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Health First Premier Access H1099-025 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Health First Premier 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 Premier Access H1099-025 (HMO-POS) in 2026, please refer to our full plan details page.
Health First Premier 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 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 Premier 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 Premier 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 Premier 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 Premier Access H1099-025 (HMO-POS) Medicare plan features an annual prescription drug deductible of $200. For Tier 1 preferred generic drugs, members benefit from no copay for 1-month, 2-month, or 3-month supplies at both preferred and standard pharmacies. Tier 2 generic drugs are also highly affordable, starting at a $5 copay for a 1-month supply at preferred pharmacies, and standard mail order offers no copay on 3-month supplies for both Tier 1 and Tier 2 drugs. Tier 3 preferred brand drugs require a copay starting at $42 at preferred pharmacies and $47 at standard pharmacies for a 1-month supply. For higher-tier medications, Tier 4 non-preferred drugs carry a 25% coinsurance, while Tier 5 specialty drugs require a 30% coinsurance for a 1-month supply. Selecting preferred pharmacies or utilizing standard mail order for 3-month supplies helps maximize savings on this plan.
Additional Benefits
The Health First Premier Access H1099-025 (HMO-POS) plan offers comprehensive medical coverage with predictable costs, featuring no copays for primary care visits, home health services, and routine preventive care. For inpatient hospital stays, members pay a daily copay of $150 for the first eight days and no copay thereafter, with no coinsurance required. Outpatient services and specialist visits are also highly affordable, with specialist copays set at $20 and outpatient hospital copays capped at $150. Members also benefit from robust supplemental coverage, including no copays for preventive and comprehensive dental care, routine eye exams, and up to $300 annually for eyewear. Additionally, the plan features no copays for routine hearing exams and provides an $80 monthly reimbursement for over-the-counter items. While most services have no coinsurance, a 20% coinsurance applies to dialysis and durable medical equipment.
Inpatient Hospital See details
Health First Premier Access H1099-025 (HMO-POS) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring prior authorization and a copay of $150 per day for days 1 through 8, followed by no copay for days 9 through 90. Sub-services such as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services covered by Health First Premier Access H1099-025 (HMO-POS) feature no coinsurance across all categories, with copays ranging from no copay for ambulatory surgical center and blood services to $20 for substance abuse sessions and up to $150 for outpatient hospital services. Additionally, Medicare-covered observation services require a $140 copay per stay, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization services are covered by Health First Premier Access H1099-025 (HMO-POS) with a $25.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Health First Premier Access H1099-025 (HMO-POS), featuring a $250 copay and no coinsurance for both ground and air ambulance services requiring prior authorization. Transportation services are partially covered with no copay and no coinsurance for up to 26 one-way bus or subway trips per year to any health-related location, though transport to plan-approved health-related locations is not covered.
Emergency Services See details
Health First Premier Access H1099-025 (HMO-POS) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $10 copay and no coinsurance. Worldwide emergency and urgent care are covered up to a $50,000 maximum with a $130 copay and no coinsurance, while worldwide emergency transportation requires a $250 copay and no coinsurance.
Primary Care See details
Health First Premier Access H1099-025 (HMO-POS) offers primary care visits and opioid treatment with no copay and no coinsurance, while specialist visits require a $20 copay and no coinsurance. Physical, occupational, and speech therapy services have a $15 copay and no coinsurance, mental health and psychiatric sessions require a $20 copay and no coinsurance, and podiatry is not covered. Some chiropractic services are covered with a $10 copay and no coinsurance, though routine and other chiropractic services are not covered.
Preventive Services See details
Health First Premier Access H1099-025 (HMO-POS) provides partially covered preventive services with no copay and no coinsurance for annual physicals, kidney disease education, glaucoma screenings, diabetes training, and digital rectal exams, though an EKG after a welcome visit has a $25 copay and no coinsurance. Additional covered perks include fitness benefits and disease management, but excluded sub-services are health education, in-home safety assessments, personal emergency response systems, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, extra smoking cessation, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by Health First Premier Access H1099-025 (HMO-POS), featuring Medicare-covered exams for a $10 copay and annual routine exams or fitting evaluations for no copay, all with no deductible and no coinsurance. Up to two prescription hearing aids are covered per year with no coinsurance and copays ranging from $199 to $499, though OTC hearing aids and inner ear, outer ear, and over the ear prescription aids are not covered.
Vision Services See details
Vision services are partially covered by Health First Premier Access H1099-025 (HMO-POS) with no deductibles, offering one routine eye exam per year with no copay and no coinsurance, and other covered eye exams for a $10 copay and no coinsurance. Eyewear is covered with no copay and no coinsurance up to a $300 annual limit, though eyewear upgrades and other eye exam services are not covered.
Dental Services See details
Health First Premier Access H1099-025 (HMO-POS) offers partially covered dental services, featuring a $10 copay and no coinsurance for Medicare-covered care, and no copay and no coinsurance for covered preventive and comprehensive dental services. Dental sub-services that are not covered include other diagnostic services, other preventive services, endodontics, removable and fixed prosthodontics, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Health First Premier Access H1099-025 (HMO-POS) with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs require no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Health First Premier Access H1099-025 (HMO-POS) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered under the Health First Premier Access H1099-025 (HMO-POS) plan with no copays, though prior authorization is required. Members are responsible for a 20% coinsurance on durable medical equipment, prosthetics, and medical supplies, and a 10% to 20% coinsurance on diabetic supplies and therapeutic shoes.
Diagnostic and Radiological Services See details
Health First Premier Access H1099-025 (HMO-POS) covers diagnostic and radiological services, requiring prior authorization for all services. Diagnostic procedures and outpatient x-rays carry a $25 copay plus coinsurance, lab services require a copay with no coinsurance, and diagnostic radiology requires a $125 copay with no coinsurance. Therapeutic radiology services require 20% coinsurance alongside a copay.
Home Health Services See details
Health First Premier Access H1099-025 (HMO-POS) covers home health services with no copay and no coinsurance. Prior authorization is required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Health First Premier Access H1099-025 (HMO-POS) with no coinsurance, but some services are covered while standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) services are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
Health First Premier Access H1099-025 (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance and does not require a prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a daily copay of $180 for days 21 through 100, though prior authorization is required and additional days beyond the standard Medicare limit are not covered.
Other Services See details
Health First Premier Access H1099-025 (HMO-POS) other services are partially covered, offering over-the-counter items with up to $80 monthly in reimbursement and meal benefits for chronic illnesses with no copay and no coinsurance. Acupuncture is not covered under this benefit.
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