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Health First Emerald Plus H1099-028 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Health First Emerald Plus H1099-028 (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 H1099-028 (HMO) in 2026, please refer to our full plan details page.
Health First Emerald Plus H1099-028 (HMO) is a HMO plan offered by Health First Shared Services, Inc. available for enrollment in 2026 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 Emerald Plus H1099-028 (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 H1099-028 (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 H1099-028 (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 $125.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3700.00 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:
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Drug Coverage
The Health First Emerald Plus H1099-028 (HMO) Medicare plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generic drugs, there is no copay at either preferred or standard pharmacies. Tier 2 generic drugs are also highly affordable, costing as little as a $7.50 copay for a one-month supply at preferred pharmacies, or no copay when utilizing a three-month standard mail-order service. Tier 3 preferred brand drugs require a $42.00 copay per month at preferred pharmacies, while standard pharmacies charge $47.00. For higher-tier prescriptions, Tier 4 non-preferred drugs carry a 25% coinsurance, and Tier 5 specialty drugs require a 30% coinsurance for a one-month supply. This plan offers a cost-effective choice for those seeking low-cost generic medications with immediate coverage.
Additional Benefits
The Health First Emerald Plus H1099-028 (HMO) plan offers robust medical coverage with no copay for primary care visits and a $25 copay for specialist consultations. If you require hospital services, inpatient stays feature a $200 daily copay for the first eight days and no copay for days 9 through 90, while emergency room visits carry a $150 copay that is waived upon admission. Additionally, most preventive services, annual physicals, and up to 20 one-way transit trips are available with no copay. For specialized care, members benefit from routine dental, vision, and hearing exams with no copay, alongside allowances of up to $300 for eyewear and $500 for hearing aids. Durable medical equipment, prosthetic devices, and dialysis services are covered with no copay and a standard 20% coinsurance. The plan also includes an over-the-counter item benefit of up to $40 every three months with no copay to help manage your everyday health needs.
Inpatient Hospital See details
Health First Emerald Plus H1099-028 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $200 daily copay for days 1 through 8 and no copay for days 9 through 90. This benefit is partially covered, as prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Health First Emerald Plus H1099-028 (HMO) offers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require prior authorization with a $0 to $200 copay, while observation services cost a $250 copay per stay and outpatient substance abuse sessions have a $30 copay.
Partial Hospitalization See details
Partial hospitalization is covered under the Health First Emerald Plus H1099-028 (HMO) plan with a $45.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Health First Emerald Plus H1099-028 (HMO) covers ground and air ambulance services with a $260 copay and no coinsurance. Transportation services are partially covered, offering up to 20 one-way trips per year via bus or subway to any health-related location with no copay or coinsurance, though trips to plan-approved health-related locations are not covered.
Emergency Services See details
Health First Emerald Plus H1099-028 (HMO) covers emergency services with a $150 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours. Urgently needed services require a $25 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum with no coinsurance and copays ranging from $150 to $260.
Primary Care See details
Primary care benefits under Health First Emerald Plus H1099-028 (HMO) feature no copay and no coinsurance for primary care physician and opioid treatment services, while specialist visits require a $25 copay and no coinsurance. Physical, occupational, and speech therapies require a $10 copay, mental health and psychiatric sessions require a $30 copay, and telehealth ranges from no copay to $30, all with no coinsurance. Podiatry is not covered, and although some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by Health First Emerald Plus H1099-028 (HMO), featuring no copay and no coinsurance for annual physicals, kidney disease education, and most screenings, except for a post-welcome visit EKG which carries a $40 copay and no coinsurance. While fitness programs and medical nutrition therapy are covered with no copay and no coinsurance, the plan does not cover health education, in-home safety assessments, PERS, medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation, telemonitoring, remote access technologies, home safety devices, or counseling.
Hearing Services See details
Hearing services are covered by Health First Emerald Plus H1099-028 (HMO), featuring a $25 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Hearing aids are partially covered up to a $500 annual maximum with no copay and no coinsurance, though OTC, inner-ear, outer-ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Health First Emerald Plus H1099-028 (HMO) offers partially covered vision services, which include one annual routine eye exam with no copay and no coinsurance, and non-routine eye exams for a $25 copay and no coinsurance. Eyeglasses and contact lenses are covered with no copay and no coinsurance up to a $300 annual limit, though other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Health First Emerald Plus H1099-028 (HMO) partially covers dental services, with a $30 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for covered preventive and comprehensive care. However, other diagnostic and preventive services, endodontics, implants, orthodontics, maxillofacial prosthetics, and fixed or removable prosthodontics are not covered.
Home Infusion bundled Services See details
Health First Emerald Plus H1099-028 (HMO) covers home infusion bundled services with no copay, although prior authorization is required. Medicare Part B chemotherapy, radiation, and other Part B drugs carry no copay and range from no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Health First Emerald Plus H1099-028 (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits under Health First Emerald Plus H1099-028 (HMO) are covered with no copay, though prior authorization is required for these services. Members will pay a 20% coinsurance for durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts, while diabetic supplies carry a 10% to 20% coinsurance.
Diagnostic and Radiological Services See details
Health First Emerald Plus H1099-028 (HMO) covers diagnostic and radiological services, with prior authorization required for all services. Diagnostic procedures and outpatient X-rays require a $40 copay, diagnostic radiological services require a $175 copay, therapeutic radiological services require a 20% coinsurance, and lab services feature no coinsurance.
Home Health Services See details
Health First Emerald Plus H1099-028 (HMO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Health First Emerald Plus H1099-028 (HMO) with no coinsurance, though some services are covered while standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and carry a $20 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Health First Emerald Plus H1099-028 (HMO) with no coinsurance, featuring no copay for days 1 to 20 and a $180 daily copay for days 21 to 100. Prior authorization is required, a three-day prior hospital stay is not required, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Health First Emerald Plus H1099-028 (HMO) partially covers other services, providing over-the-counter (OTC) items with no copay and no coinsurance up to a $40 maximum benefit every three months. Acupuncture and meal benefits are not covered under this plan.
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