NY Manual
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New York Provider Manual
2.1 Healthfirst PHSP Programs | 2.3 Healthfirst Commercial Programs

2.2 Healthfirst Medicare Plans

 

Healthfirst offers several Medicare Advantage Plans (MA Plans) under contract with the Centers for Medicare & Medicaid Services (CMS). Some of these MA Plans also include Medicaid benefits offered through a contract with the New York State Department of Health. The Healthfirst MA Plans are issued by Healthfirst Health Plan, Inc., part of the family of Healthfirst companies.  

To meet the eligibility requirements for Healthfirst MA Plans, beneficiaries must have both Part A and Part B Medicare, live in the particular MA Plan’s service area, and not have end-stage renal disease (ESRD). An individual who receives a kidney transplant and who no longer requires a regular course of dialysis to maintain life is not considered to have ESRD for purposes of MA eligibility. If a beneficiary no longer requires regular dialysis or has had a successful transplant, the beneficiary should obtain a note or records from the beneficiary’s physician showing that the ESRD status has changed and the beneficiary is in fact eligible to enroll in the MA Plan. Generally, the benefits for MA Plans change on a yearly basis, and providers are informed of these changes through our provider newsmagazine, The Source; through a direct mailing to provider offices; and through updates on the Provider Secure Services website (www.healthfirst.org/providerservices). Most MA Plans include Standard Medicare Prescription Drug Coverage (Part D) unless otherwise noted.  

Healthfirst MA Plans currently include the following Medicare Advantage HMO plans and Special Needs Plans (SNP): 

Healthfirst 65 Plus Plan  

Our 65 Plus Plan is designed to be the preferred plan for Medicare beneficiaries who do not qualify for “Extra Help,” either in the form of Low Income Subsidy (LIS) for Part D, or Medicare Savings Programs (MSP) for medical benefits. As such, this plan offers a comprehensive benefit package, including additional benefits not covered by Original Medicare, but at a $0 monthly premium, making it a high-value yet affordable choice. 

Healthfirst Increased Benefits Plan  

The Healthfirst Increased Benefits Plan (IBP) is designed for Medicare beneficiaries who qualify for some level of Low Income Subsidy (LIS) for Part D and possibly some level of assistance in the form of Medicare Savings Programs (MSP) for medical benefits but are not fully dual eligible. While our IBP does charge the full Part D premium, members of this plan should qualify for “Extra Help” to cover the cost of the monthly premium, while also receiving a richer benefit package. 

Healthfirst Coordinated Benefits Plan  

The Healthfirst Coordinated Benefits Plan is a Medicare Advantage only plan, designed to be the preferred plan for Medicare beneficiaries who already receive creditable Prescription Drug Coverage from sources other than Medicare Part D (e.g., Veteran’s Administration, unions).   

Healthfirst Life Improvement Plan  

The Healthfirst Life Improvement Plan is a Dual-Eligible Special Needs Plan (SNP), designed specifically for those Medicare beneficiaries who are eligible for both Medicare and full Medicaid through New York State. Through our Model of Care, this Special Needs Plan provides the basic Medicare benefit package for members but coordinates the additional Medicaid benefits the member may be eligible to receive through New York State. 

Healthfirst CompleteCare  

Healthfirst CompleteCare is a Medicaid Advantage Plus (MAP) Special Needs Plan (SNP) that combines Medicare and Medicaid benefits with added long-term care services like medical social services and adult day health care. CompleteCare is designed specifically for beneficiaries who require nursing home level of care but can safely stay at home. 

Healthfirst AbsoluteCare FIDA Plan  

Healthfirst AbsoluteCare FIDA Plan (Medicare-Medicaid Plan) is a Fully Integrated Dual Advantage (FIDA) plan for beneficiaries age 21 or over who receive Medicare and full Medicaid and who require community-based long-term care services or reside in a nursing home. AbsoluteCare provides benefits of both Medicaid and Medicare to participants in the FIDA Demonstration. 

 

Plan Name
Counties of Service
65 Plus Plan
 
 
Bronx, Kings, New York, Queens, Richmond, Nassau
Increased Benefits Plan
 
 
Bronx, Kings, New York, Queens, Richmond, Nassau
Coordinated Benefits Plan
 
 
Bronx, Kings, New York, Queens, Richmond, Nassau
Life Improvement Plan
 
 
Bronx, Kings, New York, Queens, Richmond, Nassau, Westchester
CompleteCare
 
 
Bronx, Kings, New York, Queens, Richmond, Nassau, Westchester
​AbsoluteCare FIDA Plan
 
​Bronx, Kings, New York, Queens, Richmond, Nassau, Westchester