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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 2025, 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 2025.
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 $590.00 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 $6700.00 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) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. After the deductible, you will pay a copay or coinsurance for your drugs, depending on the tier and pharmacy. For example, you will pay a $15.00 copay for preferred generic drugs at a standard or mail-order pharmacy. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Healthfirst Signature (HMO) plan offers a range of benefits beyond standard Medicare coverage. This includes coverage for inpatient hospital stays with a copay, outpatient services with varying copays and coinsurance, and emergency services. You'll also find coverage for primary care, preventive services, hearing, vision, and dental services with specific copays or maximum benefits. Additional benefits include coverage for ambulance and transportation services, as well as home health, skilled nursing facility, and dialysis services. The plan also covers medical equipment, diagnostic and radiological services, and cardiac rehabilitation services, along with other services like acupuncture and over-the-counter items. However, some services like specific hearing aids, certain vision services, and dental services are not covered, and prior authorization may be required for some services.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with a copay of $430 for days 1-5, and no copay for days 6-90 for acute care, and a copay of $410 for days 1-5, and no copay for days 6-90 for psychiatric care. Additional days for inpatient hospital-acute have no copay, while non-Medicare-covered stays and upgrades for inpatient hospital-acute and additional days and non-Medicare-covered stays for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a 0% - 20% coinsurance, observation services with a $125 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Healthfirst Signature (HMO) plan, but requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Healthfirst Signature (HMO) plan, including Medicare-covered ground and air ambulance services with a $275 copay. Transportation Services to a plan-approved health-related location are covered for 30 one-way trips per year via taxi, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Healthfirst Signature (HMO) plan. Emergency Services has a $125 copay, Urgently Needed Services has a $55 copay, Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $55 copay, and Worldwide Emergency Transportation has a $275 copay.
Primary Care See details
The Healthfirst Signature (HMO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $20 copay, physician specialist services with a $30 copay, podiatry services with a $30 copay, other health care professional services with a copay from $0-$30, physical therapy and speech-language pathology services with a $20 copay, additional telehealth benefits, and opioid treatment program services. However, individual and group sessions for mental health and psychiatric services are not covered.
Preventive Services See details
Preventive Services, including services not usually covered by Medicare, are covered. Health Education, In-Home Safety Assessment, Medical Nutrition Therapy, 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, 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, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with a $30 copay. Fitting/Evaluation for Hearing Aids are covered, and Prescription Hearing Aids (all types) are covered with a copay between $0 and $1475. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services include routine eye exams, other eye exam services, and eyewear. Routine eye exams and other eye exam services, including contact lens fitting, are covered once per year. Eyewear, including contact lenses and eyeglasses (lenses and frames), is covered with a combined maximum benefit of $250 per year; however, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Healthfirst Signature (HMO) plan covers a variety of dental services, including oral exams, dental x-rays, cleanings, fluoride treatments, and other preventive services, with a maximum benefit of $2,500 per year. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, and oral and maxillofacial surgery are also covered, though implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Healthfirst Signature (HMO) plan. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Healthfirst Signature (HMO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0-20%, and Prosthetic Devices and Medical Supplies with a 20% coinsurance. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Healthfirst Signature (HMO). Diagnostic services and lab services are not covered. Diagnostic Radiological Services have a copay of up to $60.00, while Therapeutic Radiological Services have a coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by the Healthfirst Signature (HMO) plan with no copay and no coinsurance, but prior authorization is required. 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 Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required, and the copay information is available below.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Healthfirst Signature (HMO) with a copay of $10 for days 1-20, and $214 for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Healthfirst Signature (HMO) plan covers acupuncture with a limit of 12 treatments per year and requires prior authorization. Over-the-counter (OTC) items are covered up to $85 every three months, including nicotine replacement therapy and Naloxone. The plan also offers a meal benefit for chronic illnesses, which requires prior authorization. Several other services are not covered.
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