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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 2025, 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 Counties: BR, IR. This plan received an overall rating of 4.5 out of 5 stars in 2025.
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 $95.00. 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 has an "Enhanced Alternative" drug benefit. The plan has no deductible for prescription drugs. In the initial coverage phase, you will pay a $5 copay for preferred generic drugs at a preferred pharmacy and $10 at a standard pharmacy. For preferred brand drugs, you will pay 25% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Health First Classic H1099-001 (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services have copays that vary by service. Emergency and urgently needed services both have copays, and primary care physician visits have no copay. Preventive services, vision services, and home health services are covered with no copay, and hearing services have copays for exams and hearing aids. The plan also covers dental services and medical equipment with coinsurance. Additionally, there is an over-the-counter items benefit and a meal benefit for chronic illnesses.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $140 copay for days 1-7 and no copay for days 8-90, and for Inpatient Hospital Psychiatric, you will pay a $180 copay for days 1-7 and no copay for days 8-90. Additional days, and non-Medicare-covered stays for both services are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services with a copay between $0 and $100, observation services with a $150 copay, ambulatory surgical center (ASC) services with no copay, and outpatient substance abuse services with a $15 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered, with a $15 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services, which have a copay of $230.00. Transportation Services to any health-related location are covered for up to 32 one-way trips per year via bus or subway, but transportation to plan-approved health-related locations is not covered.
Emergency Services See details
Emergency services, urgently needed services, and worldwide emergency coverage are covered by Health First Classic H1099-001 (HMO-POS). Emergency services have a $140 copay and no coinsurance, while urgently needed services have a $25 copay and no coinsurance. Worldwide emergency coverage and worldwide urgent coverage have a $140 copay and no coinsurance. Worldwide emergency transportation is not covered.
Primary Care See details
Primary Care services include no copay for Primary Care Physician Services, a $20 copay for Chiropractic Services, a $5 copay for Occupational Therapy Services, a $15 copay for Physician Specialist Services, and a $15 copay for both Individual and Group Sessions for Mental Health and Psychiatric Services. Physical Therapy and Speech-Language Pathology Services have a $5 copay, and Additional Telehealth Benefits have a copay between $0 and $25. Opioid Treatment Program Services have a minimum and maximum copay of $15. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional preventive services are covered, but require prior authorization. The plan also covers kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, all with no copay.
Hearing Services See details
Hearing Services include hearing exams with a $15 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum benefit of $2000 every two years, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$15, and eyewear with a combined maximum plan benefit of $400 per year. Eyewear includes contact lenses with no copay, eyeglasses (lenses and frames), and eyeglass lenses and frames. Upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a $20 copay, and other dental services including oral exams, dental x-rays, and more with a $1,000 maximum benefit per year. Orthodontic services are also covered, covered under Diagnostic and Preventive Dental.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, the copay is $35, with a coinsurance between 0% and 20%. The coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Health First Classic H1099-001 (HMO-POS) plan. The coinsurance for dialysis services is between 20% and 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment, is covered by the Health First Classic H1099-001 (HMO-POS) plan. Durable Medical Equipment has a 20% coinsurance and requires authorization. Prosthetic Devices and Medical Supplies have a 20% coinsurance, while Diabetic Supplies have between 0% and 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have no coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and lab services with no copay, diagnostic radiological services with a copay of at most $100, and therapeutic radiological services with a coinsurance of at most 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Health First Classic H1099-001 (HMO-POS) plan with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. There is a copay for this benefit, but the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Health First Classic H1099-001 (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $100.
Other Services See details
Other Services include an Over-the-Counter (OTC) items benefit with a maximum of $125 every three months, and a meal benefit for a chronic illness. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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