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CompleteCare (HMO D-SNP)
- 65 Plus Plan (HMO)
- CompleteCare (HMO D-SNP)
- Connection Plan (HMO D-SNP)
- Increased Benefits Plan (HMO)
- Life Improvement Plan (HMO D-SNP)
- Senior Health Partners Plan
- Signature (HMO)
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The Healthfirst CompleteCare plan is a Medicare Advantage Dual-Eligible Special Needs (HMO D-SNP) plan that offers members the benefits of Original Medicare and Medicaid, plus prescription drugs; dental, vision, and hearing; an OTC Plus card; the SilverSneakers® fitness program; and more. You’ll also get a Care Team, led by a Registered Nurse or a Licensed Social Worker, that will help you coordinate the services you need to stay healthy. And you don’t need referrals to see in-network specialists. This plan is designed for people who have both Medicare and full Medicaid and need in-home care and long-term care services.
Plan Highlights:
- Prescription drug coverage
- Comprehensive dental
- Vision exams and eyeglasses
- Hearing exams and hearing aids
- OTC Plus card for OTC, non-prescription drugs and health-related items, healthy foods, exercise equipment, fitness trackers, and home utilities such as gas, oil, electric, water, and internet service
- SilverSneakers fitness program
- Acupuncture
- Long-term care benefits (i.e. Care Management Team, personal care services)
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Prescription Cost
OTC Plus Benefit
Premium
$0
Eligible Age
18 or older
Eligible Service Areas
Reside within New York City's five boroughs (The Bronx, Kings (Brooklyn), New York (Manhattan), Queens, Richmond (Staten Island)), Nassau, Orange, Rockland, Sullivan and Westchester counties.
Other Eligibility Requirements
Must have evidence of Medicare Part A and Part B coverage and full Medicaid coverage.
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 danger to your health and/or safety
Require at least one of the following Community Based Long Term Care Services (CBLTCS) covered by the plan for more than 120 days from the effective date of enrollment
Medical Deductible
$0
Maximum Out-of-Pocket
$8,300
OTC Plus Card
$250 per month for over-the-counter (OTC) nonprescription drugs, health-related items, healthy foods, fitness equipment and activity trackers, and home utilities such as gas, oil, electric, water, and internet service
Dental
$0 copay
Vision
$0 copay for vision exams; $550 allowance for frames/lenses and contact lenses.
Hearing
$0 copay for hearing exams and entry-level hearing aids
Acupuncture
40 supplemental visits per year
Telemedicine (Teladoc)
$0 copay
Nurse Help Line Access
$0 copay
Rides to Your Healthcare Providers
$0 transportation to/from your doctor for covered services
Fitness Program
$0 copay for access to the SilverSneakers network of fitness facilities, group exercise classes, classes held at parks and community locations, and at-home kits
Your Annual Checkup
$0 copay
Primary Care Provider (PCP) Visit
$0 copay
Specialist Visit
$0 copay
Urgent Care
$0 copay
Emergency Room
$0 copay
Ambulance
$0 copay
Ambulatory Surgery Visit
$0 copay
Outpatient Facility
$0 copay
Inpatient Hospital Stay
$0 copay
Skilled Nursing Facility
$0 copay
Prescription Drug Benefits
We want to help you get the most out of your Part D prescription drug benefits. Please refer to the formulary below to see which medications are covered. Healthfirst may add drugs to or remove them from its Medicare formulary during the year. You will receive notice when changes are made.
Generic Drugs
$0 copay
All Other Drugs
$0 copay
Quantity Limits
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.
Additional Plan Highlights
24/7 Access to Telemedicine with Teladoc*
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).
24/7 Access to care with the Nurse Help Line**
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).
Urgent Care Center Network
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.
SilverSneakers
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.
Healthfirst Medication Therapy Management Program
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:
- Phone consultation with a licensed pharmacist to complete a Comprehensive Medication Review (CMR). The call will take about 30 to 60 minutes and the pharmacist will answer any questions you may have. (A CMR is offered once each year, if you qualify.)
- Medication Action Plan (MAP)
- Medication recommendations may be sent to your provider from the MTM pharmacist, also known as Targeted Medication Review (TMR)
- A list that shows all your medications
Learn More
Plan Documents
2024 CompleteCare (HMO D-SNP)
General Plan Information
The Healthfirst CompleteCare Plan is rated a Four-Star-Rated Medicare Advantage Plan in 2024
Every year, Medicare evaluates plans based on a 5-star rating system.
2024 Star Ratings
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Dental Benefit Guide
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Low Income Subsidy Pricing
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Summary of Benefits
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Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
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List of Drugs Requiring Prior Authorization
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List of Drugs Requiring Step Therapy
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Helpful Resources
Disenrollment Rights and Responsibilities
Healthfirst Medication Therapy Management Program
Medicare Coverage Decisions, Appeals and Complaints
Disclaimer
Healthfirst will cover non-emergency Medicaid-covered transportation provided that it is included as a Managed Long Term Care benefit by the New York State Department of Health.
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.
Coverage is provided by Healthfirst Health Plan, Inc., which offers HMO plans with a Medicare contract and a contract with the NY State Medicaid program. 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).
OTC items are subject to the plan’s list of eligible items and the plan’s participating network of retail, online, and utility providers.
Healthy foods/groceries and home utilities are special supplemental benefits. To be eligible for these benefits, you must have one of the following chronic conditions: cardiovascular disorder, disabling mental health condition, diabetes, lung disorders, or obesity. There are other eligible conditions not listed. Your chronic condition alone cannot guarantee eligibility for these benefits. All applicable eligibility requirements must be met before the benefits are provided.
No out-of-pocket costs for entry-level hearing aids. Eyewear allowance can only be used at participating retailers.
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.
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).
SilverSneakers is a registered trademark of Tivity Health, Inc.© 2023 Tivity Health, Inc. All rights reserved.
The benefits mentioned are a part of special supplemental program for the chronically ill. Not all members qualify.
Modivcare and Medical Answering Services provide the covered transportation services under your plan.
Last update September 11, 2024 @ 11:30 am
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Frequently Asked Questions
See All
What is an HMO D-SNP or SNP insurance plan?
For individuals eligible for both Medicare and Medicaid, our Dual-Eligible Special Needs plans (D-SNPs) are designed to make Part D prescription drugs, healthy foods and even home utilities more affordable!
Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage Plan that limit membership to people with specific diseases or characteristics. Medicare SNPs tailor their plan benefits, provider choices, and drug formularies to best meet the specific needs of the members they serve.
Our CompleteCare (HMO D-SNP) Medicare Advantage Prescription Drug plan is designed to help our members live better, healthier lives with Long Term Services and Supports (LTSS), a monthly OTC Plus card allowance that can be used for healthy foods, and more. Plus, there are no out-of-pocket costs for CompleteCare members.
What can I purchase with the Healthfirst CompleteCare OTC Plus card?
With the Healthfirst CompleteCare (HMO D-SNP) Medicare Advantage Prescription Drug plan, you receive a $250/month ($3,000/year) OTC Plus card that can be used to pay for over-the-counter (OTC) non-prescription medicines and health related items, healthy foods, exercise equipment and activity trackers, or even home utilities such as gas, oil, electric, water, and internet service.
Where to buy OTC items with the OTC Plus card:
- Visit participating retailers and farmers’ markets in your neighborhood
- Shop at nationwide retailers in person such as Walgreens, Walmart, and Rite Aid or
- Shop online with no-cost delivery at https://www.conveyhfotc.com/login.
What dental benefits are available with the Healthfirst CompleteCare plan?
The Healthfirst CompleteCare (HMO D-SNP) plan covers preventive dental care such as yearly checkups, cleanings, and fluoride treatment. Plus, comprehensive dental care including dentures, crowns, root canals, and extractions.
How can I save money on my healthcare costs?
There are no out-of-pocket costs for in-network covered services for CompleteCare members. Be sure to take advantage of your plan benefits, such as annual physical and dental checkups, to keep you healthy and identify potential health risks early.
- Make sure you see an in-network doctor or facility for treatment to avoid surprise bills.
- Visit an urgent care center for non-emergency issues such as colds or flu, sprains, and wounds.
- Ask your in-network doctor or pharmacist for 90-day prescription refills and $0 Preferred Generic Drugs whenever possible.
- Use your convenient telemedicine benefit whenever you cannot see a healthcare provider in person.
How do I access my pharmacy benefits?
Pharmacy benefits are different for each Healthfirst health insurance plan. Please check your plan’s formulary for more information on which prescription medicines and other items are covered.
Healthfirst has partnered with CVS Caremark to bring you a personal prescription drug account that will give you 24/7 access to important drug benefit information and tools that will make getting your prescription drugs easier. Click here to create your account or log in.
Have questions about your plan? Looking to enroll?
Have questions or
ready to enroll?
We can help!
Support When You Need It
We’re happy to answer your questions. Our service centers hours are:
- October through March, 7 days a week, 8am—8pm
- April through September, Monday to Friday, 8am—8pm
Learn about enrollment 1-877-237-1303
TTY English: 1-888-542-3821
TTY Español: 1-888-867-4132
Medicare Member Services 1-888-260-1010
TTY English: 1-888-542-3821
TTY Español: 1-888-867-4132
Need help enrolling in a health plan?
Request a call and our sales team will call you within one business day.
You can also visit us in person at one of our community offices
If you receive Medicaid and want to know whether you are eligible for a Managed Long-Term Care Plan, you can call the New York Independent Assessor (NYIA) formerly Conflict-Free Evaluation Enrollment Center (CFEEC) at1-855-222-8350, TTY at1-888-329-1541, Monday to Friday, 8:30am-8pm, and Saturday, 10am-6pm, to schedule your initial assessment.
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