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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 2025, 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 2025.
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 $72.30. 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 $8750.00 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) plan has a $590 deductible for prescription drugs. In the initial coverage phase, you'll pay coinsurance for your prescriptions. The coinsurance rate depends on the drug tier and whether you use a preferred or standard pharmacy. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS).
Additional Benefits
The Healthfirst CompleteCare (HMO D-SNP) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services, including primary care, have 20% coinsurance. Emergency services have a $110 copay, and dental and vision services are covered. The plan also covers home health services with no copay or coinsurance, and skilled nursing facility stays have a copay after the first 20 days. Diagnostic and radiological services have no copay, and there is coverage for acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $478 copay for days 1-5, and no copay for days 6-90; and for Inpatient Hospital Psychiatric, you will pay a $407 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered with no copay. 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, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services have a 20% coinsurance, while observation services have a $110 copay. Individual and group sessions for outpatient substance abuse have a minimum and maximum coinsurance of 20%. Outpatient blood services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by Healthfirst CompleteCare (HMO D-SNP) with a 20% coinsurance, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Healthfirst CompleteCare (HMO D-SNP). Ground and Air Ambulance Services have a 20% coinsurance, and there is no copay. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including urgently needed services and worldwide emergency services, are covered. Emergency services have a $110 copay, while urgently needed services have 20% coinsurance and worldwide emergency services have a maximum benefit coverage of $200,000.
Primary Care See details
The Healthfirst CompleteCare (HMO D-SNP) plan covers primary care physician services with a 20% coinsurance. Chiropractic services, including routine care, are covered, and additional telehealth benefits are covered. Physician specialist services, mental health specialty services (with 20% coinsurance for individual and group sessions), podiatry services (with 20% coinsurance for routine foot care), other health care professional services (with 20% coinsurance), psychiatric services (with 20% coinsurance for individual and group sessions), physical therapy and speech-language pathology services (with 20% coinsurance), and opioid treatment program services (with 20% coinsurance) are also covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered zero dollar preventive services, annual physical exams, health education, nutritional/dietary benefits (6 visits), fitness benefits, kidney disease education services, and other preventive services. The plan does not cover in-home safety assessments, personal emergency response systems, 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, remote access technologies, home and bathroom safety devices and modifications, or counseling services. Kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visit have a 20% coinsurance.
Hearing Services See details
Hearing Services are not covered by Healthfirst CompleteCare (HMO D-SNP). Specifically, routine hearing exams, fitting/evaluation for hearing aids, and all types of prescription hearing aids are not covered.
Vision Services See details
Vision services are covered, including eye exams with 20% coinsurance and routine eye exams once per year. Eyewear is covered with a combined maximum of $550 per year, while contact lenses and eyeglasses (lenses and frames) are also covered. 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. Prior authorization is required for some services, and limits vary by procedure.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, with a coinsurance between 0% and 20%. 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 by the Healthfirst CompleteCare (HMO D-SNP) plan and require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by Healthfirst CompleteCare (HMO D-SNP), including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance with no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Diabetic Supplies have a 20% coinsurance with no copay. Medical Supplies have a 20% coinsurance and no copay. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, 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 CompleteCare (HMO D-SNP) plan with no copay and no coinsurance, but 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 CompleteCare (HMO D-SNP) plan. Specifically, 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 are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Healthfirst CompleteCare (HMO D-SNP) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional and non-Medicare-covered SNF days are not covered.
Other Services See details
The Healthfirst CompleteCare (HMO D-SNP) plan covers acupuncture with a limit of 40 treatments per year, and requires prior authorization. Over-the-counter (OTC) items are covered with a maximum benefit of $280.00 every month, including nicotine replacement therapy and naloxone. However, meal benefits, and several other services are not covered.
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