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2014 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)
  • Do not have End-Stage Renal Disease (ESRD) (permanent kidney disease requiring dialysis or a kidney transplant), except under certain limited circumstances. 
  • 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 more than 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 
  • private duty nursing
  • consumer directed personal care services

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. 

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

Your level of extra help

Monthly Premium for:

Healthfirst CompleteCare (HMO SNP)*









*This does not include any Medicare Part B premium you may have to pay.

Click here to download your Low Income Subsidy (LIS) Premium Table. (English  Español  中文)

You do not pay a separate monthly plan premium for Healthfirst CompleteCare (HMO SNP).
You must continue to pay your Medicare Part B premium, unless your Part B premium is paid for by Medicaid or another third party.
Medicare Part B is covered for full-dual members.
The monthly plan premium for the Healthfirst CompleteCare (HMO SNP) is $0 per month.  

Eligible beneficiaries can enroll in this plan at any time. Contact Healthfirst for more information.

Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year.

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
As a Healthfirst Medicare member, you may be eligible to sign up for more cost-saving programs through My Advocate from Altegra Health.
Find out if you qualify to get help paying for your healthcare or other non-medical costs like nutrition, home expenses, and transportation.
Click the box to learn more. This link will take you away from the Healthfirst website.

Healthfirst Medicare Plan is an HMO plan with a Medicare contract and a contract with the New York Medicaid program. Enrollment in Healthfirst Medicare Plan depends on contract renewal.

H3359_MKT14_18 CMS Approved 10252013

Last update 2014-08-25 08:24

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