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Health First Rewards H1099-014 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Health First Rewards H1099-014 (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Health First Rewards H1099-014 (HMO) in 2025, please refer to our full plan details page.
Health First Rewards H1099-014 (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 Rewards H1099-014 (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 Rewards H1099-014 (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 Rewards H1099-014 (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.
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 Rewards H1099-014 (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, the copay is $5 at a preferred pharmacy and $10 at a standard pharmacy. For standard generic drugs, the copay is $42 at a preferred pharmacy and $47 at a standard pharmacy. For preferred brand drugs and non-preferred drugs, you pay 25% and 33% coinsurance respectively. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Health First Rewards H1099-014 (HMO) plan offers a range of benefits with varying costs. For inpatient hospital stays, you'll pay a $165 copay per day for the first 7 days, and no copay for days 8-90. Outpatient services have copays ranging from $0 to $150. The plan includes coverage for primary care, mental health, and specialist services with copays between $15-$20. Preventive services, vision, and hearing exams are covered with no copay or low copays, while dental services have a $35 copay. Ambulance and transportation services, home health, and skilled nursing facilities are also covered, but may have copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital coverage requires prior authorization, and includes both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For the first 7 days, there is a $165 copay per day, and for days 8-90, there is no copay. Additional days and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for 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 Individual and Group Sessions both having a copay of $15.00. Outpatient Blood Services are also covered, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Health First Rewards H1099-014 (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. Ground and air ambulance services each have a $250 copay, with no coinsurance. Transportation Services to any health-related location are covered, up to 32 one-way trips per year via bus or subway.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by Health First Rewards H1099-014 (HMO). Emergency Services and Worldwide Emergency Coverage have a $140 copay, and Urgently Needed Services have a $20 copay, with no coinsurance for any of these services. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Health First Rewards H1099-014 (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 $15 copay, and mental health services with a $15 copay. The plan also covers physical therapy and speech-language pathology services with a $15 copay, additional telehealth benefits with a copay between $0 and $20, and opioid treatment program services with a $15 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Annual Physical Exams with no copay, and additional preventive services like In-Home Safety Assessment and Medical Nutrition Therapy. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, and Digital Rectal Exams are covered with no copay, while EKG following Welcome Visit has a $20 copay. Health Education, Personal Emergency Response System (PERS), 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, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $30 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 Prescription Hearing Aids (all types) are covered with no copay. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$15, and eyewear with no copay, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Upgrades are not covered.
Dental Services See details
The Health First Rewards H1099-014 (HMO) plan offers dental services, including Medicare dental services with a $35 copay. This plan also covers oral exams (2 per year), dental x-rays, other diagnostic dental services, prophylaxis (cleaning) (2 per year), fluoride treatment (1 per year), and other preventive dental services. Restorative services are limited to one visit every 36 months per surface per tooth, and Adjunctive General Services are limited to one palliative treatment every 12 months, one consultation every 6 months, and two teledentistry visits per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the Health First Rewards H1099-014 (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment. DME has a 20% coinsurance, while durable medical equipment for use outside the home is not covered. Prosthetics and medical supplies have a 20% coinsurance, and diabetic supplies and therapeutic shoes/inserts have a coinsurance between 15% and 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $20, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at least $100, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Health First Rewards H1099-014 (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Health First Rewards H1099-014 (HMO) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
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, but for days 21-100, there is a $180 copay.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items, with a maximum benefit of $110 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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