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Healthfirst Signature (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Healthfirst Signature (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Healthfirst Signature (HMO) in 2026, please refer to our full plan details page.
Healthfirst Signature (HMO) is a HMO plan offered by Healthfirst, Inc. available for enrollment in 2025 to people living in Orange, Rockland, Sullivan, and Westchester County. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Healthfirst Signature (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 Healthfirst Signature (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 Healthfirst Signature (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.
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 $615.00 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 $9250.00 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 Healthfirst Signature (HMO) Medicare plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics, you will pay a low copay of $1.00 for a 1-month supply and $2.50 for a 3-month supply through standard pharmacies or mail order. Tier 2 generic drugs are also highly affordable, costing a $2.00 copay for a 1-month supply and $5.00 for a 3-month supply. Higher-tier prescriptions require coinsurance, with Tier 3 preferred brands requiring 19% coinsurance and Tier 4 non-preferred drugs requiring 25% coinsurance. Tier 5 specialty drugs also carry a 25% coinsurance for a 1-month supply through standard pharmacy or mail order. Notably, Tier 6 select care drugs are covered with no copay for up to a 3-month supply.
Additional Benefits
The Healthfirst Signature (HMO) plan offers comprehensive medical coverage with no copay for primary care, telehealth, and home health care. Specialist visits, routine hearing exams, and urgent care require a $40 copay, while emergency room visits have a $115 copay, all with no coinsurance. For hospital stays, inpatient services feature no coinsurance but require daily copays for the first four days, whereas outpatient hospital services carry no copay and a 0% to 20% coinsurance. Dental care is covered with no copay or coinsurance up to a $1,000 annual limit, and routine vision care includes annual exams and up to $200 for eyewear with no copay. Prescription hearing aids are covered with copays ranging from no copay up to $1,475. Additionally, skilled nursing facility stays feature no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
Healthfirst Signature (HMO) partially covers inpatient hospital services with no coinsurance, requiring prior authorization for both acute and psychiatric stays. Medicare-covered acute stays require a $611 copay for days 1 to 4 and no copay for days 5 and beyond, while psychiatric stays require a $520 copay for days 1 to 4 and no copay for days 5 to 90; however, upgrades, psychiatric additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Healthfirst Signature (HMO) covers outpatient hospital services with 0% to 20% coinsurance and no copay, and outpatient observation services with a $115 copay per stay and no coinsurance. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse services are not covered.
Partial Hospitalization See details
Healthfirst Signature (HMO) covers partial hospitalization services with no copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Healthfirst Signature (HMO) covers Medicare-approved ground and air ambulance services with a $315 copay and no coinsurance, requiring prior authorization. While transportation services are technically included, some services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Healthfirst Signature (HMO) covers emergency services with a $115 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $115, $40, and $315 respectively, up to a $200,000 maximum plan benefit.
Primary Care See details
Healthfirst Signature (HMO) provides primary care, telehealth, and opioid treatment with no copay and no coinsurance, while specialist visits and podiatry require a $40 copay and no coinsurance. Physical, occupational, and speech therapies have a $35 copay with no coinsurance, and chiropractic care is partially covered with a $15 copay and no coinsurance, though other chiropractic services are not covered. Some mental health and psychiatric services are covered with no copay and no coinsurance, but individual and group sessions are not covered.
Preventive Services See details
Preventive services are partially covered by Healthfirst Signature (HMO) with no copay and no coinsurance for annual exams, kidney disease education, counseling, and fitness benefits. However, several sub-services are not covered, including health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, and home safety modifications.
Hearing Services See details
Hearing services are partially covered by Healthfirst Signature (HMO), including routine exams for a $40 copay and no coinsurance, and up to two prescription hearing aids per year with a copay ranging from no copay up to $1,475 and no coinsurance. However, OTC hearing aids and inner-ear, outer-ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Healthfirst Signature (HMO) covers vision services with no copay and no coinsurance, including one routine eye exam and one contact lens fitting per year. Eyewear is partially covered with no copay or coinsurance up to a $200 annual limit for contact lenses and one pair of eyeglasses, though individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Healthfirst Signature (HMO) with no copay and no coinsurance up to a maximum annual limit of $1,000, though prior authorization is required for most services. Covered benefits include preventive and comprehensive care, while other diagnostic dental services, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Healthfirst Signature (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy, radiation, and other medications, require no coinsurance to 20% coinsurance, while Part B insulin is available with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Healthfirst Signature (HMO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Healthfirst Signature (HMO) with no copays, featuring a 0% to 20% coinsurance for durable medical equipment and a 20% coinsurance for prosthetics and medical supplies. Diabetic equipment is partially covered with no copay or coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Healthfirst Signature (HMO) covers diagnostic and radiological services with prior authorization, offering diagnostic tests with a $0 to $40 copay plus coinsurance, and lab services with a copay and no coinsurance. Diagnostic radiological services feature no copay, while outpatient X-rays require a $40 copay and coinsurance, and therapeutic radiological services require a 20% coinsurance and a copay.
Home Health Services See details
Home Health Services are covered under the Healthfirst Signature (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Healthfirst Signature (HMO) partially covers Cardiac Rehabilitation Services with a $15 copay, no coinsurance, and prior authorization required. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Healthfirst Signature (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Healthfirst Signature (HMO), featuring no copay and no coinsurance for acupuncture up to 12 treatments per year, family planning, and chronic illness meal benefits with prior authorization. Over-the-counter (OTC) items are not covered under this plan.
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