A non-government entity
Health First Emerald Plus H1099-026 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Health First Emerald Plus H1099-026 (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 H1099-026 (HMO) in 2025, please refer to our full plan details page.
Health First Emerald Plus H1099-026 (HMO) is a HMO plan offered by Health First Shared Services, Inc. available for enrollment in 2025 to people living in Indian River. 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 H1099-026 (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 H1099-026 (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 H1099-026 (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 $148.00. 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 $350.00 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 $4150.00 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:
Sign up for Health First Emerald Plus H1099-026 (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Health First Emerald Plus H1099-026 (HMO) plan has a $350 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, you will pay a $5 copay for preferred generic drugs at a preferred pharmacy, and 25% coinsurance for preferred brand drugs at either a preferred or standard pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Health First Emerald Plus H1099-026 (HMO) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays depending on the specific service. The plan also covers primary care, specialist visits, and mental health services, all with copays. Additionally, this plan provides coverage for preventive services, hearing, vision, dental, and home health services, with specific copays and coinsurance amounts for each. This plan includes coverage for emergency services, ambulance and transportation services, and home infusion services. Other covered services include diagnostic and radiological services, skilled nursing facility, and cardiac rehabilitation. However, some services, like additional days in the hospital, certain dental procedures, and specific rehabilitation and therapy services, are not covered by the plan.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric, are covered with prior authorization. For days 1-8, the copay is $200, and for days 9-90, there is no copay. The plan does not cover additional days or non-Medicare-covered stays for either acute or psychiatric inpatient hospital services.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $150, observation services with a $200 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services, including individual and group sessions, have a copay of $25. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by this plan, with a $45 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a $260 copay, and transportation services to any health-related location, with 20 one-way trips per year via bus/subway. Transportation services to plan-approved health-related locations are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Coverage, and Urgent Care 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 H1099-026 (HMO) plan covers primary care physician services with no copay, and chiropractic services with a $20 copay. Occupational Therapy Services have a $20 copay, and Physician Specialist Services have a $20 copay. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a $25 copay for individual and group sessions, while Physical Therapy and Speech-Language Pathology Services have a $20 copay. Additional Telehealth Benefits have a copay between $0 and $25.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, and additional services like in-home safety assessments, medical nutrition therapy, fitness benefits, and kidney disease education services. Other services, like the EKG following Welcome Visit, have a $40 copay, but glaucoma screening, diabetes self-management training, barium enemas, and digital rectal exams have no copay.
Hearing Services See details
Hearing Services include hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $500 per year, while inner ear, outer ear, and over the ear prescription hearing aids, along with OTC hearing aids, are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$25, and eyewear with a $0 copay and a combined maximum benefit of $200 per year. Routine eye exams have no copay, and contact lenses are covered. Upgrades are not covered.
Dental Services See details
Dental services include coverage for oral exams with a $40 copay, dental x-rays, prophylaxis (cleaning) with a $40 copay, and fluoride treatment with a $40 copay. Orthodontic and restorative services, as well as 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 Medicare Part B Insulin Drugs, 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%. 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 by the Health First Emerald Plus H1099-026 (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. Durable Medical Equipment has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 0-20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures and tests with a copay between $0 and $40, and for lab services with at most 20% coinsurance. Diagnostic radiological services have a copay of $175, and therapeutic radiological services have at most 20% coinsurance. Outpatient X-ray services have a $40 copay.
Home Health Services See details
Home Health Services are covered by the Health First Emerald Plus H1099-026 (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 covered, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. There is a copay for the covered services, but the amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Health First Emerald Plus H1099-026 (HMO) plan, but require prior authorization. There is no copay for days 1-20, and a $180 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services offered by Health First Emerald Plus H1099-026 (HMO) include Over-the-Counter (OTC) Items with a maximum benefit of $40 every three months, and 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved