Is Healthfirst Medicaid or Medicare?

Navigating the landscape of healthcare coverage can be tricky. If you’re wondering ‘is Healthfirst Medicaid or Medicare,’ the simple answer is both. Healthfirst offers a spectrum of Medicaid and Medicare plans, tailored to meet diverse health care needs.

Stay with us as we delve into the specifics of each plan, understanding eligibility, coverage, and how to enroll, ensuring you can make an informed decision.


Key Takeaways

  • Healthfirst provides a range of health plans including Medicaid and Medicare options tailored to meet the needs of seniors, individuals with low income, and families seeking cost-effective insurance solutions.



  • Enrollment in Healthfirst plans is streamlined and accessible, with eligibility for Medicaid Managed Care based on income and Medicare Advantage Plans requiring Medicare enrollment, U.S. residency, and being within the service area.

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Understanding Healthfirst Coverage: Medicaid vs. Medicare

Before exploring the specifics of Healthfirst’s offerings, we should first comprehend the distinction between Medicaid and Medicare. Medicaid is a joint program between federal and state governments that provides financial assistance for medical expenses to individuals with restricted income and resources.

Medicare, on the other hand, is a federal health insurance program for seniors and certain disabled individuals. So how does Healthfirst fit into this? Healthfirst offers diverse health plans, encompassing Medicaid and Medicare options, designed to accommodate individuals of all ages, requirements, and income levels.

Understanding Healthfirst Coverage: Medicaid vs. Medicare

Regardless if you’re a senior searching for extensive health coverage, an individual with low income seeking aid, or a family in need of cost-effective health insurance, Healthfirst caters to your needs. But what do these plans exactly entail? Let’s discover.


Healthfirst Medicaid Managed Care Explained

Imagine a plan designed specifically for low-income families and individuals under 65 years of age, offering a $0 monthly plan premium and low or no copays for doctor visits, lab tests, prescription drugs, hospitalization, and more.

This is not a dream; it’s Healthfirst’s Medicaid Managed Care Plan. The array of services it covers is impressive, encompassing routine dental checkups, cleanings, X-rays, fillings, preventive vision care, and covered vaccines for members under 19. It also provides coverage for essential medical requirements such as doctor visits, lab tests, prescription drugs, and hospitalization, making it a great alternative to Original Medicare.

To illustrate, let’s consider Ana, a single mother of two, struggling to make ends meet. With Healthfirst’s Medicaid Managed Care Plan, she not only gets coverage for her and her children’s medical requirements but also enjoys the peace of mind knowing that it won’t break the bank.


Healthfirst Medicare Advantage Plans Unveiled

Now, we shall discuss Healthfirst’s Medicare Advantage plans. These plans are perfect for individuals aged 65 and above, who require more than just the standard Medicare coverage. Healthfirst provides a range of Medicare Advantage plans, including:


  • CompleteCare for those needing nursing home level of care
  • The Life Improvement Plan for individuals with both Medicare and Medicaid
  • The Signature (HMO) plan with $0 premium and prescription drug coverage
  • The Connection Plan for new Medicare enrollees who are current Healthfirst Medicaid members


However, what differentiates these plans are the extra benefits. Healthfirst’s Medicare Advantage plans offer supplementary benefits such as:


  • OTC Plus cards
  • Dental
  • Vision
  • Other supplemental benefits


These plans emphasize minimal copays or no copays, and certain plans have a monthly plan premium of $0. So, if you’re someone like George, a 67-year-old retired school teacher, you can enjoy a comprehensive health plan that takes care of your regular medical needs and more, all without burdening your retirement savings.

Enrollment Essentials: Joining a Healthfirst Plan

Having explored Healthfirst’s offerings, you might be considering, “How do I join?” Don’t worry as Healthfirst ensures a simple and trouble-free enrollment process. For Medicaid Managed Care, eligibility includes low-income families or individuals under 65 meeting specific household income criteria.

For Medicare Advantage Plan, eligibility requires residency in the plan’s service area, U.S. citizenship or lawful presence in the country, and possession of a Medicare Number with Part A and/or Part B coverage.

As for the actual enrollment process, for Medicaid Managed Care, individuals can contact Healthfirst’s customer service, arrange an appointment, or submit an online application via the NY Medicaid website.


What does healthfirst medicaid cover



For Medicare Advantage Plans, the enrollment period is a seven-month timeframe that begins three months before your birth month and ends three months after. So whether it’s Medicaid or Medicare, Healthfirst’s enrollment process is designed to get you covered as swiftly and smoothly as possible.


Learn About Enrollment in Healthfirst Medicaid

Let’s focus on the process of enrolling in Healthfirst’s Medicaid Managed Care Plan. This plan is intended for:


  • Qualified low-income families and individuals under 65
  • Qualified individuals and eligible immigrants aged 19-64 who do not qualify for Medicaid
  • Individuals aged 19 to 64 years who are New York State residents, within the income requirements, lawfully present in the U.S., and not eligible for Medicaid, Child Health Plus, or equivalent programs.


The enrollment process is as simple as:


  1. Visiting Healthfirst’s website
  2. Adhering to the provided instructions
  3. Reviewing the step-by-step guide for easy navigation
  4. Verifying eligibility by reviewing the essential benefits covered by Medicaid to ensure meeting the necessary requirements.


So, if you’re someone like Ana, all it takes are a few straightforward steps to ensure you and your children are well-covered.


How to Enroll in a Healthfirst Medicare Plan

For those intrigued by Healthfirst’s Medicare Advantage plans, the enrollment procedure is just as simple. Eligibility requires enrolling in Medicare three months prior to turning 65 and meeting the requirements for Medicare Part A. Additionally, maintaining payments for Medicare Part B is necessary.

As for the enrollment process, it involves checking your eligibility and selecting the most convenient enrollment option. And if you need assistance, Healthfirst is there to guide you through the process. So, for retirees like George, a comprehensive health plan is just a few steps away.

Comparing Healthfirst Plans: Benefits at a Glance

Having examined Healthfirst’s Medicaid and Medicare plans, it’s time to briefly compare the benefits and coverage they provide. Healthfirst’s Medicaid Managed Care offers essential health benefits, including $0 annual checkups, hospital, emergency room, urgent care, retail health clinic, dental, and vision.


Healthfirst medicare



On the other hand, Healthfirst’s Medicare Advantage plans offer supplementary benefits like dental services, vision coverage, hearing coverage, and an OTC Plus card for over-the-counter items, while prioritizing essential benefits with $0 monthly premium and low or no copays for various services.

When it comes to prescription drug coverage, both plans rely on a formulary list. However, the drugs covered and approved by each plan may vary. Regardless, drugs listed are typically covered if they are deemed medically necessary and obtained from a network pharmacy.

So, whether it’s Ana seeking comprehensive coverage for her family or George looking for extensive benefits to supplement his Medicare, Healthfirst’s plans offer a wide range of benefits to suit varied needs.

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Prescription Drug Benefits in Focus

Prescription drug coverage stands as a vital aspect of any health plan. Healthfirst offers a prescription drug formulary for their Medicaid and Medicare plans, which includes an extensive list of approved prescription medications covered by the plan.

The copayment structure for prescription drugs under Healthfirst’s Medicare and Medicaid plans is determined by the formulary, with different copayment amounts required depending on the medication.

But what about saving on prescription drug costs? Healthfirst offers a range of cost-saving opportunities and discount programs for prescription drugs. The Pharmacy Team is available to help Medicare Advantage plan members reduce costs, and the Life Improvement Plan provides $0 cost for prescription medications and OTC allowances for dual eligible Medicaid and Medicare members.





So, whether it’s Ana trying to save on her children’s medications or George managing his routine medication costs, Healthfirst’s prescription drug benefits ensure affordability without compromising on healthcare needs.

Accessing Care with Healthfirst: Networks and Providers

One prominent aspect of any health plan is the accessibility it grants to high-quality healthcare providers. With Healthfirst, members have the option to access their health information and plan benefits through the Healthfirst website or seek assistance via phone.

They can locate in-network providers by searching by:


  • Name
  • Specialty
  • National provider identifier (NPI)
  • Phone number


Healthfirst goes above and beyond to maintain quality within their provider network by conducting clinical quality assessments and implementing compliance measures. This is evidenced by their Medicaid plan achieving a perfect score of 100% in clinical quality.

Furthermore, Healthfirst offers telehealth and virtual care services, encompassing eVisits, Same-Day Virtual Visits, as well as virtual visits at their primary care practices and urgent care centers.

So, whether Ana needs to find a pediatrician for her kids or George needs to consult with a specialist, Healthfirst ensures that quality healthcare is just a phone call or click away.

Additional Healthfirst Perks: Vision and Dental Coverage

Besides wide-ranging health coverage, Healthfirst also presents extra benefits like vision and dental coverage. Vision care is often overlooked despite its importance. With Healthfirst, members can enjoy comprehensive vision care, including vision exams with a $0 copay, a $550 allowance for frames/lenses, and coverage for contact lenses.


Healthfirst medicaid dentist



When it comes to dental coverage, Healthfirst provides enhanced, supplemental preventive dental benefits through their partners. In addition, pediatric dental benefits are offered with no additional premium, no cost share for covered benefits, and no annual maximum for members with HSA or Catastrophic plans.

So, whether it’s Ana ensuring her kids get their annual dental check-up or George maintaining his oral health in his golden years, Healthfirst’s additional benefits ensure they have their needs covered.

Support When You Need It: Healthfirst Member Services

Healthfirst’s dedication to its members extends beyond just providing holistic health coverage through their healthfirst insurance. They also offer robust member services that assist in:


  • Navigating health plans
  • Finding doctors
  • Accessing health information
  • And more


Members can access these services by logging into their secure account on the Healthfirst website, using the menu icon with the faq dropdown arrow or the regular dropdown arrow, or through the Healthfirst NY Mobile App by utilizing the mobile search icon.

To reach Healthfirst Member Services, individuals can utilize the phone number listed on their Member ID card or dial 1.800.716.7737 (TTY/TDD relay: 1.800.955.8771) during the hours of Monday to Friday 8am to 8 PM.

So, whether you’re a new member trying to navigate your plan or an existing member with a query, Healthfirst’s Member Services are always there to assist you.

Navigating Your Health Plan: Tools and Resources

Simplicity of navigation is key while handling your health plan. Healthfirst offers a Member portal, which acts as the primary platform for overseeing health plan activities such as bill payments, benefit access, claim reviews, and more.

The Member portal offers a range of features that enable Healthfirst users to conveniently pay bills, access benefits, view claims, and manage their Healthfirst plan information in a streamlined manner, ensuring accessibility to key information.

In addition to the Member portal, Healthfirst’s website also offers the following resources:


  • Locating healthcare providers
  • Accessing health plan details
  • A dedicated informational page with FAQs that offer valuable guidance on plan details and usage


So, whether you’re Ana, managing her family’s health plan, or George, keeping track of his Medicare Advantage plan, Healthfirst’s tools and resources ensure that navigating your health plan is a breeze.


Financial Considerations: Understanding Costs

Comprehending the costs linked with your health plan is vital. With Healthfirst’s Medicaid plans, there’s no monthly premium and they are offered at $0. The copayment amounts for Healthfirst Medicaid and Medicare plans are subject to variation based on the individual plan. Certain services may have no copayment, while copayments for different tiers of drugs can range from $10 to $60.


Connex medicare



Healthfirst plans do have out-of-pocket maximums, with the specific amount varying depending on the plan. These amounts can range from as low as $360 to as high as $8,850 annually. So, whether you’re budget-conscious like Ana or meticulous with finances like George, understanding costs with Healthfirst is straightforward and transparent.


Long-Term Care Options with Healthfirst

As we grow older or encounter certain health issues, the need for long-term care becomes a significant factor. Healthfirst offers hospital, medical, and prescription drug coverage, as well as long-term care benefits.

They also have a stand-alone managed long-term care plan option available. To qualify for Healthfirst’s Managed Long-Term Care plans, individuals must meet the criteria of receiving Medicaid and requiring home care for a period exceeding 120 days.

Healthfirst’s long-term care options encompass a range of health benefits designed to support individuals in maintaining their independence and staying at home. This coverage includes:


  • Medical care
  • Hospital care
  • Prescription drug coverage
  • Dental care
  • Various other services


So, whether you’re a family member concerned about long-term care for your aging parents, like Ana, or an individual planning for your future, like George, Healthfirst offers suitable options to cater to your needs.


Navigating the world of health insurance can be daunting, but with providers like Healthfirst, it doesn’t have to be. Whether you’re seeking coverage for your family under Medicaid or looking for extensive benefits with a Medicare Advantage plan, Healthfirst offers diverse plans to suit varied needs.

With added benefits like prescription drug coverage, vision and dental care, robust member support, user-friendly tools and resources, and transparent cost structures, Healthfirst ensures that managing health coverage is less of a chore and more of a seamless experience. So, why wait? Start your journey with Healthfirst today and embrace the peace of mind that comes with comprehensive health coverage.

Frequently Asked Questions



Is healthfirst Medicaid in NY?

Yes, Healthfirst provides the New York State Medicaid Managed Care plan to Medicaid eligible individuals, offering coverage with $0 monthly plan premium and little to no copay cost.


What is the difference of Medicare and Medicaid?

Medicare is federal health insurance for individuals 65 and older, or those with certain disabilities, regardless of income, while Medicaid is a joint federal and state program providing health coverage to people with low income. Therefore, the key difference lies in the eligibility criteria for each program.


What does Medicaid cover in NY?

In New York, Medicaid covers hospital and emergency room visits, maternity care, newborn enrollment, hearing/vision/dental coverage, and transportation to medical appointments. It also includes regular exams, prescriptions, immunizations, relevant medical supplies, and nursing home services.


What types of health plans does Healthfirst offer?

Healthfirst offers a diverse range of health plans, including Medicaid and Medicare options, to accommodate individuals of all ages, requirements, and income levels.


What are the enrollment processes for Healthfirst’s Medicaid and Medicare plans?

To enroll in Healthfirst’s Medicaid Managed Care, contact their customer service, arrange an appointment, or submit an online application via the NY Medicaid website. For Medicare Advantage Plans, the enrollment period is a seven-month timeframe around your birth month.

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Russell Noga
( Medicare Expert )

Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.