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Health First Easy Access H1099-027 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Health First Easy Access H1099-027 (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 H1099-027 (HMO-POS) in 2025, please refer to our full plan details page.
Health First Easy Access H1099-027 (HMO-POS) is a HMO-POS plan offered by Health First Shared Services, Inc. available for enrollment in 2025 to people living in Volusia, Flagler, Hardee, Highlands. 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 H1099-027 (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 H1099-027 (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 H1099-027 (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 $4700.00 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 H1099-027 (HMO-POS) plan has a $200 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, preferred generic drugs have a $7.50 copay at a preferred pharmacy, while preferred brand drugs have a 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, your Part D costs will be $0.
Additional Benefits
The Health First Easy Access H1099-027 (HMO-POS) plan offers comprehensive coverage for a variety of healthcare needs. This plan includes coverage for inpatient hospital stays with a copay, outpatient services with varying copays, and services like ambulance, emergency, and primary care with specified copays. Additional benefits include coverage for hearing and vision services, with copays for exams and allowances for hearing aids and eyewear. Dental services are also covered, focusing on exams and oral surgery. The plan also offers coverage for home infusion, dialysis, medical equipment, and home health services, along with other services, such as OTC items and a meal benefit for chronic illnesses.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For days 1-8, you will pay a $195 copay, and for days 9-90, there is no copay.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $250, Observation Services have a $175 copay, Ambulatory Surgical Center Services have no copay, and Outpatient Substance Abuse services, including individual and group sessions, have a copay of $30.
Partial Hospitalization See details
Partial Hospitalization is covered by the Health First Easy Access H1099-027 (HMO-POS) plan. You will have a $15 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Health First Easy Access H1099-027 (HMO-POS) plan, with a $260 copay for both Ground Ambulance Services and Air Ambulance Services. Transportation Services to a plan-approved health-related location are not covered, while transportation to any health-related location is covered for up to 24 one-way trips per year via bus or subway.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Health First Easy Access H1099-027 (HMO-POS) plan. Emergency Services has a $125 copay, and Urgently Needed Services has a $25 copay, with no coinsurance for either. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Health First Easy Access H1099-027 (HMO-POS) plan covers Primary Care Physician Services with no copay. Chiropractic Services have a $20 copay. Occupational Therapy Services have a $10 copay, while Physician Specialist Services have a $35 copay. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a $30 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $10 copay. Additional Telehealth Benefits have a copay between $0 and $35.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams with no copay, and additional preventive services. Additional preventive services such as Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), 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 Benefit, 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 (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. Medical Nutrition Therapy (MNT) and Fitness Benefit are covered. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, and Digital Rectal Exams have no copay, while EKG following Welcome Visit has a $35 copay.
Hearing Services See details
The Health First Easy Access H1099-027 (HMO-POS) plan covers hearing exams with a $35 copay, routine hearing exams (1 exam every year) with no copay, and fitting/evaluation for hearing aids (1 exam every year) with no copay. This plan provides up to $1000 every two years for prescription hearing aids, but does not cover inner ear, outer ear, or over the ear prescription hearing aids, and does not cover OTC hearing aids.
Vision Services See details
Vision services include coverage for eye exams and eyewear. Eye exams have a copay between $0 and $15, while routine eye exams have no copay. Eyewear has no copay, and contact lenses are covered. Eyeglass lenses and frames are covered, and there is a combined maximum of $250 per year for all eyewear. Upgrades are not covered.
Dental Services See details
Dental services include coverage for oral exams with a $30 copay, dental x-rays, prophylaxis (cleaning), fluoride treatment, and oral and maxillofacial surgery. This plan does not cover endodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and 0-20% coinsurance, while other Medicare Part B drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Health First Easy Access H1099-027 (HMO-POS), with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies and Diabetic Equipment. DME has a 20% coinsurance, while Prosthetics/Medical Supplies have a 20% coinsurance, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have between 10% and 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, lab services, and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $35.00, while Lab Services have no coinsurance, and Diagnostic Radiological Services have a minimum copay of $100.00. Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $35.00 copay.
Home Health Services See details
Home Health Services are covered under the Health First Easy Access H1099-027 (HMO-POS) 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 Easy Access H1099-027 (HMO-POS) plan. This includes Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Health First Easy Access H1099-027 (HMO-POS) plan, with a $0 copay for days 1-20 and a $150 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Health First Easy Access H1099-027 (HMO-POS) plan does not cover acupuncture, 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. The plan covers Over-the-Counter (OTC) Items, with a maximum benefit of $115.00 every three months, and a Meal Benefit for chronic illnesses.
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