A non-government entity
Health First Complete Care H1099-023 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Health First Complete Care H1099-023 (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Health First Complete Care H1099-023 (HMO) in 2026, please refer to our full plan details page.
Health First Complete Care H1099-023 (HMO) is a HMO plan offered by Health First Shared Services, Inc. available for enrollment in 2025 to people living in Hernando Lake Orange Osceola Pasco Polk Seminole. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Health First Complete Care H1099-023 (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 Complete Care H1099-023 (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 Complete Care H1099-023 (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 $2400.00 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:
Sign up for Health First Complete Care H1099-023 (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Health First Complete Care H1099-023 (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 either preferred or standard pharmacies. Tier 2 generic drugs are also highly affordable, with copays starting at just $2.50 for a one-month supply at preferred pharmacies and no copay for a three-month standard mail-order supply. Tier 3 preferred brand drugs require a $42.00 copay per month at preferred pharmacies, while standard mail-order options offer a three-month supply for a $117.50 copay. Tier 4 non-preferred drugs carry a 25% coinsurance across all pharmacy and mail-order options. High-cost specialty medications in Tier 5 require a 33% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Health First Complete Care H1099-023 (HMO) plan offers comprehensive medical coverage with no copays for primary care visits, routine preventive care, and home health services. For specialist visits, members pay a low $10 copay, while inpatient hospital stays require a $50 daily copay for the first eight days and no copay for days 9 through 90. Emergency room visits carry a $150 copay, which is waived upon admission, and urgent care is available for a $10 copay. Supplemental benefits feature no deductibles and include routine vision and hearing exams with no copay, along with a $400 annual eyewear allowance. Members also benefit from a $90 monthly over-the-counter reimbursement and dental coverage with no copay for select services. Durable medical equipment and dialysis services are covered with no copays and a 10% to 20% coinsurance.
Inpatient Hospital See details
Health First Complete Care H1099-023 (HMO) partially covers inpatient acute and psychiatric hospital stays with no coinsurance and prior authorization required, charging a $50 copay per day for days 1 through 8 and no copay for days 9 through 90. Additional hospital days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Health First Complete Care H1099-023 (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services require a copay of $0 to $75, observation services cost a $140 copay per stay, and outpatient substance abuse sessions have a $15 copay.
Partial Hospitalization See details
Health First Complete Care H1099-023 (HMO) covers partial hospitalization services with a $25.00 copay and no coinsurance. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
Health First Complete Care H1099-023 (HMO) covers Medicare-approved ground and air ambulance services with a $250 copay and no coinsurance, though prior authorization is required. Transportation services are partially covered with no copay or coinsurance for up to 36 one-way trips per year to any health-related location via bus or subway, while transportation to plan-approved health-related locations is not covered.
Emergency Services See details
Health First Complete Care H1099-023 (HMO) covers emergency services with a $150 copay (waived if admitted within 24 hours) and urgently needed services with a $10 copay, both with no coinsurance. Worldwide emergency and urgent services are covered with a $150 copay, and worldwide emergency transportation is covered with a $250 copay, all with no coinsurance up to a $50,000 maximum.
Primary Care See details
Health First Complete Care H1099-023 (HMO) covers primary care physician visits and opioid treatment with no copay and no coinsurance, while specialist visits require a $10 copay and no coinsurance. Physical, occupational, speech, and mental health therapies have a $15 copay and no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by Health First Complete Care H1099-023 (HMO), offering no copay and no coinsurance for annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management training, and digital rectal exams. An EKG following a welcome visit is covered with a $25 copay and no coinsurance, while physical and memory fitness, enhanced disease management, and medical nutrition therapy are covered with no copay and no coinsurance. Sub-services that are not covered include health education, in-home safety assessments, PERS, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home palliative care, in-home support, caregiver support, additional smoking cessation, telemonitoring, remote access, home/bathroom safety, and counseling.
Hearing Services See details
Health First Complete Care H1099-023 (HMO) covers hearing services with no deductible, offering Medicare-covered exams for a $10 copay and no coinsurance, and routine exams and fitting evaluations for no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay between $199 and $499 for up to two aids yearly, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered by Health First Complete Care H1099-023 (HMO) with no deductibles, offering routine eye exams with no copay or coinsurance, and other eye exams for a $10 copay and no coinsurance. Eyewear is covered with no copay or coinsurance up to a $400 annual limit, though upgrades and other eye exam services are not covered.
Dental Services See details
Dental services are partially covered by Health First Complete Care H1099-023 (HMO), with Medicare-covered dental requiring a $10 copay and no coinsurance, and other covered dental services requiring no copay and no coinsurance. However, other diagnostic, other preventive, endodontics, removable and fixed prosthodontics, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Health First Complete Care H1099-023 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and range from no coinsurance to 20% coinsurance, while Medicare Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Health First Complete Care H1099-023 (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Health First Complete Care H1099-023 (HMO) covers medical equipment with no copay, though prior authorization is required. Covered durable medical equipment, prosthetics, and medical supplies carry a 20% coinsurance, while diabetic supplies have a 10% to 20% coinsurance and therapeutic shoes or inserts have a 10% coinsurance.
Diagnostic and Radiological Services See details
Health First Complete Care H1099-023 (HMO) covers diagnostic and radiological services with prior authorization required. Members pay a $25 copay for diagnostic procedures and outpatient X-rays, a $100 copay for diagnostic radiological services, a 20% coinsurance for therapeutic radiological services, and no coinsurance for lab services.
Home Health Services See details
Health First Complete Care H1099-023 (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required for these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under Health First Complete Care H1099-023 (HMO), meaning members are responsible for the full cost of these services. This exclusion applies to 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 Complete Care H1099-023 (HMO) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $180 copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Health First Complete Care H1099-023 (HMO) partially covers other services, offering a chronic illness meal benefit and a $90 monthly reimbursement for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture and other additional services are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved