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Healthfirst CompleteCare (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Healthfirst CompleteCare (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 CompleteCare (HMO D-SNP) in 2026, please refer to our full plan details page.
Healthfirst CompleteCare (HMO D-SNP) is a HMO D-SNP plan offered by Healthfirst, Inc. available for enrollment in 2025 to people living in NYC, Nassau, Some Lower Hudson Valley Counties. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Healthfirst CompleteCare (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 CompleteCare (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 CompleteCare (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 CompleteCare (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 CompleteCare (HMO D-SNP) Medicare plan features an annual prescription drug deductible of $615. This deductible is the amount you must pay out of pocket for your covered medications before the plan begins to pay its share. Understanding this initial cost is an important factor when evaluating your overall Medicare prescription drug coverage options. Specific prescription drug tier details, including individual copayments and coinsurance rates for different medication levels, are currently not available for this plan. To get a complete picture of your potential out-of-pocket costs, you may want to verify how your specific prescriptions are categorized under this plan's formulary.
Additional Benefits
The Healthfirst CompleteCare (HMO D-SNP) plan offers comprehensive medical coverage, generally featuring no copay and a 20% coinsurance for primary care, specialist visits, outpatient hospital services, and diagnostic tests. Inpatient hospital stays require a $611 copay for the first four days followed by no copay, while skilled nursing facility care has no copay for the first 20 days. Emergency room visits carry a $115 copay, which is waived if you are admitted to the hospital within 24 hours. This plan also includes valuable supplemental benefits, such as comprehensive dental care and home health services with no copay and no coinsurance. Vision benefits feature eye exams with a 20% coinsurance and up to $400 annually for eyewear with no copay or coinsurance. Additionally, members can take advantage of a $252 monthly over-the-counter allowance and up to 40 acupuncture treatments per year with no copay and no coinsurance.
Inpatient Hospital See details
Healthfirst CompleteCare (HMO D-SNP) covers inpatient hospital services with no coinsurance, requiring prior authorization and a $611 copay for days 1 to 4 of acute stays, with no copay for days 5 and beyond. For psychiatric hospital stays, there is a $520 copay for days 1 to 4 and no copay for days 5 to 90, while upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Healthfirst CompleteCare (HMO D-SNP) covers outpatient hospital services with a 20% coinsurance and observation services with a $115 copay per stay. Ambulatory surgical, outpatient substance abuse, and blood services are covered with no copay and a 20% coinsurance, with prior authorization required for some services.
Partial Hospitalization See details
Healthfirst CompleteCare (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by Healthfirst CompleteCare (HMO D-SNP) with a 20% coinsurance and no copay for both ground and air transportation, subject to prior authorization. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Healthfirst CompleteCare (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a 20% coinsurance (up to $40 per visit) and no copay, while worldwide emergency, urgent, and transportation services are covered with no copay or coinsurance up to a $200,000 maximum limit.
Primary Care See details
Healthfirst CompleteCare (HMO D-SNP) covers primary care, specialist, psychiatric, and therapy services with no copay and a 20% coinsurance, while telehealth is available with no copay and no coinsurance. Chiropractic services are partially covered, as routine chiropractic care is covered with no copay or coinsurance but other chiropractic services are not covered.
Preventive Services See details
Healthfirst CompleteCare (HMO D-SNP) partially covers preventive services, offering annual physical exams, fitness benefits, and caregiver support with no copay and no coinsurance, while kidney education and other screenings carry no copay and 20% coinsurance. The plan does not cover in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemo wigs, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, extra smoking cessation, enhanced disease management, telemonitoring, home modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by Healthfirst CompleteCare (HMO D-SNP), which offers diagnostic hearing exams with no copay and no coinsurance. Routine hearing exams, fitting and evaluations, prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Vision services under Healthfirst CompleteCare (HMO D-SNP) are partially covered, featuring eye exams with no copay and a 20% coinsurance, and eyewear with no copay or coinsurance up to a $400 yearly limit. Routine eye exams and contact lens fittings are covered annually, but individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Healthfirst CompleteCare (HMO D-SNP) covers preventive and comprehensive dental services, including exams, cleanings, x-rays, implants, and orthodontics, with no copay and no coinsurance. While there is no overall maximum plan benefit limit, individual service frequency limits apply and prior authorization is required for most procedures.
Home Infusion bundled Services See details
Healthfirst CompleteCare (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B chemotherapy, radiation, and other drugs have no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin requires a $35 copay and a coinsurance of no coinsurance to 20%.
Dialysis Services See details
Healthfirst CompleteCare (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Healthfirst CompleteCare (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic services with no copay and 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Healthfirst CompleteCare (HMO D-SNP) with no copay and a 20% coinsurance, subject to prior authorization. This coverage applies to outpatient diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Home health services are covered by Healthfirst CompleteCare (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered by Healthfirst CompleteCare (HMO D-SNP) with no copay and prior authorization required, but in practice only some services are covered as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Healthfirst CompleteCare (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 copay for days 21 through 100, and additional days beyond the standard limit are not covered.
Other Services See details
Healthfirst CompleteCare (HMO D-SNP) offers partial coverage for other services with no copay and no coinsurance, including acupuncture up to 40 treatments yearly and a $252 monthly over-the-counter (OTC) item allowance. Meal benefits and other additional services in this category are not covered.
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