Healthfirst: The New York Health Insurance

October 16, 2020

Healthfirst is a health insurance for New Yorkers. This means that the services of this company are only available to the residents and citizens of New York. The company prides itself as a company that has been serving New Yorkers for more than twenty-five (25) years now. The company has helped pioneer the value-based healthcare model where hospitals and physicians are paid based on patient outcomes because the company was founded on the belief that insurers need to be true partners in the health system. To find out more about Healthfirst and the kind of services they offer, continue reading.

Healthfirst

The company, Healthfirst, was founded in 1995 and operates four hospitals which are Cape Canaveral Hospital, Holmes Regional Medical Center, Palm Bay Hospital, and Viera Hospital. The Healthfirst also includes Healthfirst Health Plans which offers a variety of health insurance options, offers outpatient and wellness services including fitness centers, home care, hospice care, aging services, and family pharmacies.

Healthfirst is New York’s largest not-for-profit health insurer, offering high-quality, affordable plans to fit every life stage, including Medicaid plans, Medicare advantage plans. Long-term care plans, qualified health plans, and individual and small group plans. Healthfirst serves members in New York and on Long Island, as well as in Westchester, Sullivan, and Orange counties.

Since the founding of the company, Healthfirst has grown to have over one million, four hundred members, more than forty thousand providers, above eighty participating hospitals, and over twenty community offices.

The company is currently under the leadership of Pat Wang as the president and chief executive officer (CEO), with other supporting personnel and the Healthfirst Company currently has more than four thousand employees working in the company.

Healthfirst Services

The services of the Healthfirst Company are referred to as Plans. Therefore, the plans offered by Healthfirst are designed to fit the needs of every potential customer. In this regard, the plans have been grouped into three major categories. The categories are;

Individuals & family
Medicare & managed long term care
Small business

These are the three distinct categories of the plans offered by Healthfirst. Under these categories, there are, however, specific plans that would meet and fit the needs of every of their customers. I would explain further on these categories.

Individuals & Family

In this category of individual and family, Healthfirst focuses on individual and family health care services and medical benefits. Healthfirst provides you and your family with the benefits and services you need for a bright future. The plans offered under this category are;

Medicaid Managed care
Essential plans
Child Health Plus
Marketplace: Leaf & Leaf Premier plans
Personal Wellness plan

Medicaid Managed Care

The Medicaid plan for individuals and families is a plan with $0 monthly plan premium. The plan offers low or no copays for doctor visits, lab tests, prescription drugs, hospitalization, urgent care, emergency care, maternity, dental, vision, hearing, wellness, and more. This plan is sponsored by the New York State and it is for qualified low-income families and individuals under 65. The highlights of this plan are;

No-cost annual checkups
Hospital, emergency room, and urgent care visits
Prescription and over-the-counter nonprescription drug coverage
Maternity coverage, plus your newborn is automatically enrolled in Medicaid
Hearing, vision, and dental coverage
Transportation to and from doctor appointments for covered services
Physical, occupational, and speech therapy
Health and wellness programs
Institution for Mental Disease (IMD) In Lieu of Service (ILS)

The areas this service covers are Long Island, and Westchester, Sullivan, Orange counties, within New York City’s five boroughs which are the Bronx, Brooklyn, Manhattan, Queens, and Staten Island. There are also drugs this plan covers.

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Essential Plans

The essential plans give you access to essential health benefits like doctor visits, lab tests, prescription drugs, hospitalization, urgent care, emergency care, and more. However, there are options for vision and dental benefits. This plan comes at a $0 or low monthly plan premium and the qualified individuals must be within the age 19-64. The highlights of this plan are;

No-cost annual checkups
Hospital, emergency room, and urgent care visits
Lab tests and X-rays
Prescription drug coverage
Maternity and newborn coverage
Optional dental and vision coverage
24/7 access to care with telemedicine
Physical, occupational, and speech therapy
Annual gym membership reimbursement

The essential options are of four different types with slightly different coverage, other requirements like income and age eligibility. The plans are named;

Essential Plan 1: eligible age is 19-64, income between $18 210 and $24 280, no dental cleanings and vision exams coverage and the monthly premium cost depends on income.
Essential Plan 2: eligible age is 19-64, income is between 16,753 and $18,210, no dental cleanings and vision exams coverage and the monthly premium cost depends on income.
Essential Plan 3: eligible age is 21-64, income is between $12,140 and $16,753, requires legal U.S. residency for less than five years, and covers dental cleanings and vision exams coverage.
Essential Plan 4: eligible age is 21-64, income less than $12,140, requires legal U.S. residency for less than five years, and covers dental cleanings and vision exams coverage.

In all these essential plans, teledoc is coming free at $0 and is covered.

Child Health Plus

The child health plus plan offered by Healthfirst provides no or low-cost healthcare coverage for the children of uninsured or underinsured families who do not qualify for Medicaid. The benefits of the plan include pediatrician and other doctor visits, lab tests, prescription drugs, hospitalization, urgent care, emergency care, wellness, dental, vision, hearing, and more. The plan is sponsored by the New York State and only available for children under the age of 19. The highlights of this plan are;

Hospital, emergency room, and urgent care visits
Lab tests and X-rays
Prescription drug coverage
Vaccines (shots)
Hearing, vision, and dental coverage
Care Management programs
Physical, occupational, and speech therapy

The plan covers dental cleanings and vision exams, and regardless of family income or immigration status, every child under 19 is qualified for this service.

Marketplace: Leaf & Leaf Premier Plans

The leaf and leaf premium are two different options available for this service. These options are totally dependent on your needs and your budget. The leaf plan is the standard plan and it covers the essential health protections you and your family need to feel secure. The leaf premium is the comprehensive option that covers all the standard leaf plan plus adult vision and adult dental care. The highlights of both plans are;

No-cost annual checkups
Preventive and wellness visits
Hospital, emergency room, and urgent care visits
Lab tests and X-rays
Prescription drug coverage
Maternity and newborn coverage
Optional dental and vision coverage
24/7 access to care with telemedicine
Physical, occupational, and speech therapy
Annual gym membership reimbursement

The monthly premium cost depends on household income and size and everyone under the age of 65 is eligible to opt for this plan.

Personal Wellness Plan

The Healthfirst personal wellness plan is for Medicaid managed care members who may benefit from extra behavioral health or substance abuse services. This plan offers all of the benefits in Medicaid, plus extra services like community support and substance abuse programs, mental health treatment, and behavioral health services. The highlights of this service are;

All your current Medicaid benefits
Individual and group counseling
Crisis intervention services
Substance use disorder services
Continuing day treatment
Personalized recovery services
Assertive community treatment services
Access to home- and community-based services
Institution for Mental Disease (IMD) In Lieu of Service (ILS)

This service is only available for persons between the ages of 21-64 and must have been enrolled in a Medicaid managed care plan. Another eligibility requirement the person must be identified by New York State as eligible for a Health and Recovery Plan.

Medicare & Managed Long Term Care

The Medicare & Managed Long Term Care is a category that focuses on health insurance plans for the customers and the health insurance are Health Maintenance Organization (HMO) and Medicare Special Needs Plans (SNPs) contains two groups of plans. The groups have a variety of plans under them. The varieties of plans offered under this category are grouped in to;

Medicare Advantage Plans
Managed Long Term Care Plans

Medicare Advantage Plans

The Healthfirst Medicare advantage plans provide all the benefits and services that Original Medicare does plus more for less. The company offers a variety of plans to meet your needs, with benefits such as an over-the-counter nonprescription drug card, SilverSneakers fitness program, dental and vision benefits, hearing aids, prescription drug coverage, and more.

Life improvement plan (HMO SNP)
Increased benefits plan (HMO)
65 Plus Plan (HMO)
Coordinated Benefits Plan

Life Improvement Plan (HMO SNP)

Healthfirst Life Improvement Plan is a Medicare Advantage Dual-Eligible Special Needs Plan that offers members the benefits of Original Medicare and Medicaid, plus prescription drug coverage, over-the-counter benefits, the SilverSneakers® fitness program, and dental, vision, and hearing. The highlights of this plan are;

Prescription drug coverage
Over-the-counter benefits
SilverSneakers® fitness program
Comprehensive dental
Vision exams and eyeglasses
Hearing exams and hearing aids
Acupuncture

This plan is designed for people who have both Medicare and Medicaid and you do not need referrals to see in-network specialists. The eligible age requirement is 65 or older and under 65 with certain disabilities.

Other requirements are enrolled in and continue to pay for Medicare Part B (Medicare Part B premium is covered for dual-eligible members with full Medicaid coverage), do not have End-Stage Renal Disease (ESRD) (permanent kidney disease requiring dialysis or a kidney transplant), except under a certain limited circumstance

Increased Benefits Plan (HMO)

Healthfirst Increased Benefits Plan is a Medicare Advantage plan made for those who qualify for full Extra Help, which helps lower prescription drug costs. The increased benefits plan offers the benefits of Original Medicare plus more, such as prescription drug coverage, dental, vision, hearing, acupuncture, and 24/7 access to care with Teladoc and the Nurse Help Line. The highlights of this plan are;

Prescription drug coverage
Comprehensive dental
Vision exams and eyeglasses
Hearing exams and hearing aids
Routine transportation
Acupuncture

The eligibility age is 65 or older and under 65 with certain disabilities.

65 Plus Plan (HMO)

The Healthfirst 65 Plus plan is a Medicare Advantage plan that offers the benefits of original Medicare, plus prescription drug coverage, dental, hearing, vision, acupuncture, and 24/7 access to care with Teledoc and the nurse helpline. The plan is designed for people who do not qualify for programs like extra help which is also known as a low-income subsidy, Medicare Savings Program (MSP). The highlights of this plan are;

Comprehensive dental
Prescription drug coverage
Vision exams and eyeglasses
Hearing exams and hearing aids
Acupuncture

The eligibility age is 65 or older and under 65 with certain disabilities. Other requirements are to qualify for Medicare Part A, enroll and continue to pay for Medicare Part B, and do not have End-Stage Renal Disease (ESRD), except under certain circumstances

Coordinated Benefits Plan

The Healthfirst Coordinated Benefits Plan is a Medicare Advantage plan that offers members all the benefits of original Medicare, plus dental, hearing, vision, routine transportation, and 24/7 access to care with Teladoc and the Nurse Help Line. The highlights of this plan are;

Comprehensive dental
Vision exams and eyeglasses
Hearing exams and hearing aids
Routine transportation

The eligibility age is 65 and older.

Managed Long Term Care Plans

The Healthfirst Managed Long Term Care plans to provide health benefits that help you or your loved one remain in your home and as independent as possible. This plan also offers plans that combine hospital, medical, prescription drug coverage with long-term care benefits, as well as a stand-alone, managed long-term care plan option. The Managed Long Term Care plans provide access to a care management team that includes a nurse, a social worker, and a support coordinator. This team helps you or your loved one with your day to day needs and will coordinate care with you, your doctor, and your family.

CompleteCare (HMO SNP)
Senior Health Partners

CompleteCare (HMO SNP)

The Healthfirst CompleteCare Plan is a Medicaid Advantage Dual-Eligible Special Needs plan that offers members the benefits of Original Medicare and Medicaid, plus prescription drug coverage, over-the-counter benefits, the SilverSneakers® fitness program, and dental, vision, and hearing coverage. The highlights of the plan are;

Prescription drug coverage
Over-the-counter benefits
SilverSneakers® fitness program
Comprehensive dental
Vision exams and eyeglasses
Hearing exams and hearing aids
Acupuncture

With this plan, you also get a primary care manager who will manage your day-to-day needs, identify health concerns early, and adjust your care plan to help you stay in your home for as long as possible. The eligibility age is 18 years and above and another requirement is a care management and needs at least one of these services covered by Medicaid Advantage Plus for more than 120 days from the effective date of enrollment.

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Senior Health Partners

The Senior Health Partners Managed Long-Term Care plan provides and coordinates services that are typically not covered by Medicaid and Medicare, including the health, social, emotional, nutritional, and rehabilitation services you may need. The highlights of the plan are;

Assistance in scheduling healthcare appointments
Non-emergency transportation
Home healthcare
Personal care
Rehabilitation therapy when medically necessary
Nursing home care
Dental care
Foot care, eye care, and hearing services.

This plan has several requirements to become eligible for it. The eligibility requirements for this plan are as follows;

Must be 18 years of age or older
Must be a resident of Manhattan, Bronx, Brooklyn, Queens, Staten Island, Nassau County, or Westchester County
Must be Medicaid eligible or private pay
Must be able to live safely at home with the support of Senior Health Partners
Must have health problems and limitations that would qualify you for nursing home level of care (for persons with Medicaid only)
Must expect to require at least one of the community based long term care services for more than 120 days from the effective date of enrollment. It includes nursing services in the home, therapies in the home, home health aide services, personal care services in the home, adult day healthcare, private duty nursing, or Consumer Directed Personal Assistance Services.

Joining the Senior Health Partners gives you access to enjoy coordinated care to help you stay at your physical and mental best.

Small Business

The small business plan offered by Healthfirst care is focused on the employees of any company or small business. The company Healthfirst knows that offering health benefits to employees is a major decision for small businesses whether it is 100 or fewer employees. This is why Healthfirst designed comprehensive health insurance plans that balance options, quality, and cost control to fit all of the employees’ needs. This category comes with benefits and plans offered by Healthfirst.

The benefits are the highlights of this plan and they include;

No-cost annual checkups
Urgent care visits and hospital stays
Lab tests (blood tests and X-rays)
Hearing, vision, and dental
Maternity and newborn care
Prescription drug coverage
24/7 access to care with telemedicine
Unlimited acupuncture visits
HSA-compatible plans
Annual gym membership reimbursement

The plans under this category are the;

Pro EPO
Pro Plus EPO Plans

These plans are comprehensive health insurance plans for New York small businesses with 1-100 employees and are available in various levels like the Platinum, Gold, Silver, and Bronze, to fit your employees’ needs. These plans regardless of whether the employees’ are full-time, part-time, or both. Feel free to research more on their official site.