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Health First Emerald Plus H1099-024 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Health First Emerald Plus H1099-024 (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Health First Emerald Plus H1099-024 (HMO) in 2025, please refer to our full plan details page.
Health First Emerald Plus H1099-024 (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 Emerald Plus H1099-024 (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 Emerald Plus H1099-024 (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 Emerald Plus H1099-024 (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. Additionally, this plan comes with a Part B Premium reduction of $158.00. You must continue to pay paying your reduced 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 a $150.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3500.00 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 Emerald Plus H1099-024 (HMO) plan has a $150 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and the pharmacy. 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. Preferred brand drugs and non-preferred drugs have a coinsurance of 25% and 31% respectively.
Additional Benefits
The Health First Emerald Plus H1099-024 (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services and home health services may have no copay. Emergency services, primary care, and hearing and vision services are covered, with copays ranging from $0 to $140. Additional benefits include coverage for prescription hearing aids, dental services, and home infusion services. The plan also covers medical equipment, diagnostic and radiological services, and skilled nursing facility stays, with copays or coinsurance applying to some services. This plan provides coverage for a variety of healthcare needs, with costs varying depending on the specific service utilized.
Inpatient Hospital See details
Inpatient Hospital services are covered, including acute and psychiatric care. For days 1-8, there is a $175 copay, and for days 9-90, there is no copay. Additional days for inpatient hospital, non-Medicare covered stays, and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $175, and observation services with a $175 copay. Ambulatory Surgical Center (ASC) services have no copay, and outpatient substance abuse services have a $25 copay for both individual and group sessions. Outpatient blood services are also covered, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered, with a $45 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance services, including both ground and air ambulance, are covered with a $260 copay per service. Transportation services to any health-related location are covered for 20 one-way trips per year via bus or subway.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage have a copay of $140, $25, and $140 respectively, with no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Health First Emerald Plus H1099-024 (HMO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $25 copay, Physician Specialist Services with a $20 copay, and Physical Therapy and Speech-Language Pathology Services with a $25 copay. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services are covered, but have a $25 copay. Additional Telehealth Benefits are covered with a copay between $0 and $25. Podiatry Services are not covered, and Routine Chiropractic Care is not covered.
Preventive Services See details
The Health First Emerald Plus H1099-024 (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services include Medical Nutrition Therapy with no copay, while the plan does not cover health education, in-home safety assessments, personal emergency response systems, 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, and counseling services. The plan also offers other preventive services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, and Digital Rectal Exams with no copay, and EKG following Welcome Visit with a $75 copay.
Hearing Services See details
The Health First Emerald Plus H1099-024 (HMO) plan covers hearing exams with a $20 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with a copay between $399 and $699, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a copay between $0 and $20, and eyewear including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Contact lenses have no copay, and eyewear has a combined maximum benefit of $200 per year.
Dental Services See details
The Health First Emerald Plus H1099-024 (HMO) plan covers Medicare Dental Services with a $20 copay, along with oral exams, dental X-rays, cleaning, and fluoride treatments. Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Insulin, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay with a coinsurance between 0% and 20%. The coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Health First Emerald Plus H1099-024 (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered under the Health First Emerald Plus H1099-024 (HMO) plan, including durable medical equipment, prosthetic devices, medical supplies, diabetic equipment, diabetic supplies, and diabetic therapeutic shoes/inserts. Durable Medical Equipment has a 20% coinsurance and requires authorization. Prosthetic devices and medical supplies have a coinsurance of 20% with no copay. Diabetic supplies and diabetic therapeutic shoes/inserts have a coinsurance between 10% and 20%.
Diagnostic and Radiological Services See details
The Health First Emerald Plus H1099-024 (HMO) plan covers diagnostic and radiological services. Diagnostic Procedures/Tests have a copay of $0-$75, while Lab Services have a coinsurance of up to 20%. Diagnostic Radiological Services have a copay of $200, and Therapeutic Radiological Services have a coinsurance of up to 20%. Outpatient X-Ray Services have a $75 copay.
Home Health Services See details
Home Health Services are covered by the Health First Emerald Plus H1099-024 (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 Emerald Plus H1099-024 (HMO) plan. The plan also does not cover 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 by the Health First Emerald Plus H1099-024 (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $180. Additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Health First Emerald Plus H1099-024 (HMO) plan covers Over-the-Counter (OTC) Items with a maximum benefit coverage amount of $25.00 every month, including Nicotine Replacement Therapy (NRT) and Naloxone. Acupuncture, Meal Benefit, 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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