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Healthfirst Connection Plan (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Healthfirst Connection 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 Connection Plan (HMO D-SNP) in 2026, please refer to our full plan details page.
Healthfirst Connection Plan (HMO D-SNP) is a HMO D-SNP plan offered by Healthfirst, Inc. available for enrollment in 2025 to people living in NYC, Nassau, and 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 Connection 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 Connection 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 Connection 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 Connection Plan (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $20.70. 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 Connection Plan (HMO D-SNP) features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs are highly accessible with no copay for one-, two-, or three-month supplies at standard pharmacies and through standard mail order. For Tier 2 generic drugs, members are responsible for a 22% coinsurance across standard pharmacy and mail-order options. Tier 3 preferred brand drugs also carry a 22% coinsurance, while Tier 4 non-preferred drugs require a 35% coinsurance for standard fills. For Tier 5 specialty drugs, members pay a 25% coinsurance for a one-month supply. This clear cost-sharing structure helps you accurately estimate your prescription expenses with this Healthfirst Medicare plan.
Additional Benefits
The Healthfirst Connection Plan (HMO D-SNP) offers comprehensive medical coverage with manageable cost-sharing, featuring no copays for primary and specialist care visits alongside a 20% coinsurance. For inpatient hospital stays, members pay a daily copay for the first four days—$611 for acute care and $520 for psychiatric care—with no copay required for additional days. Emergency room visits carry a $115 copay, which is waived upon admission, while outpatient services and diagnostic tests generally require a 20% coinsurance and no copay. This plan also includes valuable supplemental benefits, such as comprehensive dental care with no copay and no coinsurance. Routine vision and hearing exams are available with no copay and a 20% coinsurance, supported by a $250 annual eyewear allowance and up to 18 free one-way transportation trips per year. Furthermore, home health care and a $55 monthly over-the-counter allowance are provided with no copay and no coinsurance to help you manage your daily health needs.
Inpatient Hospital See details
Healthfirst Connection Plan (HMO D-SNP) covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute stays, there is a $611 copay for days 1 to 4 and no copay for days 5 and beyond, whereas psychiatric stays require a $520 copay for days 1 to 4 and no copay for days 5 to 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Healthfirst Connection Plan (HMO D-SNP) covers outpatient hospital services with a 20% coinsurance and prior authorization, while outpatient observation services require a $115 copay per stay. Ambulatory surgical center and outpatient substance abuse services are covered with no copay and a 20% coinsurance, whereas outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered under the Healthfirst Connection Plan (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required for this service.
Ambulance and Transportation Services See details
Healthfirst Connection Plan (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay and no coinsurance for up to 18 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Healthfirst Connection Plan (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay 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 services are covered with no copay or coinsurance up to a $200,000 maximum limit.
Primary Care See details
Primary care and specialist services under the Healthfirst Connection Plan (HMO D-SNP) are covered with no copay and 20% coinsurance, while routine podiatry and routine chiropractic care feature no copay and no coinsurance. Other chiropractic services are not covered, and additional benefits like telehealth, mental health, and physical therapy require prior authorization with no copay and coinsurance up to 20%.
Preventive Services See details
Preventive services under the Healthfirst Connection Plan (HMO D-SNP) are partially covered, featuring annual physicals, counseling, and fitness benefits with no copay and no coinsurance. Several sub-services are not covered, including health education, in-home safety assessments, medical nutrition therapy, weight management, and alternative therapies. Kidney disease education and other select screenings are covered with no copay and 20% coinsurance.
Hearing Services See details
Healthfirst Connection Plan (HMO D-SNP) covers hearing services, including annual routine hearing exams with no copay and 20% coinsurance, and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $0 to $1,475 and no coinsurance, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by the Healthfirst Connection Plan (HMO D-SNP) with no copays, featuring one routine eye exam and one contact lens fitting per year subject to a 20% coinsurance. Eyewear is covered up to a $250 annual limit with no copay, which includes one pair of eyeglasses per year and unlimited contact lenses at a 20% coinsurance, though individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Healthfirst Connection Plan (HMO D-SNP) covers preventive, comprehensive, and orthodontic dental services with no copay and no coinsurance. There is no maximum plan benefit limit, though prior authorization is required for most procedures and frequency limits vary by service.
Home Infusion bundled Services See details
Healthfirst Connection Plan (HMO D-SNP) covers home infusion bundled services with no copay, subject to prior authorization and step therapy. Medicare Part B chemotherapy, radiation, and other drugs have no copay and range from no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and ranges from no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the Healthfirst Connection Plan (HMO D-SNP) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Healthfirst Connection Plan (HMO D-SNP) covers medical equipment, prosthetics, and diabetic supplies with no copays, though prior authorization is required. Beneficiaries will pay a 20% coinsurance for durable medical equipment, prosthetics, and therapeutic shoes, while diabetic supplies range from no coinsurance to a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Healthfirst Connection Plan (HMO D-SNP) with prior authorization, requiring no copay and a 20% coinsurance for Medicare-covered diagnostic procedures, lab services, X-rays, and radiological treatments.
Home Health Services See details
Home Health Services are covered under the Healthfirst Connection Plan (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Healthfirst Connection Plan (HMO D-SNP) with no copay, but prior authorization is required. While some services are covered, standard 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 Connection Plan (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 to 20 and a $218 copay for days 21 to 100 per stay. Prior authorization is required, and while a prior three-day inpatient hospital stay is not required for admission, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by the Healthfirst Connection Plan (HMO D-SNP) with no copay and no coinsurance, featuring acupuncture limited to 12 treatments per year, chronic illness meals, family planning, and a $55 monthly over-the-counter allowance. Highly integrated services for dual-eligible SNPs and other unspecified services are not covered under this plan.
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