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Health First Classic H1099-001 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Health First Classic H1099-001 (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Health First Classic H1099-001 (HMO-POS) in 2026, please refer to our full plan details page.
Health First Classic H1099-001 (HMO-POS) is a HMO-POS plan offered by Health First Shared Services, Inc. available for enrollment in 2025 to people living in Brevard, Indian River. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Health First Classic H1099-001 (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Health First Classic H1099-001 (HMO-POS).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Health First Classic H1099-001 (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $90.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $10000.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10000.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $3250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10000.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Health First Classic H1099-001 (HMO-POS) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generic drugs, there is no copay for one, two, or three-month fills at preferred or standard pharmacies, nor for three-month standard mail orders. Tier 2 generic drugs cost $5 for a one-month supply at preferred pharmacies and $10 at standard pharmacies, though a three-month standard mail order carries no copay. Tier 3 preferred brand drugs require a $42 copay for a one-month supply at preferred pharmacies, compared to $47 at standard locations. Higher-tier medications under this plan transition to coinsurance, with Tier 4 non-preferred drugs requiring 25% coinsurance at retail and mail-order pharmacies. Tier 5 specialty drugs have a 33% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Health First Classic H1099-001 (HMO-POS) plan offers comprehensive medical coverage featuring no copay for primary care visits, preventive services, and home health care. Specialists require a $15 copay, while inpatient hospital stays cost a $140 copay daily for the first seven days with no copay thereafter. For urgent medical needs, the plan provides emergency room coverage with a $150 copay and urgent care visits for a $20 copay. Enrollees also benefit from extensive supplemental coverage, including no copay for routine dental services up to $1,000 annually and a $400 annual limit for eyewear with no copay. Additionally, the plan includes up to a $2,000 prescription hearing aid benefit every two years, 32 one-way transportation trips, and a $125 quarterly over-the-counter allowance. Many other services, such as home infusion and durable medical equipment, feature no copays and a coinsurance ranging from 0% to 20%.
Inpatient Hospital See details
Inpatient hospital care is covered by Health First Classic H1099-001 (HMO-POS) with no coinsurance, requiring a $140 copay for days 1 to 7 of acute stays and a $180 copay for days 1 to 7 of psychiatric stays, followed by no copay for days 8 to 90. Both benefits require prior authorization, but additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Health First Classic H1099-001 (HMO-POS) covers outpatient hospital services with a $0 to $100 copay and no coinsurance, and observation services with a $150 copay per stay and no coinsurance. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse services require a $15 copay per session and no coinsurance.
Partial Hospitalization See details
Health First Classic H1099-001 (HMO-POS) covers partial hospitalization services with a $15.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Health First Classic H1099-001 (HMO-POS), with Medicare-covered ground and air ambulance services requiring a $230 copay and no coinsurance. Additionally, the plan covers up to 32 one-way trips per year to any health-related location via bus or subway with no copay and no coinsurance, though transportation to plan-approved health-related locations is not covered.
Emergency Services See details
Health First Classic H1099-001 (HMO-POS) covers emergency services with a $150 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours. Urgently needed services require a $20 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum benefit with no coinsurance and copays ranging from $150 to $230.
Primary Care See details
Health First Classic H1099-001 (HMO-POS) offers primary care physician visits and opioid treatment with no copay and no coinsurance, while specialist visits and outpatient mental health services require a $15 copay and no coinsurance. Physical, occupational, and speech therapy are covered with a $5 copay and no coinsurance, but podiatry and routine chiropractic care are not covered.
Preventive Services See details
Health First Classic H1099-001 (HMO-POS) provides preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and select screenings. Additional preventive services are partially covered with prior authorization, excluding health education, PERS, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, smoking cessation, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by the Health First Classic H1099-001 (HMO-POS) plan, featuring Medicare-covered exams for a $15 copay and no coinsurance, and annual routine exams and fittings with no copay and no coinsurance. While some prescription hearing aid services are covered with no copay and no coinsurance up to $2,000 every two years, OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Health First Classic H1099-001 (HMO-POS) with no coinsurance, offering one routine eye exam per year and eyewear up to a $400 annual limit with no copays. Other eye exam services and eyewear upgrades are not covered under this plan.
Dental Services See details
Health First Classic H1099-001 (HMO-POS) covers Medicare-covered dental services with a $20 copay and no coinsurance, subject to prior authorization. Other preventive and comprehensive dental services, including cleanings, exams, implants, and orthodontics, are covered with no copay and no coinsurance up to a maximum benefit of $1,000 per year.
Home Infusion bundled Services See details
Health First Classic H1099-001 (HMO-POS) covers Home Infusion bundled Services with no copay and no coinsurance, although prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require no copay and a coinsurance ranging from no coinsurance up to 20%, while Part B insulin has a $35 copay and a coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Health First Classic H1099-001 (HMO-POS) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Health First Classic H1099-001 (HMO-POS) covers medical equipment with no copays, though prior authorization is required. Durable medical equipment, prosthetics, and medical supplies are subject to a 20% coinsurance, while diabetic supplies require 0% to 20% coinsurance and diabetic therapeutic shoes or inserts have no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services under Health First Classic H1099-001 (HMO-POS) are covered with no copay and no coinsurance for lab services and diagnostic tests. Diagnostic radiological services require a $100 copay, therapeutic radiological services require a 20% coinsurance, and outpatient X-rays have no copay, with prior authorization required for these services.
Home Health Services See details
Health First Classic H1099-001 (HMO-POS) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered with no coinsurance under Health First Classic H1099-001 (HMO-POS), though only some services are covered since standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and carry a $10 copay.
Skilled Nursing Facility (SNF) See details
Health First Classic H1099-001 (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $100 daily copay for days 21 through 100. Prior authorization is required, and while a three-day prior inpatient hospital stay is not required, additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Other services are partially covered by Health First Classic H1099-001 (HMO-POS), featuring a chronic illness meal benefit and a $125 quarterly over-the-counter allowance, both offered with no copay and no coinsurance. Acupuncture is not covered under this plan.
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