Haris Ashley
Healthfirst offers New Yorkers a range of Medicaid Managed Care plans, including Child Health Plus, the Essential Plan, and Marketplace Leaf and Leaf Premier plans. These plans are designed to help individuals and families with limited incomes and resources manage their health coverage and costs. Healthfirst Medicaid plans offer benefits such as $0 copays for doctor visits, lab tests, prescription drugs, hospitalization, dental and vision care, and more. The specific coverage and benefits may vary depending on the state and the individual's eligibility, but Healthfirst representatives are available to help members understand and choose the right plan for their needs.
| Characteristics | Values |
|---|---|
| Cost | $0 monthly plan premium with low or no copays |
| Who is it for? | Low-income families and individuals |
| What does it cover? | Doctor visits, lab tests, prescription drugs, hospitalization, dental, vision, and more |
| Additional benefits | Access to board-certified doctors, dermatologists, and psychiatrists |
| COVID-19 related coverage | Vaccines for members under 19 and at-home COVID-19 tests |
| Other plans | Essential Plans, Child Health Plus, Marketplace Plans, and Medicare Advantage Plans |
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What You'll Learn
COVID-19 and flu vaccines for members under 19
Healthfirst's Medicaid Managed Care Plan is sponsored by New York State and provides low-income individuals and families with health, dental, and vision coverage for a $0 or low copay.
Healthfirst Medicaid Managed Care members under the age of 19 are covered for both COVID-19 and flu vaccines. To get your child vaccinated, you can reach out to their doctor, a public health clinic, or your county's health department. Your child can also get vaccinated at a pharmacy enrolled in both NYRx (the NYS Medicaid Pharmacy program) and in the Vaccines for Children program. It is always recommended to call first to ensure that the vaccines are available for your child.
Health First Colorado (Colorado's Medicaid Program) also covers COVID-19 and flu vaccines for members under 19. The Colorado Immunization Information System offers text message and email reminders to Coloradans aged 50 and older who are due for a fourth dose of the COVID-19 vaccine. Health First Colorado-enrolled providers will be reimbursed for administering vaccines distributed by the federal government at no cost.
Healthfirst's Medicaid Managed Care Plan also provides access to comprehensive vision and dental care. This includes annual eye exams, which can help detect health risks such as diabetes, thyroid disease, and high blood pressure. Dental coverage includes preventive dental checkups, cleanings, X-rays, fillings, and other services to check for any changes or abnormalities requiring treatment or follow-up care.
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$0 copay for board-certified doctors
Healthfirst offers a range of Medicaid plans with comprehensive coverage, providing access to a wide network of healthcare services with $0 copay for board-certified doctors. This means that members can receive primary and specialist care without facing any out-of-pocket expenses for their doctor visits.
The $0 copay benefit is applicable to a vast network of board-certified doctors, ensuring that members have a diverse selection of healthcare providers to choose from. This includes primary care physicians (PCPs) who serve as the first point of contact for routine check-ups, preventive care, and referrals to specialists. By selecting a Healthfirst Medicaid plan with this $0 copay feature, members can rest assured that they can access quality healthcare without incurring any additional costs for doctor visits.
This benefit is particularly advantageous for individuals who require frequent medical attention or ongoing care for chronic conditions. With $0 copay, members are encouraged to seek timely medical assistance without financial barriers, leading to improved health outcomes. Additionally, this feature simplifies the billing process, as members do not have to worry about unexpected charges or surprise fees associated with their doctor visits.
Healthfirst's $0 copay for board-certified doctors is a valuable component of their Medicaid plans, promoting accessibility and affordability in healthcare. Members can focus on their well-being, knowing that they have a network of qualified healthcare professionals available to them at no extra cost. This feature ensures that cost is not a deterrent to seeking necessary medical care, contributing to better overall health for those enrolled in Healthfirst Medicaid plans.
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Vision care
Healthfirst offers vision care benefits to its members through EyeMed®. EyeMed is a vision benefits company that provides eye care services and products.
For adults, Medicaid covers medically necessary eye care. This includes operations to repair eye injuries and treatments for eye diseases. However, for adults aged 21 and over, coverage for routine eye care varies by state. Medicare, on the other hand, typically does not cover routine eye exams or eyeglasses, except in specific cases such as glaucoma tests, eye screenings for diabetic retinopathy, or post-eye surgery.
Medicaid and the Children's Health Insurance Program (CHIP) cover children's eye care, including eyeglasses. Vision coverage for children is mandated by the Affordable Care Act. Healthfirst's Essential Plan, available to qualified individuals aged 19 to 64 in New York, also includes vision coverage with a $0 copay.
Healthfirst offers various Medicare Advantage plans with vision benefits, such as Health First Classic (HMO-POS), Health First Value (HMO), Health First Rewards (HMO), Health First Secure (HMO), and Health First Emerald Plus (HMO). These plans provide annual allowances for eyewear, including contact lenses, and $0 copay for routine eye exams.
It is always advisable to contact your health insurance provider directly to understand the specifics of your vision coverage and any applicable restrictions.
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Dental care
Health First Colorado members of all ages can benefit from dental services. Health First Colorado (Colorado's Medicaid program) has partnered with DentaQuest to help members find a dentist and manage their dental benefits. Members receive identification cards and a welcome packet with information about their dental benefit coverage, how to use their benefits, and where to get more information.
Healthfirst Medicaid Managed Care members under the age of 19 are covered for COVID-19 and flu vaccines. Dental plans may not cover every dental service that is suggested by your dentist. For example, some plans may not cover implants, and services for strictly cosmetic reasons, such as teeth whitening, are rarely covered by dental insurance. However, discounts for these services may be available through dental discount plans or network discounts.
Health First plans vary, with some offering a yearly allowance for supplemental preventive dental benefits and other comprehensive dental services. For example, SunSaver members will have an extra $500 to use at any dental provider, while Rewards and Secure members will have an extra $250.
Health First has made it easy for members to take advantage of preventive dental services by providing access to comprehensive vision care. Covered services include preventive dental checkups, cleanings, X-rays, fillings, and other services to check for any changes or abnormalities.
Class III services (major restorative care), such as crowns, bridges, and dentures, are often covered at 50%. Class IV services (orthodontia), such as braces, usually have a separate lifetime maximum that applies to the entire course of treatment and is not part of the annual dollar maximum that applies to all other dental services.
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Psychiatric admissions
Medicaid Managed Care is specifically designed for members who may benefit from extra behavioral health or substance abuse services. This plan is offered to qualified low-income families and individuals with a $0 monthly plan premium and low or no copays for various services. Healthfirst also complies with the Affordable Care Act (ACA), which mandates that mental and behavioral health treatment be covered as essential health benefits. This includes inpatient mental health care, making psychiatric admissions a covered service.
While specific coverage details may vary depending on the state and the individual's eligibility, Healthfirst's Medicaid insurance typically covers a diverse range of therapies related to psychiatric admissions. Common therapies like cognitive-behavioral therapy (CBT) and psychotherapy are often included. However, certain limitations and exclusions may apply, such as a predetermined number of sessions or requirements for referrals.
For psychiatric admissions, Healthfirst offers an alternative care option to inpatient psychiatric services. This option includes a short-term intensive stay in a private Institution for Mental Disease (IMD) licensed by OMH. This alternative care option is available at specific facilities within the Healthfirst service area.
To find providers that accept Healthfirst Medicaid for psychiatric admissions, individuals can refer to the state Office of Mental Health's search. All providers operating an OMH program accept Medicaid and have psychiatrists available. Additionally, online resources like Psychology Today and Monarch Directory by SimplePractice can assist in finding therapists and counselors who accept Healthfirst insurance.
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Frequently asked questions
Medicaid is a joint federal and state program that helps with medical costs for people with limited income and resources.
Medicaid programs vary from state to state, but most healthcare costs are covered. This includes doctor visits, lab tests, prescription drugs, hospitalization, dental, and vision care.
You will receive a reminder when it's time to renew your Healthfirst plan. You'll also get a notice from NY State of Health (NYSOH), the Human Resources Administration (HRA), or your Local Department of Social Services (LDSS) before your anniversary date. Make sure to read these notices to understand how to renew your plan.
Yes, Healthfirst Medicaid Managed Care members under age 19 are covered for COVID-19 and flu vaccines.
