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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 2025, 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 Orange, Seminole, Lake. This plan received an overall rating of 4.5 out of 5 stars in 2025.
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 $2500.00 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 Complete Care H1099-023 (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $2.50 copay at a preferred pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, your Part D costs will be $0.
Additional Benefits
The Health First Complete Care H1099-023 (HMO) plan offers a variety of benefits, including inpatient hospital stays with a $50 copay for the first 8 days, and no copay for days 9-90. Outpatient services have copays ranging from $0 to $140, and emergency services have a $140 copay. This plan also covers primary care with no copay, and specialist visits with a $10 copay. Additionally, it includes hearing exams with a $10 copay, and vision services with a $0-$10 copay for eye exams and no copay for eyewear. Dental services have a $10 copay for Medicare services.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric, are covered with a prior authorization requirement. For days 1-8, there is a $50 copay, and days 9-90 have no copay.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, with a copay between $0 and $75 for outpatient hospital services, and a $140 copay for observation services. Ambulatory Surgical Center (ASC) Services are covered with no copay, and outpatient substance abuse services are covered with a $15 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Health First Complete Care H1099-023 (HMO) plan and requires prior authorization. You will have a $25 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Health First Complete Care H1099-023 (HMO) plan. Ground and air ambulance services have a $250 copay, and there is no coinsurance. Transportation services to any health-related location are covered for up to 36 one-way trips per year by bus or subway.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Health First Complete Care H1099-023 (HMO) plan. Emergency Services has a $140 copay, and Urgently Needed Services has a $10 copay; both have no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $140 copay, and Worldwide Emergency Transportation is not covered.
Primary Care See details
The Health First Complete Care H1099-023 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $10 copay, occupational therapy services with a $15 copay, physician specialist services with a $10 copay, and physical therapy and speech-language pathology services with a $15 copay. The plan also covers mental health specialty services and psychiatric services, both with a $15 copay for individual and group sessions, and opioid treatment program services with a $15 copay. Additionally, the plan offers additional telehealth benefits with copays ranging from $0 to $15. Routine chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
Preventive Services include Medicare-covered services with no copay, an annual physical exam with no copay, and additional preventive services that are partially covered. The plan does not cover health education, in-home safety assessment, a 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 benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, counseling services, and fitness benefits. Kidney disease education services have no copay, and other preventive services include glaucoma screening, diabetes self-management training, barium enemas, and digital rectal exams with no copay, and an EKG following a Welcome Visit with a $25 copay.
Hearing Services See details
The Health First Complete Care H1099-023 (HMO) plan covers hearing exams with a $10 copay, and fitting/evaluation for hearing aids with no copay, limited to one visit per year. Prescription Hearing Aids are partially covered, with a copay between $199 and $499 for all types of prescription hearing aids, limited to two visits per year; however, inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$10, 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 Complete Care H1099-023 (HMO) plan covers Medicare Dental Services with a $10 copay, and offers other dental services including oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, periodontics, and oral and maxillofacial surgery, with varying limitations on the number of visits and periodicity. Endodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Health First Complete Care H1099-023 (HMO) plan. Medicare Part B Insulin Drugs have a $35 copay, with a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Health First Complete Care H1099-023 (HMO) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical equipment is covered, including Durable Medical Equipment (DME), with a 20% coinsurance and no copay. Prosthetics, medical supplies, and diabetic equipment are also covered, with coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures/tests with a copay of $0-$25, lab services with a coinsurance of at most 20%, diagnostic radiological services with a copay of $100, therapeutic radiological services with a coinsurance of at most 20%, and outpatient X-ray services with a copay of $25. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Health First Complete Care H1099-023 (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 Complete Care H1099-023 (HMO) plan. Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Health First Complete Care H1099-023 (HMO) plan, with a $0 copay for days 1-20 and a $180 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under Other Services, 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. Over-the-Counter (OTC) Items are covered with a maximum benefit of $85.00 every month and Meal Benefits are covered for chronic illness.
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