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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 2026, please refer to our full plan details page.
Healthfirst Signature (PPO) is a PPO plan offered by Healthfirst, Inc. available for enrollment in 2026 to people living in NYC, Long Island, and Some Lower Hudson Valley. This plan received an overall rating of 3 out of 5 stars in 2026.
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 $55.00. 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 has a $500.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 combined Maximum Out-Of-Pocket cost of $13900.00 (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 $13900.00 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) prescription drug plan features an annual drug deductible of $615 before coverage begins. For Tier 6 select care drugs, policyholders enjoy no copay for one-, two-, or three-month supplies filled at standard pharmacies or via standard mail order. Tier 1 preferred generics cost only a $1.00 copay for a one-month supply, while Tier 2 generics carry a low $2.00 copay for a one-month supply. For higher-tier medications, costs are based on coinsurance rather than flat copayments. Tier 3 preferred brand drugs require an 18% coinsurance, whereas Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. These clear pricing tiers help you easily estimate your out-of-pocket prescription costs under the Healthfirst Signature (PPO) plan.
Additional Benefits
The Healthfirst Signature (PPO) plan offers robust coverage for essential medical needs, featuring no copay or coinsurance for primary care visits, telehealth, and preventive care. Specialist visits require a $40 copay, while inpatient hospital stays incur a daily copay of $400 to $490 for the first four days and no copay for subsequent days. Emergency care is covered with a $115 copay, which is waived if you are admitted to the hospital within 24 hours. For auxiliary healthcare, the plan includes dental benefits with no copay or coinsurance up to a $1,500 annual limit, alongside fully covered routine vision exams and up to $75 yearly for eyewear. Hearing services are also available, featuring routine exams for a $40 copay and prescription hearing aids with copays ranging from no copay up to $1,475. Additionally, members benefit from home health services with no copay or coinsurance.
Inpatient Hospital See details
Healthfirst Signature (PPO) covers inpatient hospital services with no coinsurance, requiring a $490 daily copay for days 1-4 of acute stays and a $400 daily copay for days 1-4 of psychiatric stays, with no copay for subsequent covered days. This benefit is partially covered as prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Healthfirst Signature (PPO) covers outpatient hospital services with a 0% to 20% coinsurance and a copay, and observation services with a $115 copay per stay and no coinsurance. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance. While some outpatient substance abuse services are covered with no copay and no coinsurance, individual and group sessions are not covered.
Partial Hospitalization See details
Healthfirst Signature (PPO) covers partial hospitalization services with no copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Healthfirst Signature (PPO) covers Medicare-approved ground and air ambulance services with a $340 copayment and no coinsurance, subject to prior authorization. Although transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Healthfirst Signature (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are covered up to a $200,000 maximum benefit with no coinsurance, requiring copays of $115, $40, and $340 respectively.
Primary Care See details
Healthfirst Signature (PPO) provides primary care, telehealth, and opioid treatment with no copay and no coinsurance, while specialist visits cost a $40 copay and therapy services cost $35, with no coinsurance. Chiropractic care is partially covered with a $15 copay and no coinsurance, excluding other chiropractic services, and podiatry is covered for a $40 copay and no coinsurance for up to 12 visits. For mental health and psychiatric specialty services, some services are covered but individual and group sessions are not.
Preventive Services See details
Healthfirst Signature (PPO) preventive services are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and glaucoma screenings. Additional preventive benefits are partially covered with no copay and no coinsurance for services like fitness and counseling, while sub-services such as health education, in-home safety assessments, weight management, and personal emergency response systems are not covered.
Hearing Services See details
Healthfirst Signature (PPO) partially covers hearing services, featuring routine hearing exams and fittings for a $40 copay and no coinsurance. Prescription hearing aids are covered with copays ranging from $0 to $1,475 and no coinsurance, though OTC hearing aids, and inner ear, outer ear, and over the ear prescription aids are not covered.
Vision Services See details
Vision services are covered by Healthfirst Signature (PPO) with no copays, no coinsurance, and no deductibles, including one routine eye exam and one contact lens fitting per year. Eyewear is partially covered with no copay or coinsurance up to a $75 annual limit for contact lenses and one complete pair of eyeglasses, though individual eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
Healthfirst Signature (PPO) partially covers dental services with no copay and no coinsurance up to a combined annual maximum of $1,500. While most preventive and restorative treatments are covered, other diagnostic dental services, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Healthfirst Signature (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Healthfirst Signature (PPO) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Healthfirst Signature (PPO) covers durable medical equipment with no copay and 0% to 20% coinsurance, as well as prosthetics and medical supplies with no copay and 20% coinsurance. For diabetic equipment, some services are covered with no copay and no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Healthfirst Signature (PPO) covers diagnostic and radiological services with prior authorization, featuring a $0 to $50 copay plus coinsurance for diagnostic tests, and a copay with no coinsurance for lab services. Diagnostic radiological services have no copay, while outpatient X-rays require a $50 copay plus coinsurance and therapeutic radiological services require a copay and a minimum 20% coinsurance.
Home Health Services See details
Healthfirst Signature (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Healthfirst Signature (PPO) partially covers cardiac rehabilitation services with no coinsurance and a $15 copayment, though prior authorization is required. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Healthfirst Signature (PPO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Healthfirst Signature (PPO) partially covers other services, offering acupuncture for up to 12 treatments per year, family planning, and meal benefits for chronic illnesses with no copay and no coinsurance. Prior authorization is required for the meal benefit, and over-the-counter (OTC) items are not covered.
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