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Health First Secure H1099-009 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Health First Secure H1099-009 (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Health First Secure H1099-009 (HMO) in 2025, please refer to our full plan details page.
Health First Secure H1099-009 (HMO) is a HMO 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 Secure H1099-009 (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Health First Secure H1099-009 (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 Secure H1099-009 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3000.00 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
Prescription drugs are not covered by Health First Secure H1099-009 (HMO).
Additional Benefits
The Health First Secure H1099-009 (HMO) plan offers a variety of benefits with varying costs. The plan covers inpatient hospital stays with copays, outpatient services with copays ranging from $0-$150, and emergency services with a $140 copay. Additional benefits include vision, dental, and hearing services with copays or coinsurance requirements. This plan provides coverage for primary care services with no copay, and specialist visits with a $20 copay. You'll also find coverage for ambulance services, home health services, and skilled nursing facilities with copays or coinsurance. Additionally, the plan includes coverage for home infusion services, medical equipment, and diagnostic services, each with specific cost-sharing arrangements.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization. For Inpatient Hospital-Acute, you will pay a $150 copay for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, you will pay a $175 copay for days 1-10, and no copay for days 11-90. Additional days, and non-Medicare covered stays are not covered for either benefit.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by Health First Secure H1099-009 (HMO). Outpatient hospital services have a copay between $0 and $150, Observation Services have a $150 copay, Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Substance Abuse Services have a $20 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Health First Secure H1099-009 (HMO) plan with a $15 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $230 copay for both ground and air ambulance services, and no coinsurance. Transportation Services to any health-related location are covered for up to 32 one-way trips per year by bus or subway, while 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. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services have a $25 copay; all have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Health First Secure H1099-009 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $15 copay, physician specialist services with a $20 copay, and physical therapy and speech-language pathology services with a $15 copay. Mental health and psychiatric services have a $20 copay for individual and group sessions, while other health care professional services have a copay that ranges from $0 to $20. Additional telehealth benefits are covered with a copay that ranges from $0 to $25. Opioid treatment program services have a $20 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The Health First Secure H1099-009 (HMO) plan covers preventive services, including an annual physical exam with no copay. Other services like health education, Personal Emergency Response System, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
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 up to a maximum of $1000 every two years, and some prescription hearing aid types are not covered. OTC hearing aids are not covered.
Vision Services See details
The Health First Secure H1099-009 (HMO) plan covers vision services, including eye exams with a copay of $0-$15, and eyewear with no copay. Eyewear has a combined maximum plan benefit coverage amount of $400. Upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $1,000 annual maximum. Medicare Dental Services have no copay and require prior authorization. Other Dental Services include oral exams (2 per year), dental X-rays (1 every 12-36 months), other diagnostic dental services, prophylaxis (cleaning) (2 per year), fluoride treatment (1 per year), other preventive dental services, orthodontic services, restorative services (1 filling every 36 months), adjunctive general services, endodontics, periodontics (every 6-36 months), prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), oral and maxillofacial surgery, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and a coinsurance between 0% and 20%, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the Health First Secure H1099-009 (HMO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment (DME), is covered, with a 20% coinsurance and authorization required. Prosthetics and medical supplies have a 20% coinsurance, while diabetic supplies have a coinsurance between 0% and 20%, 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 under this plan. Diagnostic Procedures/Tests have no copay, Lab Services have no copay, Diagnostic Radiological Services have a minimum copay of $125, and Outpatient X-Ray Services have no copay. Therapeutic Radiological Services have a minimum coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by the Health First Secure H1099-009 (HMO) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Health First Secure H1099-009 (HMO) plan. While the plan covers Cardiac Rehabilitation Services in general, none of the specific services are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under the "Other Services" benefit, acupuncture, meal benefits, and services for those with intellectual disabilities are not covered. Over-the-Counter (OTC) Items are covered, with a maximum benefit of $50 every three months, and include nicotine replacement therapy and Naloxone coverage.
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