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Medicaid Managed Care provides important health benefits for a $0 monthly premium and low or $0 copays. This NY State Medicaid plan is for qualified low-income families and individuals.

Plan Highlights:

Quick Links Eligible Age Eligible Service Areas

Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, and Westchester, Orange, Rockland, and Sullivan counties

Other Eligibility Requirements Meet the Medicaid Managed Care income requirements. Not sure if you’re eligible?
Find out now Deductible (individual) Maximum Out-of-Pocket (individual) $0
For maximum out-of-pocket pharmacy copay information, visit NYRx, the Medicaid Pharmacy Program Your Annual Checkup Primary Care Provider (PCP) Visit Dental Cleanings Pediatric – $0 copay
Adult - $0 copay Vision Exams Pediatric – $0 copay
Adult - $0 copay Telemedicine (Teladoc) Specialist Visit Retail Health Clinic Urgent Care Emergency Room Outpatient Facility Inpatient Hospital Stay

Additional Benefits

24/7 Access to Telemedicine with Teladoc

Talk to a doctor any time—for a $0 copay. Connect with board-certified doctors through video chat or phone for prescriptions, help diagnosing and treating non-emergency conditions, and more. Access to dermatologists is also available.

See Better with Healthfirst Vision Benefits

Taking care of your eyes doesn’t just mean having clear vision. An annual eye exam can help detect a number of health risks, such as diabetes, thyroid disease, high blood pressure, and other conditions. Healthfirst has made it easy for our members to take advantage of this often overlooked preventive service by providing access to comprehensive vision care.

Dental Care That Keeps You Smiling

Healthfirst believes that providing you with good dental care is important to your overall healthcare. Covered services include regular and routine dental services such as preventive dental checkups, cleanings, X-rays, fillings, and other services to check for any changes or abnormalities that may require treatment and/or follow-up care for you. You do not need a referral from your PCP to see a dentist.

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In Lieu of Services (ILS)

ILS are services or settings that are not covered by Medicaid but are medically appropriate substitutes for covered services or settings.

Covered ILS Benefit: Psychiatric Admissions
You have covered care options than can be used instead of Inpatient Psychiatric services available in some hospitals.

The alternative care option is a short-term intensive stay in a private Institution for Mental Disease (IMD) licensed by OMH, available only at the following four facilities in the Healthfirst service area:

Plan Documents

2024 Medicaid Managed Care

General Plan Information
The Healthfirst Medicaid Managed Care Plan is rated a 5-Star-Rated Plan in 2024

Ratings are based on a five-star scale from indicators chosen by the New York State Department of Health and are published in its 2014 through 2023 publications of A Consumer’s Guide to Medicaid Managed Care in NYC and on Long Island.

Prescription Drug Information

Helpful Resources

The benefit information provided is a brief summary, not a complete description, of benefits. For more information, contact the plan.

Coverage is provided by Healthfirst PHSP, Inc.
Plans contain exclusions and limitations.
Healthfirst complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-305-0408 (TTY 1-888-867-4132). 注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 1-866-305-0408 (TTY 1-888-542-3821)。

**Telemedicine (Teladoc) isn't a replacement for your primary care provider (PCP). Your PCP should always be your first choice for care (both in-person and virtual visits).

DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.

EyeMed® is contracted with Healthfirst to provide vision benefits to its members.

*Modivcare and Medical Answering Services provide the covered transportation services under your plan.