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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 2026, 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 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 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 features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generic drugs, you will pay no copay at preferred and standard pharmacies, as well as for a three-month standard mail order supply. Tier 2 generic medications cost as little as a $5 copay for a one-month supply at preferred pharmacies, or no copay for a three-month standard mail order. Tier 3 preferred brand drugs require a $42 copay for a one-month supply at preferred pharmacies, or a $47 copay at standard pharmacies. Tier 4 non-preferred drugs carry a 25% coinsurance across preferred and standard pharmacies, while Tier 5 specialty drugs require a 33% coinsurance for a one-month supply.
Additional Benefits
The Health First Rewards H1099-014 (HMO) plan offers comprehensive medical coverage featuring no copays for primary care visits, preventive services, and routine lab tests. Inpatient hospital stays require a $165 daily copay for the first seven days, followed by no copay for days 8 through 90, with no coinsurance. Specialist visits, physical therapy, and outpatient substance abuse sessions are highly affordable with a flat $15 copay and no coinsurance. This plan also includes valuable supplemental benefits like dental, vision, and hearing care with no copays or coinsurance, including up to $1,250 annually for dental services and $400 for eyewear. Members also benefit from no-copay transit options for up to 32 one-way trips per year and a $110 quarterly allowance for over-the-counter items. Emergency care is available with a $150 copay, which is waived if you are admitted to the hospital within 24 hours.
Inpatient Hospital See details
Health First Rewards H1099-014 (HMO) partially 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. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Health First Rewards H1099-014 (HMO) offers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay and no coinsurance. Outpatient hospital services require a $0 to $100 copay, observation services have a $150 copay per stay, and outpatient substance abuse sessions carry a $15 copay, all with no coinsurance.
Partial Hospitalization See details
Health First Rewards H1099-014 (HMO) covers partial hospitalization services with a $15.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Health First Rewards H1099-014 (HMO) covers ambulance services with a $250 copay and no coinsurance for both ground and air transport, requiring prior authorization. Transportation services are partially covered with no copay or coinsurance, providing up to 32 one-way trips per year to any health-related location via bus or subway, while trips to plan-approved health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Health First Rewards H1099-014 (HMO) with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $20 copay and no coinsurance, while worldwide emergency services are covered up to a $50,000 maximum limit with no coinsurance and copays of $150 for emergency and urgent care, and $250 for emergency transportation.
Primary Care See details
Health First Rewards H1099-014 (HMO) provides primary care and opioid treatment services with no copay and no coinsurance, while specialist visits, mental health, and therapy services require a $15 copay and no coinsurance. Telehealth and other professional services have copays ranging from $0 to $20 with no coinsurance, but podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Health First Rewards H1099-014 (HMO), offering annual physicals, diabetes training, and glaucoma screenings with no copay and no coinsurance, though a $20 copay and no coinsurance apply to post-welcome visit EKGs. While fitness benefits and in-home safety assessments are covered, sub-services like health education, weight management programs, and personal emergency response systems are not covered.
Hearing Services See details
Health First Rewards H1099-014 (HMO) covers Medicare-covered hearing exams for a $30 copay and no coinsurance, plus one routine hearing exam and one fitting evaluation annually with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $1,000 maximum benefit every two years, although inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Health First Rewards H1099-014 (HMO) with no deductibles, featuring no copay and no coinsurance for one routine eye exam per year and up to $400 annually for eyewear. Other eye exam services and eyewear upgrades are not covered under this plan.
Dental Services See details
Health First Rewards H1099-014 (HMO) covers Medicare dental services with a $35 copay and no coinsurance, while other preventive and comprehensive dental services are covered with no copay and no coinsurance up to a $1,250 annual maximum. Covered dental services include exams, cleanings, x-rays, restorative care, endodontics, periodontics, and implants.
Home Infusion bundled Services See details
Health First Rewards H1099-014 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other Part B drugs carry no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Health First Rewards H1099-014 (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Health First Rewards H1099-014 (HMO) with no copays, though prior authorization is required. Covered durable medical equipment, prosthetics, and medical supplies require a 20% coinsurance, while diabetic supplies and therapeutic shoes or inserts carry a 15% to 20% coinsurance.
Diagnostic and Radiological Services See details
Health First Rewards H1099-014 (HMO) covers diagnostic and radiological services with prior authorization, featuring no coinsurance and a $20 copay for diagnostic tests, and no copay or coinsurance for lab services. Radiological services require a $20 copay for X-rays, a minimum $100 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by Health First Rewards H1099-014 (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Health First Rewards H1099-014 (HMO) features no coinsurance for cardiac rehabilitation, and though some services are covered, cardiac rehabilitation, intensive cardiac, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered in practice. These uncovered services require a copay of $15 for cardiac, intensive cardiac, and pulmonary rehab, and $20 for SET for PAD.
Skilled Nursing Facility (SNF) See details
Health First Rewards H1099-014 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $180 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the Medicare-covered 100-day limit are not covered.
Other Services See details
Health First Rewards H1099-014 (HMO) partially covers other services, featuring over-the-counter (OTC) items up to $110 every three months and chronic illness meal benefits with no copay and no coinsurance. Acupuncture and other additional services under this benefit are not covered.
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