Healthfirst insurance offers a range of health plans tailored for New York residents, including Medicare Advantage, Medicaid, and marketplace options.
Known for affordability and quality, it serves nearly 2 million members with comprehensive benefits.
This article explains Healthfirst’s plans, costs, and benefits in simple language. It helps you understand if Healthfirst is the right choice for your healthcare needs.
What Is Healthfirst Insurance?
Healthfirst insurance is a not-for-profit health insurer based in New York. It provides affordable plans like Medicare Advantage, Medicaid, and Essential Plans.
Operating for over 30 years, it serves New York City, Long Island, and nearby areas. Plans are designed to meet diverse health and budget needs.
Healthfirst partners with over 40,000 providers and 80 hospitals. Its plans often include extras like dental, vision, and over-the-counter (OTC) benefits. The company emphasizes community care and accessibility. Many plans have low or no premiums for eligible members.
Who Can Enroll in Healthfirst Plans?
Healthfirst insurance is available to New York residents of all ages. Eligibility depends on income, age, or health status. Medicare Advantage plans are for those 65 or older or with qualifying disabilities. Medicaid and Essential Plans target low-income individuals and families.
Special Needs Plans (SNPs) serve dual-eligible members with Medicare and Medicaid. Marketplace plans are open to anyone seeking coverage. Check Healthfirst’s website or call 888-260-1010 to confirm eligibility. Coverage areas include NYC, Nassau, Suffolk, and Westchester counties.
Types of Healthfirst Plans
Healthfirst insurance offers a variety of plans to suit different needs. Most plans are Health Maintenance Organizations (HMOs), with one Preferred Provider Organization (PPO) option. Below are the main plan types:
- Medicare Advantage: Covers hospital, medical, and often prescription drugs, with extras like dental.
- Medicaid Managed Care: Free or low-cost coverage for low-income residents.
- Essential Plans: Affordable marketplace plans for individuals and families.
- Special Needs Plans (SNPs): For dual-eligible or long-term care needs.
Each plan includes access to a large provider network. Plans vary by county, so check availability.
Benefits of Healthfirst Insurance
Healthfirst insurance provides comprehensive coverage beyond Original Medicare. Medicare Advantage plans include hospital stays, doctor visits, and prescriptions. Many offer dental, vision, and hearing benefits with no annual maximums. Preventive care, like screenings, is covered at no cost.
Plans often include an OTC Plus card for health products and utilities. Fitness programs, like SilverSneakers, promote wellness. Telehealth services offer convenient virtual care. These benefits support health and reduce out-of-pocket costs.
Costs of Healthfirst Plans
Many Healthfirst plans have $0 monthly premiums, especially for Medicaid and some Medicare Advantage plans. Copays and deductibles vary by plan and service. For example, primary care visits may have $0 copays in-network. PPO plans have higher out-of-network costs.
The OTC Plus card covers items like vitamins or healthy foods. Extra Help or Medicare Savings Programs can lower drug costs for eligible members. Use Healthfirst’s website to estimate costs by ZIP code.
Table: Sample Healthfirst Medicare Advantage Plans (2025, NYC Area)
| Plan Name | Location (ZIP) | Monthly Premium | Key Benefits | Out-of-Pocket Max |
|---|---|---|---|---|
| Signature (HMO) | Brooklyn (11201) | $0 | $0 copay primary care, OTC card | $6,700 |
| Signature (PPO) | Manhattan (10001) | $0-$36 | Out-of-network care, $725 Flex card | $7,500-$10,000 |
| Life Improvement (D-SNP) | Bronx (10451) | $0 | Medicaid coordination, dental coverage | $6,900 |
| 65 Plus Plan (HMO) | Queens (11354) | $0 | Prescription drugs, no copays for drugs | $6,800 |
This table shows sample 2025 plans in New York City. Costs and benefits vary by county. Contact Healthfirst for exact details.
Enrolling in Healthfirst Insurance
Enrolling in Healthfirst insurance is easy. Visit Healthfirst’s website and enter your ZIP code to find plans. You can enroll online, call 888-260-1010, or visit a community office. TTY users can call 888-542-3821.
Medicare Advantage open enrollment runs from October 15 to December 7. Medicaid and Essential Plans allow year-round enrollment for eligible individuals. Have your Medicare or personal details ready when applying. Healthfirst’s team can guide you through the process.
Accessing Care with Healthfirst
Healthfirst’s HMO plans require in-network providers, except for emergencies. The PPO plan allows out-of-network care at higher costs. The network includes over 100,000 providers, including doctors, hospitals, and pharmacies. You choose a primary care provider (PCP) to manage care.
Referrals are needed for specialists in HMO plans, but not in the PPO plan. Telehealth services provide virtual doctor visits. Use the HFDocFinder tool to locate in-network providers. Staying in-network keeps costs low.
Preventive Care and Wellness Programs
Healthfirst insurance prioritizes preventive care. Plans cover annual checkups, screenings, and vaccinations at no cost in-network. These services help catch health issues early, reducing future expenses. Wellness programs encourage healthy lifestyles.
SilverSneakers offers free gym memberships to promote fitness. The OTC Plus card covers health products and utilities like internet or gas. Educational seminars teach members about managing health. These features support long-term well-being.
Special Features of Healthfirst Plans
Healthfirst offers unique benefits not found in Original Medicare. The Signature PPO plan includes a $725/year Flex card for dental, vision, or hearing costs. D-SNPs coordinate Medicare and Medicaid benefits for dual-eligible members. Many plans have $0 copays for prescription drugs with Extra Help.
The OTC Plus card can be used for healthy foods or utilities. Dental coverage often has no annual limit, unlike many competitors. These extras make Healthfirst plans comprehensive and valuable.
Managing Your Healthfirst Plan
After enrolling, you’ll receive a member ID card. Carry it to appointments to verify coverage. Healthfirst’s website and app let you track claims, find providers, and view benefits. Customer service (888-260-1010) assists with billing or coverage questions.
Keep records of medical visits and payments. For PPO plans, confirm out-of-network coverage before care. Review your plan annually to ensure it fits your needs. Healthfirst’s tools simplify plan management.
Why Choose Healthfirst Insurance?
Healthfirst insurance is known for affordability and quality. Its 4-star CMS rating for 2025 reflects high performance. The not-for-profit model prioritizes member care over profit. Plans are tailored to New York’s diverse communities, with multilingual support.
The large provider network ensures access to care. Low or no-cost premiums and extras like the OTC Plus card add value. Healthfirst’s focus on prevention and community support makes it a trusted choice.
Community Impact and Resources
Healthfirst supports New York communities through local partnerships. Community offices in NYC, Long Island, and Westchester offer in-person help in multiple languages. Health fairs and wellness events promote health education. These efforts improve access in underserved areas.
The website provides tools like HFDocFinder and plan comparison guides. SHINE, New York’s State Health Insurance Assistance Program, offers free Medicare counseling. Healthfirst’s resources empower members to make informed health choices.
Summary
Healthfirst insurance offers affordable, quality health plans in New York, including Medicare Advantage, Medicaid, and Essential Plans. With nearly 2 million members, it provides hospital, medical, and prescription coverage, plus extras like dental and vision.
Many plans have $0 premiums, with costs varying by plan and location. Enrollment is simple via Healthfirst’s website or community offices.
The large provider network and telehealth services ensure access to care. Preventive care, wellness programs, and the OTC Plus card promote health and savings. Healthfirst’s not-for-profit mission and community focus make it a reliable option. Visit Healthfirst’s website to explore plans in your area.
FAQ
What is Healthfirst insurance?
Healthfirst insurance is a not-for-profit insurer offering Medicare Advantage, Medicaid, and Essential Plans in New York. It covers hospital, medical, and prescription drugs, with extras like dental and vision. Plans serve nearly 2 million members.
Who can enroll in Healthfirst plans?
New York residents of all ages can enroll, depending on income or Medicare eligibility. Medicare Advantage is for those 65+ or with disabilities. Medicaid and Essential Plans target low-income individuals.
How do I enroll in Healthfirst insurance?
Enroll online at Healthfirst’s website, call 888-260-1010, or visit a community office. Medicare open enrollment is October 15 to December 7. Medicaid enrollment is year-round for eligible individuals.
What does Healthfirst insurance cover?
Healthfirst covers hospital stays, doctor visits, prescriptions, and preventive care. Many plans include dental, vision, hearing, and OTC benefits. Some offer a Flex card for extra costs.
Are Healthfirst plans expensive?
Many plans have $0 premiums, especially Medicaid and some Medicare plans. Copays and deductibles vary, with PPO plans costing more out-of-network. Extra Help lowers drug costs for eligible members.
How do I find providers with Healthfirst?
Use the HFDocFinder tool on Healthfirst’s website to find in-network providers. HMO plans require in-network care and referrals; PPO plans allow out-of-network flexibility. Telehealth is available.