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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 2026, 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 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 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 $163.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3200.00 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 features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generic drugs, there is no copay for one, two, or three-month supplies at both preferred and standard pharmacies. Tier 2 generic drugs are also highly affordable, with copays starting at $5 at preferred pharmacies and no copay for a three-month standard mail-order supply. Tier 3 preferred brand drugs require a copay starting at $42 at preferred pharmacies, while standard pharmacies charge slightly higher copays starting at $47. For higher-tier prescriptions, Tier 4 non-preferred drugs carry a 25% coinsurance, and Tier 5 specialty drugs require a 31% coinsurance for a one-month supply. Choosing standard mail order for three-month supplies can help lower costs, offering a reduced copay of $117.50 for Tier 3 brands.
Additional Benefits
The Health First Emerald Plus H1099-024 (HMO) plan offers comprehensive medical coverage with no copay for primary care visits and a low $15 copay for specialists. Inpatient hospital stays require a $150 daily copay for the first eight days, with no copay for subsequent days, while emergency room visits carry a $150 copay that is waived if you are admitted. Outpatient hospital services are also highly affordable, ranging from no copay up to a $175 copay with no coinsurance. This plan also features strong ancillary benefits, including no copay for routine dental, vision, and hearing exams, alongside allowances for eyewear and hearing aids. Members enjoy no copay for home health services, the first 20 days of skilled nursing care, and up to 20 one-way transit trips per year. Additionally, a $25 monthly over-the-counter allowance is provided with no copay, helping you manage everyday health costs easily.
Inpatient Hospital See details
Health First Emerald Plus H1099-024 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $150 daily copay for days 1 through 8 and no copay for days 9 through 90. Prior authorization is required, and certain services like additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Health First Emerald Plus H1099-024 (HMO) covers outpatient hospital services with a $0 to $175 copay and no coinsurance, and observation services with a $175 copay per stay and no coinsurance. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $25 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Health First Emerald Plus H1099-024 (HMO) with a $45.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Health First Emerald Plus H1099-024 (HMO) covers ground and air ambulance services with a $260 copay and no coinsurance, requiring prior authorization. Transportation services are partially covered, offering up to 20 one-way bus or subway trips per year to any health-related location with no copay and no coinsurance, while transportation to plan-approved health-related locations is not covered.
Emergency Services See details
Health First Emerald Plus H1099-024 (HMO) covers emergency services with a $150 copay and no coinsurance, with the copay 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 lifetime maximum with no coinsurance and copays ranging from $150 to $260.
Primary Care See details
Health First Emerald Plus H1099-024 (HMO) provides primary care physician services and opioid treatment with no copay and no coinsurance, while specialist visits have a $15 copay and no coinsurance. Physical, occupational, speech, mental health, and psychiatric therapies require a $25 copay and no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Health First Emerald Plus H1099-024 (HMO) preventive services are partially covered with no copay and no coinsurance for annual physicals, kidney disease education, and diabetes training, though an EKG after a welcome visit requires a $75 copay and no coinsurance. Additional benefits like fitness programs and nutrition therapy have no copay and no coinsurance, but sub-services such as health education, in-home safety assessments, personal emergency response systems, weight management, therapeutic massage, and in-home support are not covered.
Hearing Services See details
Health First Emerald Plus H1099-024 (HMO) covers hearing services with no coinsurance, featuring a $20 copay for Medicare-covered exams and no copay for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399 to $699 for up to two devices per year, though 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 Emerald Plus H1099-024 (HMO), offering one routine eye exam annually and eyewear with no copay or coinsurance up to a $200 yearly limit. Other covered eye exams require a $20 copay and no coinsurance, while other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Health First Emerald Plus H1099-024 (HMO), offering Medicare-covered dental services for a $20 copay and no coinsurance, and other covered preventive and comprehensive services with no copay and no coinsurance. Sub-services that are not covered under this plan include other diagnostic, other preventive, endodontics, prosthodontics, maxillofacial prosthetics, implants, and orthodontics.
Home Infusion bundled Services See details
Health First Emerald Plus H1099-024 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, and insulin, carry a coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the Health First Emerald Plus H1099-024 (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits under the Health First Emerald Plus H1099-024 (HMO) plan are covered with no copay, though prior authorization is required. Members are responsible for a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies, and a 10% to 20% coinsurance for diabetic equipment and supplies.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Health First Emerald Plus H1099-024 (HMO) with prior authorization required. Diagnostic tests and outpatient X-rays require a $75 copay plus coinsurance, diagnostic radiological services require a $200 copay, therapeutic radiological services require a 20% coinsurance plus a copay, and lab services require a copay with no coinsurance.
Home Health Services See details
Home health services are covered under the Health First Emerald Plus H1099-024 (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Health First Emerald Plus H1099-024 (HMO) with no coinsurance, and while some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $25 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Health First Emerald Plus H1099-024 (HMO) with no coinsurance and do not require a prior three-day hospital stay, though prior authorization is required. There is no copay for days 1 through 20, followed by a $180 daily copay for days 21 through 100, with no coverage provided for additional days beyond the Medicare-covered limit.
Other Services See details
Health First Emerald Plus H1099-024 (HMO) partially covers other services, providing an over-the-counter (OTC) benefit of up to $25 per month with no copay and no coinsurance via reimbursement. Acupuncture, meal benefits, and other additional services are not covered under this plan.
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