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Health First Easy Access H1099-025 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Health First Easy Access H1099-025 (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Health First Easy Access H1099-025 (HMO-POS) in 2025, please refer to our full plan details page.
Health First Easy Access H1099-025 (HMO-POS) is a HMO-POS 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 Easy Access H1099-025 (HMO-POS) 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 Easy Access H1099-025 (HMO-POS).
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 Easy Access H1099-025 (HMO-POS), 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 a $200.00 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 $9500.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $9500.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $4500.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $9500.00 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 Easy Access H1099-025 (HMO-POS) plan has a $200 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you'll pay a $5 copay at preferred pharmacies and a $10 copay at standard pharmacies. For preferred brand drugs, you pay 25% coinsurance.
Additional Benefits
The Health First Easy Access H1099-025 (HMO-POS) plan offers a range of benefits, including inpatient hospital stays with a $150 copay for days 1-8, and no copay for days 9-90. Outpatient services vary in cost, with some services having no copay, while others have copays ranging from $10 to $150. The plan also covers a variety of other services, such as dental, vision, and hearing. Dental services have a $10 copay for oral exams, and vision services have no copay for eye exams and eyewear. Hearing exams have a $10 copay, and routine hearing exams have no copay. The plan also covers medical equipment and home health services with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits with Health First Easy Access H1099-025 (HMO-POS) have a $150 copay for days 1-8, and no copay for days 9-90, for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services with a copay between $0 and $150, observation services with a $140 copay, and ambulatory surgical center (ASC) services with no copay. Outpatient substance abuse services have a $20 copay for both individual and group sessions, and outpatient blood services are covered with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, with a $25 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. 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 25 one-way trips per year by bus or subway.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Health First Easy Access H1099-025 (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $10 copay; all services have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Health First Easy Access H1099-025 (HMO-POS) plan covers primary care physician services with no copay, and chiropractic services with a $10 copay. Occupational therapy services have a $15 copay, and physician specialist services have a $20 copay. Mental health and psychiatric services, as well as opioid treatment services, have a $20 copay. Physical therapy and speech-language pathology services have a $15 copay, and additional telehealth benefits have a copay between $0 and $20. Routine Chiropractic care and podiatry services are not covered.
Preventive Services See details
The Health First Easy Access H1099-025 (HMO-POS) plan covers a wide variety of preventive services, including an annual physical exam with no copay, and medical nutrition therapy, and fitness benefits. Other preventive services like glaucoma screening, diabetes self-management training, barium enemas, and digital rectal exams have no copay. EKG following a welcome visit has a $25 copay.
Hearing Services See details
Health First Easy Access H1099-025 (HMO-POS) covers hearing exams with a $10 copay, routine hearing exams (1 per year) with no copay, and fitting/evaluation for hearing aids (1 per year) with no copay. Prescription hearing aids are partially covered, but 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 coverage for eye exams with a copay of $0-$10, and eyewear with no copay. Routine eye exams are covered with no copay, and you are eligible for one exam per year. Eyewear has a combined maximum benefit of $300 per year, and contact lenses are covered. Eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are also covered. Upgrades are not covered.
Dental Services See details
Dental services are covered, including oral exams with a $10 copay, dental x-rays, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, periodontics, and oral and maxillofacial surgery. 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, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Health First Easy Access H1099-025 (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance. Diabetic Equipment is covered, including Diabetic Supplies with a 10-20% coinsurance and Diabetic Therapeutic Shoes/Inserts with a 10% coinsurance; however, Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests, lab services, and radiological services. Diagnostic procedures/tests have a copay between $0 and $25, lab services have up to 20% coinsurance, and diagnostic radiological services have a $125 copay. Therapeutic radiological services have up to 20% coinsurance, and outpatient X-ray services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the Health First Easy Access H1099-025 (HMO-POS) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Health First Easy Access H1099-025 (HMO-POS) plan, but specific services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. There is a copay for some cardiac and pulmonary rehabilitation services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Health First Easy Access H1099-025 (HMO-POS) plan, but require prior authorization. You will have no copay for days 1-20, and a $180 copay for days 21-100. Additional days beyond Medicare and non-Medicare stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefit. The plan provides up to $75.00 each month for OTC items, including nicotine replacement therapy and Naloxone. The meal benefit is for a chronic illness. Acupuncture, Dual Eligible SNPs, 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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