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 under contract with the Centers for Medicare & Medicaid Services (CMS). The Healthfirst Medicare Plan falls under the Healthfirst Health Plan, Inc. license within the family of Healthfirst companies.

To meet the eligibility requirements for Healthfirst Medicare Plan beneficiaries must have both Part A and Part B Medicare, live in the Healthfirst Medicare Plan 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 Medicare plans change on a yearly basis and providers are informed of these changes through our provider news magazine, The Source, through a direct mailing to provider offices, and through updates on the Provider Secure Services web site (www.healthfirst.org/providerservices). Most Medicare plans include Standard Medicare Prescription Drug Coverage (Part D) unless otherwise noted.

Healthfirst Medicare Plan currently offers 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 Mount Sinai Select

Healthfirst Mount Sinai Select is designed exclusively for Manhattan residents and offers affordable access to Mount Sinai’s network of top-rated primary care doctors, specialists, and hospitals. The plan provides incentives to access care through the preferred Mount Sinai Health System in the form of lower out of pocket costs for Tier one (1) MSHS preferred providers.

Healthfirst Increased Benefits Plan 

Increased Benefits Plan 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 plan 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 

Coordinated Benefits Plan is a Medicare Advantage (MA) 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). 

Healthfirst Life Improvement Plan 

Life Improvement Plan is a Dual Eligible Special Needs Plan (SNP), designed specifically for those Medicare beneficiaries who are eligible for both Medicare and some level of assistance through New York State Medicaid (“dual eligible”). 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 AssuredCare

Healthfirst AssuredCare is an Institutional Special Needs Plan (ISNP), designed specifically for frail, Medicare beneficiares who, for 90 days or more, have had or are expected to need the level of services provided in a long-term care (LTC) skilled nursing facility (SNF), a LTC nursing facility (NF), or a SNF/NF.  In partnership with Skilled Nursing Facilities, Healthfirst applies a Model of Care to address the specific needs of its institutionalized members. 

 

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 is a Fully Integrated Dual Advantage (FIDA) demonstration Medicare-Medicaid Plan (MMP) for full benefit Medicare-Medicaid beneficiaries age 21 or over 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

Mount Sinai Select

 

​New York
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

AssuredCare

 

Bronx, Kings, New York, Queens, Richmond, Nassau
CompleteCare
 
 
Bronx, Kings, New York, Queens, Richmond, Nassau

​AbsoluteCare FIDA Plan

 

Bronx, Kings, New York, Queens, Richmond, Nassau, Westchester