfirst plans may include additional benefits, either related to a particular plan or across all plans.
Choice Extras
The Healthfirst Signature plan offers an option to select one additional benefit from a package of Choice Extras. This extra benefit can be added to a person’s plan on enrollment, but they cannot change it during the year.
The HealthFirst Signature plan offers a choice from the following:
- $35 per quarter over-the-counter (OTC) allowance
- $0 copay for 12 one-way trips to a doctor or pharmacy
- $0 deductible for comprehensive dental services
Other benefits
Other benefits include:
- acupuncture
- dental services
- hearing exams and hearing aids
- OTC allowance for some nonprescription items
- SilverSneakers fitness program
- vision care, such as eye exams or eyeglasses
Care management team
The Complete Care (HMO SNP) plan also provides benefits specific to people with long-term care needs. The benefits include a care management team and personal care services to assist in coordinating a person’s care.
Because the plan is a dual-eligibility SNP, the benefits are in addition to the services a person may get through the Medicaid program.
Each year, the Centers for Medicare and Medicaid Services (CMS) evaluate Medicare Advantage plans and award star ratings, ranging from 5 stars (excellent) to 1 star (poor).
For 2021, Healthfirst received the following ratings:
- overall star rating: 4 stars (above average)
- health plan service rating: 3.5 stars (average/above average)
- drug plan service rating: 4 stars (above average)
The ratings are based on specific measurements. The CMS will review and update them each fall.
The New York State Health Insurance Assistance Program (SHIP) offers impartial, free advice. It is part of a nationwide network of free Medicare and health insurance counseling programs.
This tool can help people find and compare plans. A person can also enter their prescription drugs and determine whether or not a particular plan will cover them.
Healthfirst offer Medicare Advantage plans in some areas of New York state.
The plans contract with healthcare providers and hospitals to reduce people’s medical costs and offer expanded coverage beyond that of original Medicare.