A non-government entity
Health First Premier Access H1099-027 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Health First Premier 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 Premier Access H1099-027 (HMO-POS) in 2026, please refer to our full plan details page.
Health First Premier 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 Flagler Highlands Volusia. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Health First Premier Access H1099-027 (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 Premier 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 Premier 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:
Sign up for Health First Premier Access H1099-027 (HMO-POS)
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 Premier Access H1099-027 (HMO-POS) Medicare plan features an annual drug deductible of $200. Tier 1 preferred generic drugs are highly affordable, offering no copay for up to a three-month supply at both preferred and standard pharmacies. For Tier 2 generic drugs, you will pay a low $7.50 copay for a one-month supply at preferred pharmacies, or no copay for a three-month supply filled through standard mail order. For brand-name and higher-tier medications, costs vary based on the tier and pharmacy selected. Tier 3 preferred brand drugs require a $42 copay for a one-month supply at preferred pharmacies, while Tier 4 non-preferred drugs carry a 25% coinsurance. Tier 5 specialty drugs require a 30% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Health First Premier Access H1099-027 (HMO-POS) plan offers comprehensive medical coverage with no copay for primary care visits, preventive screenings, and home health services. For inpatient hospital stays, members pay a daily copay of $195 for days 1 through 8 and no copay for days 9 through 90, with no coinsurance. Outpatient hospital services feature copays ranging from no copay up to $250, while specialist visits require copays between $10 and $35. This plan also includes key supplemental benefits, such as routine dental, vision, and hearing care with no copay, alongside allowances of up to $1,000 for dental and hearing aids. Additionally, members receive a $125 quarterly allowance for over-the-counter items and up to 24 one-way transportation trips with no copay. For specialized care, durable medical equipment, dialysis, and select Part B drugs are covered with no copay and coinsurance ranging from 10% to 20%.
Inpatient Hospital See details
Inpatient hospital services under Health First Premier Access H1099-027 (HMO-POS) are covered with no coinsurance, requiring a $195 copay per day for days 1 through 8 and no copay for days 9 through 90 for both acute and psychiatric stays. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Health First Premier Access H1099-027 (HMO-POS) covers outpatient services with no coinsurance, featuring copays ranging from $0 to $250 for outpatient hospital services and a $175 copay per stay for observation services. There is no copay or coinsurance for ambulatory surgical center and outpatient blood services, while outpatient substance abuse sessions require a $30 copay and no coinsurance.
Partial Hospitalization See details
Health First Premier Access H1099-027 (HMO-POS) covers partial hospitalization benefits with a $15.00 copay and no coinsurance. Prior authorization is required to receive these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Health First Premier Access H1099-027 (HMO-POS), featuring a $260 copay and no coinsurance for ground and air ambulance services. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way bus or subway trips per year to any health-related location, though plan-approved health-related location transportation is not covered.
Emergency Services See details
Health First Premier Access H1099-027 (HMO-POS) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with a $25 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum with no coinsurance and copays of $130, $130, and $260 respectively.
Primary Care See details
Health First Premier Access H1099-027 (HMO-POS) provides primary care physician visits, telehealth, and opioid treatment with no copay and no coinsurance. Specialist visits, psychiatric care, and physical therapy require copays ranging from $10 to $35 and no coinsurance, while podiatry and routine chiropractic services are not covered.
Preventive Services See details
Health First Premier Access H1099-027 (HMO-POS) covers preventive services, offering annual physical exams, kidney disease education, and select screenings with no copay and no coinsurance, while an EKG following a welcome visit requires a $35 copay and no coinsurance. Additional preventive services are partially covered with no copay and no coinsurance for fitness and medical nutrition therapy, but exclude sub-services such as health education, weight management, and personal emergency response systems.
Hearing Services See details
Hearing services covered by Health First Premier Access H1099-027 (HMO-POS) include annual routine exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $30 copay and no coinsurance. Prescription hearing aids are covered with no copay and no coinsurance up to a $1,000 maximum every two years, though OTC hearing aids and inner ear, outer ear, or over-the-ear models are not covered.
Vision Services See details
Health First Premier Access H1099-027 (HMO-POS) vision services are partially covered, featuring one annual routine eye exam with no copay and no coinsurance, while other eye exams are not covered. Eyewear is covered with no copay and no coinsurance up to a $250 annual limit, but eyewear upgrades are not covered.
Dental Services See details
Health First Premier Access H1099-027 (HMO-POS) partially covers dental services, providing Medicare-covered dental for a $30 copay and no coinsurance, alongside other covered dental care with no copay and no coinsurance up to a $1,000 yearly maximum. While preventive cleanings, exams, x-rays, fluoride, restorative care, periodontics, and oral surgery are covered, this plan does not cover other diagnostic and preventive services, endodontics, prosthodontics, maxillofacial prosthetics, implants, or orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Health First Premier Access H1099-027 (HMO-POS) with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance up to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Health First Premier Access H1099-027 (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Health First Premier Access H1099-027 (HMO-POS) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, with no copay. Beneficiaries are responsible for a 20% coinsurance for DME, prosthetics, and medical supplies, and a 10% to 20% coinsurance for diabetic supplies and therapeutic shoes or inserts.
Diagnostic and Radiological Services See details
Health First Premier Access H1099-027 (HMO-POS) covers diagnostic and radiological services with prior authorization, featuring a $35 copay for diagnostic tests and outpatient X-rays, and lab services with no coinsurance. Diagnostic radiological services require a $100 copay, while therapeutic radiological services require a 20% coinsurance and a copay.
Home Health Services See details
Health First Premier Access H1099-027 (HMO-POS) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Health First Premier Access H1099-027 (HMO-POS) features no coinsurance for cardiac rehabilitation, though only some services are covered. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation services (each requiring a $15 copay), and Supervised Exercise Therapy (SET) for symptomatic peripheral artery disease (requiring a $10 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits under Health First Premier Access H1099-027 (HMO-POS) are covered with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $150 daily copay for days 21 through 100, and additional days beyond the standard Medicare benefit are not covered.
Other Services See details
Health First Premier Access H1099-027 (HMO-POS) partially covers other services, providing chronic illness meal benefits and up to $125 every three months for over-the-counter items with no copay and no coinsurance. Acupuncture and other additional services under this benefit 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