2013 CompleteCare (HMO SNP) - Eligibility and Cost

To receive coverage under the Healthfirst CompleteCare (HMO SNP), you must meet the following qualifications:

• Qualify as Dual Eligible, entitled to both Medicare (Part A & B) and full Medicaid coverage or full Medicaid coverage with Qualified Medicare Beneficiary (QMB) eligibility from New York State Medicaid; 
• Reside in the service area New York State counties: Bronx, Kings (Brooklyn), Nassau (Long Island), New York (Manhattan), Richmond (Staten Island) or Queens; 
• Require nursing home level of care (as of the time of enrollment); 
• Have the ability, at the time of enrollment, of returning to or remaining in your home and community without jeopardy to your health and safety; 
• Require care management and be expected to need at least one of the following services covered by Medicaid Advantage Plus for at least 120 days from the effective date of enrollment:
• nursing home services in the home 
• therapies in the home 
• home health aide services 
• personal care services in the home 
• adult day health care 
• social day care if used as a substitute for in-home personal care services
• private duty nursing

If you get extra help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium (monthly plan payment) will be lower than what it would be if you did not get extra help from Medicare. The amount of extra help you get will determine your total monthly plan premium as a member of our plan.

This table shows you what your monthly plan premium will be if you get extra help.

Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1, 2014.

You must use contracted network pharmacies to access your prescription drug benefit except under non-routine circumstances, in which case quantity limitations and restrictions may apply.

Premiums, copays, co-insurance, and deductibles may vary based on the level of help that beneficiaries may receive; beneficiaries should contact the plan for further details.

The plan's contract with the Centers for Medicare & Medicaid Services is renewed annually. Availability of coverage beyond the end of the current contract year is not guaranteed.

Money Saving Programs Social Service Coordinators (SSC) help Healthfirst Medicare Plan members apply for cost-saving programs.  Find out if you qualify for help paying your health care premiums and out-of-pocket or prescription drug costs.  You may even qualify for help paying your telephone, utility or other non-medical costs.  Click on the SSC box below to learn more. Please note that clicking on this link will take you away from the Healthfirst website.

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Healthfirst Medicare Plan is a Coordinated Care plan with a Medicare contract and a contract with the New York Medicaid program.

H3359_MKT13_17 CMS Approved 11152012