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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 2025, 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 2025.
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 $45.10. 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 Connection Plan (HMO D-SNP) has an enhanced alternative drug benefit. The plan has a deductible of $590. During the initial coverage phase, after the deductible is met, you will pay coinsurance for your prescriptions. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Healthfirst Connection Plan (HMO D-SNP) offers a wide range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays and coinsurance amounts. You'll find coverage for services like primary care, mental health, vision, and dental, often with coinsurance requirements. The plan also includes coverage for hearing aids, ambulance services, and medical equipment. This plan provides coverage for many services with no copay, such as home health services and diagnostic services. This plan also offers additional benefits such as a meal benefit and coverage for over-the-counter items. However, some services, such as cardiac rehabilitation, are not covered, and some services require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $478 copay for days 1-5, and no copay for days 6-90; additional days (91-999) have no copay. For Inpatient Hospital Psychiatric, you pay a $407 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services with 20% coinsurance, observation services with a $110 copay, ambulatory surgical center services with 20% coinsurance, outpatient substance abuse services with 20% coinsurance, and outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including Ground and Air Ambulance, are covered by the Healthfirst Connection Plan (HMO D-SNP), with a 20% coinsurance. Transportation Services to a plan-approved health-related location are also covered, with a limit of 28 one-way trips per year via taxi, rideshare, or medical transport.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered by the Healthfirst Connection Plan (HMO D-SNP). Emergency Services have a $110 copay with no coinsurance, while Urgently Needed Services have a 20% coinsurance with no copay; Worldwide Emergency Services has a maximum plan benefit coverage of $200,000.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Primary Care Physician Services, Physician Specialist Services, and Physical Therapy and Speech-Language Pathology Services have a 20% coinsurance. Chiropractic Services, Occupational Therapy Services, and Opioid Treatment Program Services have a 20% coinsurance. Mental Health Specialty Services and Psychiatric Services have a 20% coinsurance for individual and group sessions. Additional Telehealth Benefits have a coinsurance between 0% and 20%. Podiatry Services cover up to 12 visits per year.
Preventive Services See details
Preventive services, including annual physical exams, are covered by the Healthfirst Connection Plan (HMO D-SNP). Some additional services, such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, have a 20% coinsurance.
Hearing Services See details
The Healthfirst Connection Plan (HMO D-SNP) covers hearing exams with a coinsurance of at most 20%, and covers routine hearing exams and fitting/evaluation for hearing aids. The plan also covers prescription hearing aids with a copay from $0 to $1475 for all types of aids, but does not cover inner ear, outer ear, or over the ear hearing aids, and does not cover OTC hearing aids.
Vision Services See details
Vision Services includes coverage for eye exams and eyewear. Eye exams have a 20% coinsurance, and include one routine eye exam and one other eye exam service per year. Eyewear, which includes contact lenses and eyeglasses (lenses and frames), also has a 20% coinsurance and a combined maximum benefit of $350 per year; however, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Healthfirst Connection Plan (HMO D-SNP) covers dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental 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 prior authorization is required for some services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay, and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Healthfirst Connection Plan (HMO D-SNP), but require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
The Healthfirst Connection Plan (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Durable medical equipment has a 20% coinsurance and requires authorization. Diabetic supplies have a 0-20% coinsurance, while Medicare-covered prosthetic devices, medical supplies, and diabetic therapeutic shoes/inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. There is no copay for any of these services, and the coinsurance is at most 20%.
Home Health Services See details
Home Health Services are covered by the Healthfirst Connection Plan (HMO D-SNP) with no copay or coinsurance, but prior 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 Connection 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 Connection Plan (HMO D-SNP), but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Healthfirst Connection Plan (HMO D-SNP) covers acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a limit of 12 treatments per year and requires prior authorization, while OTC items have a maximum benefit of $170 every three months, and the meal benefit requires prior authorization. Other services such as Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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