Healthfirst Medicare Advantage Plans 2025

Exploring Healthfirst Medicare Advantage Plans

When it comes to meeting diverse healthcare needs, Healthfirst Medicare Advantage plans are sometimes a cut above the rest. Offering a variety of HMO, PPO, and POS options, these plans often surpass the offerings of Original Medicare by providing expanded coverage.

Some of the benefits of Healthfirst Medicare Advantage plans may include:

• Virtual health consultations

• Transportation to medical appointments

• Prescription drug coverage

• Dental and vision coverage

• Fitness and wellness programs

With Healthfirst, your healthcare journey is as smooth as possible.

What’s more, these plans may be highly cost-effective, with some offering $0 premiums and zero copayments for primary care visits, enhancing affordability. And the best part? Joining Healthfirst is a breeze, thanks to several straightforward enrollment options.

Healthfirst Signature Options

The Healthfirst Signature (PPO) plan may offer:

• Flexibility to choose between in-network or out-of-network providers

• Comprehensive coverage

• Thousands of providers in Healthfirst’s extensive network

• Specialist visits without the need for referrals

Adding to its appeal, the Signature plan may offer a $700 yearly Flex card, providing additional coverage for dental, vision, and hearing out-of-pocket costs.

Specialized HMO Plans

Healthfirst’s commitment to personalized healthcare is reflected in its specialized HMO health plans, including the HMO D SNP. The ‘Increased Benefits Plan’ is designed for individuals eligible for full Extra Help and may provide them with prescription drug coverage at low or no copay to ease medication expenses.

On the other hand, the ‘65 Plus Plan (HMO)’ caters to beneficiaries over the age of 65, likely offering low to $0 monthly premiums and covering a broad range of healthcare services.

Tailored Plans for Dual Eligibles

Recognizing the unique needs of dual eligibles, Healthfirst offers tailored plans for individuals eligible for both Medicaid and Medicare, including the Healthfirst Medicare Plan. These individuals will likely enjoy the flexibility to change their Medicare Advantage plans once every quarter, ensuring their healthcare plan adapts to their evolving needs.

The Value of Prescription Drug Coverage

Prescription drug coverage is a cornerstone of many of Healthfirst’s Medicare Advantage plans. With more than 150 prescription drugs available at a $0 copay, these plans aim to significantly reduce out-of-pocket expenses for members.

The integrated prescription drug plan will likely cover all necessary medications, ensuring beneficiaries have access to the prescriptions they need.

This comprehensive coverage extends to a range of plans, such as the Signature (PPO), which will likely include no-cost preferred generic drugs.

Comprehensive Drug Lists

At the heart of Healthfirst’s prescription drug coverage is a comprehensive formulary, regularly updated to include a broad list of medications. This approved list of covered prescription medications ensures members have access to the drugs they need, playing a pivotal role in prescription drug coverage.

Managing Costs with Tiered Pricing

Understanding that managing medication costs can be challenging, Healthfirst’s Medicare Advantage plans will likely include a tiered pricing structure. This structure groups prescription drugs into different cost tiers, with generic drugs often placed in lower-cost tiers.

This approach aids members in managing their medication costs effectively.

Dental, Vision, and Hearing: Enhanced Benefits

Beyond medical and prescription coverage, many Healthfirst Medicare Advantage plans also prioritize dental, vision, and hearing health. These plans will likely provide in-network and out-of-network coverage for dental services, including access to supplemental dental benefits through partner networks.

Vision care includes routine vision exams and eyeglasses, with additional quality eye care available from hundreds of professionals in the Davis Vision network. To ensure comprehensive hearing health, one hearing aid per ear is included in many plans annually, often with no out-of-pocket costs for entry-level models.

Preventive and Routine Care

Some Healthfirst Medicare Advantage plans may cover preventive and comprehensive dental services at no additional premium, sometimes including essential services such as exams, cleanings, and x-rays. To enhance dental care, Healthfirst will likely offer Classic Plan members a $1,000 pre-loaded debit card and Value Plan members a $750 card for comprehensive dental services.

Beyond the Basics

Taking vision care to the next level, Healthfirst has partnered with Davis Vision, offering access to a network of qualified eye care professionals. Comprehensive vision exams are likely included in coverage, allowing for the identification of eye diseases and systemic conditions such as diabetes and hypertension.

Under this beneficial collaboration, members may receive a $400 eyewear allowance to use for eyeglass frames, lenses, and contact lenses.

Fitness and Wellness Incentives

Healthfirst understands the importance of fitness and wellness, especially for seniors. To this end, some of their Medicare Advantage plans may offer the SilverSneakers program, a fitness initiative designed to encourage an active lifestyle among seniors.

The program provides seniors with access to live classes, workshops, and an extensive online library of workout videos.

Staying Active with SilverSneakers®

The SilverSneakers fitness program is a testament to Healthfirst’s commitment to promoting physical activity among seniors. The program offers a variety of fitness classes and workshops, tailored to meet the fitness needs of seniors.

In addition, members may have access to SilverSneakers online resources, including hundreds of workout videos, fitness and nutrition tips, and a dedicated mobile app offering digital workout programs.

Over the Counter (OTC) Benefits

Understanding the importance of convenience, Healthfirst will likely offer the OTC Plus card. With this card, members can purchase a wide range of items, from non-prescription drugs to fitness equipment and some home utilities.

Many plans provide a quarterly OTC allowance, which can be used for approved non-prescription drugs and health-related items at participating providers.

Network Freedom and Access to Care

Healthfirst’s PPO plans stand out by offering network freedom and access to care. Many of these plans provide the flexibility to receive out-of-network care, allowing beneficiaries to see a wide range of healthcare providers.

Whether you choose lower-cost in-network care or opt for out-of-network care, when necessary, Healthfirst’s PPO plans will likely have you covered.

In-Network vs. Out-of-Network Options

The flexibility of Healthfirst’s PPO plan will likely allow members to choose out-of-network providers, albeit usually at higher copays or coinsurance rates than in-network services.

On the other hand, the Signature (HMO) plan will likely facilitate in-network specialized care access without the prerequisite of a referral.

Emergency and Urgent Care Coverage

Many of Healthfirst’s Medicare Advantage plans provide coverage for both emergency and urgent care services, ensuring members have access to necessary healthcare when it’s most critical. For non-emergency health issues, Healthfirst members can often utilize in-network urgent care centers conveniently, without the requirement for a prior appointment.

Even when traveling, members can likely rely on their Medicare Advantage plans for emergency coverage abroad.

Making Sense of Enrollment Periods

The Medicare Annual Enrollment Period is the primary time when individuals can enroll in Healthfirst Medicare Advantage plans. Running from October 15 to December 7 each year, any plan changes become effective on January 1 of the following year.

For instances of certain life events, individuals may qualify for a Special Enrollment Period, allowing them to make specific changes to their plans.

Initial Enrollment and Deadlines

For those turning 65, a seven-month Initial Enrollment Period for Medicare starts three months before their birth month and continues for three months after.

The Initial Coverage Election Period for Medicare Advantage plans coincides with the Initial Enrollment Period for Medicare, covering a total of seven months.

Special Enrollment for Life Changes

Special Enrollment Periods (SEPs) can be triggered by certain life changes, such as moving to a new area or qualifying for additional assistance programs. Beneficiaries have the option to join or switch to a five-star Medicare Advantage or Part D plan once per calendar year outside of the Annual Enrollment Period, as permitted by a Special Enrollment Period.

Understanding Plan Ratings and Renewal

The Medicare program provides annual star ratings that help to compare the performance of Healthfirst’s plans with other plans. Healthfirst Medicare Advantage Plans have received a 4-Star Rating for the 2024 Star Program Year.

Contract renewals with Medicare, also known as a Medicare contract, may influence the availability and choice of Healthfirst Medicare Advantage plans for beneficiaries.

Deciphering Star Ratings

Medicare Advantage and Part D plans are annually rated by CMS, with up to 40 measures for plans that include prescription drug coverage and 30 measures for those without, helping consumers understand their quality and performance. For the 2024 Star Ratings, CMS increased the weighting for some measures and added new ones, reflecting the evolving criteria to assess plan quality and efficiency.

Contract Renewal Considerations

Enrollment in Healthfirst Medicare Advantage plans depends on annual contract renewal with Medicare, including for plans tailored to individuals eligible for both Medicare and Medicaid. Beneficiaries may need to select a new Medicare Advantage plan or default into Traditional Medicare if their Medicare Advantage plan’s contract is not renewed.

Medicare beneficiaries of non-renewing Medicare Advantage plans are granted a Special Enrollment Period to choose new coverage.

Summary

From comprehensive healthcare coverage to value-added wellness programs, Healthfirst Medicare Advantage plans offer an enriching experience for beneficiaries.

With the flexibility to choose between in-network and out-of-network care, a wide range of prescription drug coverage, and enhanced benefits for dental, vision, and hearing, Healthfirst provides health plans that truly cater to individual needs. So, step into a world where your healthcare is a priority and experience a plan that goes beyond the basics.

Keep checking back here for updates on Healthfirst Medicare Advantage Plans for 2025.