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2014 Increased Benefits Plan (HMO) - Eligibility and Cost

To receive coverage under the Healthfirst Increased Benefits Plan (HMO), you must meet the following qualifications:

  • Qualify for Medicare Part A (you are 65 or older, or under 65 with certain disabilities).
  • Enroll in and continue to pay for Medicare Part B.
  • Live in the Healthfirst service area: Bronx, Kings (Brooklyn), New York (Manhattan), Queens, Richmond (Staten Island), and Nassau counties.
  • Do not have End-Stage Renal Disease (ESRD) (permanent kidney disease requiring dialysis or a kidney transplant), except under certain limited circumstances.
  • Members may enroll in the plan only during specific times of the year. Contact Healthfirst for more information.

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.

Your level of extra help

Monthly Premium for:

Healthfirst Increased Benefits Plan (HMO)*









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

Premium includes coverage for both medical services and prescription drug coverage.

The monthly plan premium for the Healthfirst Increased Benefits Plan (HMO) is $30 per month.

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

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 08:27

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