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Healthfirst Signature (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Healthfirst Signature (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Healthfirst Signature (HMO) in 2025, please refer to our full plan details page.
Healthfirst Signature (HMO) is a HMO plan offered by Healthfirst, Inc. available for enrollment in 2025 to people living in New York City and Nassau County. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Healthfirst Signature (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Healthfirst Signature (HMO).
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 Signature (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $6700.00 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 Signature (HMO) plan has a $590 deductible for prescription drugs. After you meet your deductible, your cost for drugs will vary depending on the specific drug tier and whether you use a preferred or standard pharmacy. For example, in the initial coverage phase, you will pay a $15 copay for preferred generic drugs and a $47 copay for standard generic drugs. For preferred and non-preferred brand drugs, you pay 50% and 25% coinsurance, respectively. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Healthfirst Signature (HMO) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services may have copays or coinsurance. Emergency, primary care, and preventive services are covered, with some services having no copay. Additional benefits include hearing, vision, and dental services, with limits on coverage for eyewear and dental services. The plan also covers ambulance services, medical equipment, home health services, and other services like acupuncture and over-the-counter items. Some services, like skilled nursing and dialysis, require prior authorization and have copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits under Healthfirst Signature (HMO) include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a copay of $430 for days 1-5 and no copay for days 6-90, with additional days 91-999 having no copay, while Inpatient Hospital Psychiatric services have a $410 copay for days 1-5 and no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a 0% - 20% coinsurance, Observation Services with a $125 copay, Ambulatory Surgical Center (ASC) Services with no copay, and Outpatient Blood Services with no copay. Outpatient Substance Abuse Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Healthfirst Signature (HMO) plan, but requires prior authorization. There is no information about the cost of this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and air ambulance services have a $275 copay, and transportation services to plan-approved health-related locations are covered for up to 30 one-way taxi trips per year.
Emergency Services See details
Emergency Services, including Urgent and Worldwide Emergency Services, are covered by the Healthfirst Signature (HMO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $55 copay, and Worldwide Emergency Transportation has a $275 copay; all other services have no coinsurance.
Primary Care See details
The Healthfirst Signature (HMO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $20 copay, physician specialist services with a $30 copay, podiatry services with a $30 copay, other health care professional services with a copay between $0 and $30, physical therapy and speech-language pathology services with a $20 copay, opioid treatment program services, and additional telehealth benefits. Individual and group sessions for mental health specialty services and individual and group sessions for psychiatric services are not covered.
Preventive Services See details
The Healthfirst Signature (HMO) plan covers preventive services, including annual physical exams, with no copay. Additional covered services include Personal Emergency Response System (PERS), Nutritional/Dietary Benefit (6 visits), Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Health Education, In-Home Safety Assessment, Medical Nutrition Therapy (MNT), 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, and Counseling Services are not covered.
Hearing Services See details
Hearing services include routine hearing exams with a $30 copay. Prescription hearing aids are covered with a copay between $0 and $1475, and the plan does not cover prescription hearing aids for the inner or outer ear, or over the ear.
Vision Services See details
The Healthfirst Signature (HMO) plan covers vision services, including routine eye exams once per year, and other eye exam services, including contact lens fitting, once per year. This plan also covers contact lenses, and eyeglasses (lenses and frames) once per year, but eyeglass lenses, frames, and upgrades are not covered. Eyewear has a combined maximum benefit of $250 per year.
Dental Services See details
The Healthfirst Signature (HMO) plan covers a range of dental services, including oral exams, dental x-rays, cleanings, fluoride treatments, other preventive dental services, restorative services, and more, up to a maximum of $2,500 per year. However, implant services and orthodontics are not covered by this plan.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. Medicare Part B Insulin Drugs have a $35 copay and 0-20% coinsurance. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Healthfirst Signature (HMO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with a 20% coinsurance. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by the Healthfirst Signature (HMO) plan, with no copay for all diagnostic services. Diagnostic procedures, tests, and lab services are not covered, while diagnostic radiological services have a copay of at most $60, and therapeutic radiological services have coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Healthfirst Signature (HMO) plan with no copay or coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Healthfirst Signature (HMO) plan, but the specific services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required, and the copay information is available in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Healthfirst Signature (HMO) plan, but require prior authorization. For days 1-20, there is a $10 copay, and for days 21-100, there is a $214 copay. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Healthfirst Signature (HMO) plan covers acupuncture, with a limit of 12 treatments per year, but requires prior authorization. Over-the-counter (OTC) items are covered with a maximum benefit of $85 every three months, including nicotine replacement therapy and Naloxone. The plan also offers a meal benefit for chronic illness, but not for other services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others.
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