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Healthfirst Life Improvement Plan (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Healthfirst Life Improvement Plan (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Healthfirst Life Improvement Plan (HMO D-SNP) in 2025, please refer to our full plan details page.
Healthfirst Life Improvement Plan (HMO D-SNP) is a HMO D-SNP plan offered by Healthfirst, Inc. available for enrollment in 2025 to people living in NYC, Long Island, and Some Lower Hudson Valley. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Healthfirst Life Improvement Plan (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Healthfirst Life Improvement Plan (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Healthfirst Life Improvement Plan (HMO D-SNP).
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 Life Improvement Plan (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $63.10. 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 $9350.00 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 Life Improvement Plan (HMO D-SNP) has a $590 deductible for prescription drugs. During the initial coverage phase, after you meet your deductible, you will pay coinsurance for your prescriptions. The coinsurance rates vary depending on the drug tier and the pharmacy you use, with rates ranging from 23% to 26%. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS), also known as "Extra Help", with a monthly premium of $63.10.
Additional Benefits
The Healthfirst Life Improvement Plan (HMO D-SNP) offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays and coinsurance. Emergency and urgent care services are covered, with a copay for emergencies and coinsurance for urgently needed services. The plan also includes coverage for primary care, preventive services, hearing, vision, and dental services, with associated copays and coinsurance depending on the specific service. Additional benefits include ambulance and transportation services, home health services with no copay, and coverage for medical equipment and diagnostic services. The plan also covers skilled nursing facility stays, acupuncture, and over-the-counter items, with specific limits and prior authorization requirements. Some services, such as cardiac rehabilitation and certain home health services, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a copay of $450 for days 1-5 and no copay for days 6-90 for Inpatient Hospital-Acute, and a copay of $400 for days 1-5 and no copay for days 6-90 for Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute has no copay for days 91-999. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for outpatient hospital services with a 20% coinsurance, and observation services with a $110 copay. This plan also covers ambulatory surgical center services and outpatient substance abuse services, with a 20% coinsurance. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Healthfirst Life Improvement Plan (HMO D-SNP), but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered for 28 one-way trips per year via taxi, rideshare, or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $105 copay, while Urgently Needed Services have a 20% coinsurance. Worldwide Emergency Services have a maximum plan benefit coverage of $200,000.
Primary Care See details
The Healthfirst Life Improvement Plan (HMO D-SNP) covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, physician specialist services, physical therapy and speech-language pathology services, and mental health and psychiatric services all have a 20% coinsurance. Occupational therapy services, individual and group mental health and psychiatric sessions, and opioid treatment program services all have a minimum and maximum coinsurance of 20%. Additional telehealth benefits have a coinsurance between 0% and 20%.
Preventive Services See details
Preventive services, including annual physical exams and additional preventive services, are covered. Kidney disease education services and other preventive services, including glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, are covered with a 20% coinsurance. Health education, in-home safety assessments, 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, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, and counseling services are not covered. Fitness benefits, personal emergency response systems (PERS), remote access technologies, and home and bathroom safety devices are covered. The plan also covers a nutritional/dietary benefit for 6 visits.
Hearing Services See details
Hearing Services include hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams and fitting/evaluation for hearing aids have no copay, with a coinsurance of at most 20% for routine hearing exams. Prescription hearing aids have a copay between $0 and $1475, and some prescription hearing aid services are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a 20% coinsurance, and include one routine eye exam and one other eye exam service, such as a contact lens fitting, per year. Eyewear, including contact lenses and eyeglasses, is covered with a 20% coinsurance and a combined maximum plan benefit of $350 per year, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics. Limits vary by procedure, and some services require prior authorization.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Insulin, Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered under the Healthfirst Life Improvement Plan (HMO D-SNP). Medicare Part B Insulin Drugs have a $35 copay with 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, with a coinsurance between 20% and 20%. Prior authorization is required.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Equipment is covered, including Diabetic Supplies with 0-20% coinsurance and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance.
Diagnostic and Radiological Services See details
The Healthfirst Life Improvement Plan (HMO D-SNP) covers diagnostic and radiological services with no copay. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Healthfirst Life Improvement Plan (HMO D-SNP) with no copay or coinsurance, though authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Healthfirst Life Improvement Plan (HMO D-SNP). This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Healthfirst Life Improvement Plan (HMO D-SNP), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The Healthfirst Life Improvement Plan (HMO D-SNP) covers acupuncture with prior authorization, up to 12 treatments per year. This plan also covers over-the-counter (OTC) items, including nicotine replacement therapy and Naloxone, with a maximum benefit of $575 every three months. Additionally, a meal benefit is offered for chronic illnesses with prior authorization, while other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and Private Duty Nursing Services are not covered.
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