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Health First Value H1099-006 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Health First Value H1099-006 (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Health First Value H1099-006 (HMO) in 2026, please refer to our full plan details page.
Health First Value H1099-006 (HMO) is a HMO 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 Value H1099-006 (HMO) 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 Value H1099-006 (HMO).
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 Value H1099-006 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $25.00. 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 $3400.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 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 Value H1099-006 (HMO) plan features no drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generic drugs, you will pay no copay for one-month, two-month, or three-month supplies at both preferred and standard pharmacies. Tier 2 generic drugs cost between $5 and $15 at preferred pharmacies, though you can get a three-month supply through standard mail order with no copay. Tier 3 preferred brand drugs require copays starting at $42 for a one-month supply at preferred pharmacies, while a three-month standard mail order supply costs $117.50. For higher-tier prescriptions, Tier 4 non-preferred drugs carry a 25% coinsurance, and Tier 5 specialty drugs require a 33% coinsurance for a one-month supply.
Additional Benefits
The Health First Value H1099-006 (HMO) plan offers comprehensive medical coverage with no copay for primary care visits, preventive care, and home health services. For specialist visits, members will pay a $15 copay, while inpatient hospital stays require a $165 daily copay for days one through seven, followed by no copay for additional days. Emergency room visits carry a $150 copay, and urgent care is available with a $20 copay, both featuring no coinsurance. Additional benefits include routine dental, vision, and hearing services with no copay, featuring annual allowances of up to $750 for dental, $400 for eyewear, and $1,500 for hearing aids. Members also receive no copay for up to 32 one-way transportation trips per year and a $115 quarterly allowance for over-the-counter items. While skilled nursing facility stays require no copay for the first 20 days, durable medical equipment and dialysis services require a 10% to 20% coinsurance.
Inpatient Hospital See details
Health First Value H1099-006 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance and a copay of $165 per day for days 1 through 7, followed by no copay for days 8 through 90. This benefit is partially covered, as upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Health First Value H1099-006 (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services with no copay. Outpatient hospital services require a copay of $0 to $100, outpatient substance abuse sessions have a $15 copay, and outpatient observation services incur a $150 copay per stay.
Partial Hospitalization See details
Partial hospitalization is covered by Health First Value H1099-006 (HMO) with a $15.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Health First Value H1099-006 (HMO) covers Medicare-approved ground and air ambulance services with a $240 copay and no coinsurance, requiring prior authorization. Transportation services are also covered for up to 32 one-way trips per year to any health-related location via bus or subway, featuring no copay and no coinsurance.
Emergency Services See details
Health First Value H1099-006 (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgent care with a $20 copay and no coinsurance. Worldwide emergency services are covered up to a $50,000 maximum with no coinsurance, requiring a $150 copay for emergency or urgent care and a $240 copay for emergency transportation.
Primary Care See details
Health First Value H1099-006 (HMO) covers primary care visits and opioid treatment with no copay and no coinsurance. Specialist visits, mental health, and psychiatric services require a $15 copay, while physical, occupational, and speech therapies require a $10 copay, all with no coinsurance, though chiropractic and podiatry services are not covered.
Preventive Services See details
Health First Value H1099-006 (HMO) provides preventive services, including annual physicals, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. Additional preventive benefits like fitness and in-home support are also covered with no copay and no coinsurance, though some sub-services like health education and weight management are not covered, and an EKG following a welcome visit carries a $20 copay with no coinsurance.
Hearing Services See details
Health First Value H1099-006 (HMO) partially covers hearing services, offering Medicare-covered exams for a $30 copay and no coinsurance, and routine exams, fittings, and prescription hearing aids with no copay or coinsurance. There is no deductible, and prescription hearing aids are covered up to $1,500 every two years, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Health First Value H1099-006 (HMO) covers vision services with no deductibles, offering annual routine eye exams with no copay and other eye exams for a $15 copay, both with no coinsurance. Eyewear is covered with no copay or coinsurance up to a $400 yearly limit, but upgrades and other eye exam services are not covered.
Dental Services See details
Dental services are covered by Health First Value H1099-006 (HMO), offering Medicare-covered dental care for a $30 copay and no coinsurance. Other preventive and comprehensive dental services, such as exams, cleanings, and implants, are covered with no copay and no coinsurance up to a maximum annual benefit of $750.
Home Infusion bundled Services See details
Health First Value H1099-006 (HMO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, require no coinsurance to 20% coinsurance, with insulin also carrying a $35 copay.
Dialysis Services See details
Dialysis services are covered under the Health First Value H1099-006 (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered under the Health First Value H1099-006 (HMO) plan with no copay, although prior authorization is required for these services. Members will pay a 20% coinsurance for durable medical equipment and prosthetics, and a 10% to 20% coinsurance for diabetic supplies and therapeutic shoes or inserts.
Diagnostic and Radiological Services See details
Health First Value H1099-006 (HMO) covers diagnostic tests with a $20 copay, lab services with no copay, and outpatient x-rays with a $20 copay. Diagnostic radiological services require a minimum $100 copay, while therapeutic radiological services carry a minimum 20% coinsurance, with prior authorization required for all services.
Home Health Services See details
Home health services are covered under the Health First Value H1099-006 (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Health First Value H1099-006 (HMO) does not cover cardiac rehabilitation services, including intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Health First Value H1099-006 (HMO) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $180 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Health First Value H1099-006 (HMO) partially covers other services, offering chronic illness meals and up to $115 every three months in over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture is not covered under this plan.
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