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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 2026, 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 2026.
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 $58.80. 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 Life Improvement Plan (HMO D-SNP) prescription drug coverage includes an annual drug deductible of $615. Tier 1 preferred generic drugs are covered with no copay for one-, two-, or three-month supplies at standard pharmacies and standard mail order. For Tier 2 generic drugs and Tier 3 preferred brand drugs, you will pay a 23% coinsurance for all available supply lengths. For Tier 4 non-preferred drugs, standard pharmacies and mail-order services require a 32% coinsurance. Tier 5 specialty drugs are subject to a 25% coinsurance, which is restricted to a one-month supply. This straightforward cost-sharing structure helps you understand your out-of-pocket expenses for different medication tiers.
Additional Benefits
The Healthfirst Life Improvement Plan (HMO D-SNP) offers comprehensive medical coverage with many services requiring no copay or a standard 20% coinsurance. Primary care, specialist visits, outpatient diagnostics, and medical equipment generally feature no copay and a 20% coinsurance, while home health services and dental care are available with no copay and no coinsurance. For hospital stays, members pay daily copays for the first four days of inpatient care with no coinsurance, while emergency room visits carry a $115 copay that is waived if admitted. This plan also includes valuable supplemental benefits with no deductibles, such as routine hearing and vision exams, a $300 annual eyewear allowance, and prescription hearing aids with copays ranging from $0 to $1,475. Additionally, members can access up to 18 one-way transportation trips per year to approved locations, a $175 monthly over-the-counter allowance, and up to 12 acupuncture treatments with no copay and no coinsurance. Skilled nursing facility care is also covered with no copay for the first 20 days and no coinsurance.
Inpatient Hospital See details
Healthfirst Life Improvement Plan (HMO D-SNP) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute care requires a $611 copay per day for days 1 through 4 and no copay for days 5 and beyond, while psychiatric stays require a $520 copay per day for days 1 through 4 and no copay for days 5 through 90; however, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Healthfirst Life Improvement Plan (HMO D-SNP) covers outpatient hospital services with a 20% coinsurance and outpatient observation services with a $115 copay per stay. Ambulatory surgical center and outpatient substance abuse services are covered with no copay and a 20% coinsurance, while outpatient blood services are available with no copay and no coinsurance.
Partial Hospitalization See details
Healthfirst Life Improvement Plan (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Healthfirst Life Improvement Plan (HMO D-SNP), featuring a 20% coinsurance and no copay for both ground and air ambulance services. Transportation services are partially covered, offering up to 18 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Healthfirst Life Improvement Plan (HMO D-SNP) covers emergency services with a $115 copay (waived if admitted within 24 hours) and no coinsurance, while urgently needed services require a 20% coinsurance (up to $40 per visit) and no copay. Worldwide emergency, urgent, and transportation services are also covered up to a $200,000 maximum limit with no copay and no coinsurance.
Primary Care See details
Healthfirst Life Improvement Plan (HMO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and 20% coinsurance, while podiatry features no copay and no coinsurance. Chiropractic services are partially covered, offering routine care with no copay and no coinsurance, but other chiropractic services are not covered.
Preventive Services See details
Healthfirst Life Improvement Plan (HMO D-SNP) features partially covered preventive services, including annual physical exams, counseling, and fitness benefits with no copay and no coinsurance. Other covered services, such as kidney disease education, glaucoma screenings, and diabetes self-management training, are available with no copay and a 20% coinsurance. Several supplemental benefits, including health education, weight management, and in-home support services, are not covered.
Hearing Services See details
Hearing services are covered by the Healthfirst Life Improvement Plan (HMO D-SNP) with no deductible, featuring annual routine exams with no copay and a 20% coinsurance, and fitting evaluations with no copay. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $0 to $1,475, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Healthfirst Life Improvement Plan (HMO D-SNP) offers partially covered vision services with no copays, no deductibles, and a 20% coinsurance for routine eye exams and contact lenses. The plan covers one routine eye exam and one contact lens fitting per year, alongside a $300 annual allowance for eyewear, but individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered by the Healthfirst Life Improvement Plan (HMO D-SNP) with no copay and no coinsurance for preventive, comprehensive, and Medicare-covered dental care. This includes exams, cleanings, x-rays, and orthodontic services, though prior authorization is required for many treatments and there is no maximum benefit limit.
Home Infusion bundled Services See details
Home infusion bundled services are covered by the Healthfirst Life Improvement Plan (HMO D-SNP) with no copay, though prior authorization and step therapy are required. Covered Medicare Part B chemotherapy, radiation, and other drugs require no copay and 0% to 20% coinsurance, while Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Healthfirst Life Improvement Plan (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Medical Equipment See details
Healthfirst Life Improvement Plan (HMO D-SNP) covers durable medical equipment, prosthetics, and diabetic equipment with no copay and 20% coinsurance, except for diabetic supplies which range from no coinsurance to 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Healthfirst Life Improvement Plan (HMO D-SNP) covers diagnostic and radiological services with no copay, subject to a minimum 20% coinsurance and prior authorization requirements. This coverage includes diagnostic procedures, lab services, outpatient X-rays, and both diagnostic and therapeutic radiological services.
Home Health Services See details
Home Health Services are covered by the Healthfirst Life Improvement Plan (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Healthfirst Life Improvement Plan (HMO D-SNP) covers some Cardiac Rehabilitation Services with no copay and prior authorization, though standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Healthfirst Life Improvement Plan (HMO D-SNP) covers skilled nursing facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Healthfirst Life Improvement Plan (HMO D-SNP) offers partially covered other services with no copay and no coinsurance. Covered benefits include up to 12 acupuncture treatments per year, a $175 monthly over-the-counter allowance, family planning, and chronic illness meals with prior authorization, while highly integrated services for dual-eligibles are not covered.
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