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Healthfirst Signature (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Healthfirst Signature (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Healthfirst Signature (PPO) in 2025, please refer to our full plan details page.
Healthfirst Signature (PPO) is a PPO plan offered by Healthfirst, Inc. available for enrollment in 2025 to people living in NYC, Long Island, and Some Lower Hudson Valley. This plan received an overall rating of 2.5 out of 5 stars in 2025.
It's important to know that Healthfirst Signature (PPO) 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 (PPO).
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 (PPO), 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 combined Maximum Out-Of-Pocket cost of $8000.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $8000.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 (PPO) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and the pharmacy you use. For example, you will pay a $15 copay for a preferred generic drug at a standard or mail-order pharmacy. For preferred brand drugs, you will pay 50% coinsurance at both standard and mail-order pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs.
Additional Benefits
The Healthfirst Signature (PPO) plan offers a range of benefits, including coverage for inpatient hospital stays with a copay, outpatient services with a coinsurance, and emergency services with a copay. This plan also covers primary care, preventive services, hearing, vision, and dental services with varying cost-sharing structures. Additional benefits include ambulance services with a copay, home health services with no cost, and medical equipment with coinsurance. Coverage is also provided for skilled nursing facility services with a copay and dialysis services with coinsurance. However, certain services like cardiac rehabilitation and some outpatient services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits for the Healthfirst Signature (PPO) plan include coverage for Inpatient Hospital-Acute with a $325 copay for days 1-5, and no copay for days 6-90, and Inpatient Hospital Psychiatric with a $300 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute have no copay, while Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a coinsurance of 0% - 20%, observation services with a $125 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services are not covered, and outpatient blood services are covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Healthfirst Signature (PPO) plan, but requires prior authorization. There is no information about the cost of services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Healthfirst Signature (PPO) plan. Ground and Air Ambulance Services have a $275 copay, with no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Healthfirst Signature (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $45 copay, and Worldwide Emergency Transportation has a $275 copay.
Primary Care See details
The Healthfirst Signature (PPO) plan covers primary care, chiropractic services with a $20 copay, occupational therapy with a $20 copay, physician specialist services with a $35 copay, podiatry services with a $35 copay, physical therapy and speech-language pathology services with a $20 copay, additional telehealth benefits with a $0-$35 copay, and opioid treatment program services. Mental health and psychiatric individual and group sessions are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered preventive services with prior authorization, annual physical exams, and additional services not typically covered by Medicare, as well as kidney disease education, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. Additional benefits such as Nutritional/Dietary Benefits (6 visits), Personal Emergency Response System (PERS), Remote Access Technologies, and Fitness Benefit are also covered, while other services like Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
Hearing services are covered, including routine hearing exams with a $35 copay. Prescription hearing aids are partially covered, with a copay between $0 and $1475, but inner ear, outer ear, and over-the-ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for routine eye exams, other eye exam services, and eyewear. Routine eye exams and other eye exam services, including contact lens fittings, are covered once per year. Eyewear is covered up to a combined maximum of $250 every year, and includes contact lenses, and eyeglasses (lenses and frames). Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a maximum benefit of $1500 per year for both in-network and out-of-network services. Oral exams, dental x-rays, cleaning, fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, and oral and maxillofacial surgery are covered, but implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Healthfirst Signature (PPO) plan. This plan has a $35 copay for Medicare Part B Insulin Drugs and a coinsurance between 0% and 20% for all drugs.
Dialysis Services See details
Dialysis Services are covered by the Healthfirst Signature (PPO) plan, but require prior authorization. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0-20% coinsurance and Prosthetic Devices and Medical Supplies with 20% coinsurance, but Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with some services requiring prior authorization. Diagnostic procedures/tests, lab services, and outpatient X-ray services are not covered. Diagnostic Radiological Services have a copay of at most $100.00, and Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Healthfirst Signature (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Healthfirst Signature (PPO) plan. This includes Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Healthfirst Signature (PPO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Healthfirst Signature (PPO) plan covers acupuncture, with a limit of 12 treatments per year, and requires prior authorization. Over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. The plan also covers a meal benefit for chronic illnesses, which requires prior authorization.
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