Healthfirst Medicare Advantage Plans 2026

Enrollment Process for Healthfirst Medicare Advantage Plans

Enrollment for Healthfirst Medicare Advantage Plans can be completed by using this website or by calling our licensed agents using the number on this webpage.  The process involves confirming eligibility and selecting a suitable plan based on individual needs.

Enrolling during designated periods ensures timely benefits.

When to Enroll

Specific times during the year are designated for enrolling in Healthfirst Medicare Advantage Plans. Individuals turning 65 can enroll in Medicare during a seven-month period that includes the three months before, the month of, and the three months after their birthday.

If an individual misses their Initial Enrollment Period, they can enroll during the General Enrollment Period, which runs from January 1 to March 31 each year.

Different enrollment periods

Enrollment periods include the Initial Enrollment Period, Open Enrollment Period, and Special Enrollment Period. The Open Enrollment Period occurs annually from October 15 to December 7, allowing beneficiaries to enroll in or switch their Medicare Advantage Plans.

Special Enrollment Periods are available for individuals who experience certain life events, such as moving or losing other health coverage, allowing them to enroll outside standard periods.

OEP, AEP, Special Enrollment

The Open Enrollment Period (OEP) typically runs from January to March, allowing beneficiaries to make changes to their plans. The Annual Enrollment Period (AEP) allows Medicare beneficiaries to switch or enroll in Medicare Advantage plans and is the primary time for plan changes.

Special Enrollment Periods (SEPs) may occur if beneficiaries experience qualifying events, such as moving, losing existing coverage, or changes in household composition.

Possible Costs Associated with Healthfirst Medicare Advantage Plans

The potential expenses for some Healthfirst Medicare Advantage Plans may vary based on the selected coverage and personal circumstances. Certain plans may offer lower monthly premium, depending on the specific plan and member eligibility.

Premiums and Co-Pays

Members might need to pay for both a Part B premium and an additional premium specific to the Medicare Advantage plan. Some plans may even offer lower monthly premiums and co-pays.

Out-of-Pocket Maximums

Some Healthfirst Medicare Advantage Plans might include a maximum out-of-pocket limit for yearly healthcare expenses. Once the out-of-pocket maximum is reached, these plans cover 100% of the costs for covered medical services.

The out-of-pocket maximums will likely differ between plans, impacting overall costs for members receiving care.

How to Qualify for Healthfirst Medicare Advantage Plans

Individuals must be 65 or older, or under 65 with specific disabilities or kidney failure to qualify for Medicare coverage. Enrollment in Medicare should be initiated three months prior to turning 65 to avoid any delays.

If under 65 with a disability, enrollment in Medicare Part A and B occurs automatically after receiving Social Security benefits for two years. The Initial Enrollment Period for Medicare lasts seven months, including three months before and after the month of turning 65.

Individuals can qualify for the Medicare Savings Programs, which assists with costs, based on updated income limits.

Contracted Network and Access to Care

Healthfirst Medicare Advantage plans will likely offer members access to a broad range of healthcare services, including both in-network and out-of-network providers, although out-of-network services may incur higher costs. Members have access to a care management team, which helps coordinate medical services and develop personalized care plans. Emergency care is covered regardless of whether the provider is in-network or out-of-network.

With a large network of healthcare professionals, members have various options for their medical care. This extensive network and access to care could potentially ensure that members receive the necessary medical attention, possibly enhancing their overall healthcare experience.

Comparing Healthfirst Medicare Advantage Plans to Original Medicare

Certain Healthfirst Medicare Advantage plans might include additional benefits such as dental and vision care, which Original Medicare does not cover. Some Healthfirst Medicare Advantage plans may offer these additional benefits, potentially enhancing the coverage provided by Original Medicare.

Coverage Differences

While Original Medicare covers hospital and medical services, Medicare Advantage plans might vary in the network of providers available.

Some Medicare Advantage plans may also cover additional services that Original Medicare excludes, such as dental, vision, and hearing coverage. Original Medicare does not provide an out-of-pocket maximum, while some Medicare Advantage plans might include annual limits on out-of-pocket costs.

Cost Comparisons

Some Healthfirst Medicare Advantage plans may feature lower out-of-pocket costs and monthly premiums compared to Original Medicare. However, members still need to pay the Part B premium for Original Medicare.

Members of Healthfirst Medicare plans could potentially have lower out-of-pocket costs for services compared to those relying solely on Original Medicare.  Copays for certain services under some Healthfirst plans may be lower than the costs associated with Original Medicare’s deductibles and coinsurance.

Emergencies and Referrals

Healthfirst Medicare members may continue to receive benefits during emergencies, including coverage at non-contracted facilities. In emergencies, referral requirements and prior authorizations may be waived for Healthfirst Medicare members, ensuring that immediate care is accessible.

Healthfirst allows out-of-network services at in-network cost-sharing during public health emergencies. Changes that benefit Healthfirst members in emergencies can be implemented immediately, bypassing the usual 30-day notification period. If a member receives a surprise bill for emergency services, they are protected from balance billing and can dispute charges.

Summary

Healthfirst Medicare Advantage Plans for 2026 will likely offer comprehensive coverage, potential benefits, and financial savings compared to Original Medicare. With various plan options, extensive networks, and flexible enrollment periods, these plans will likely cater to diverse healthcare needs. Whether you need routine care, specialized services, or emergency assistance, Healthfirst Medicare Advantage Plans could provide robust support to enhance your health and wellbeing. Consider exploring these plans during the enrollment periods to ensure you receive the best possible care.

Frequently Asked Questions

→ Are there any 5-star Medicare Advantage plans?

Yes, based on data from recent years, there have been several Medicare Advantage plans that have received a 5-star rating from CMS, with standard plans available in several states. These plans represent the highest quality of care and service.

→ What are the main types of Healthfirst Medicare Advantage Plans available?

Healthfirst Medicare Advantage Plans primarily include HMO, PPO, and Special Needs Plans (SNPs), designed to meet diverse healthcare requirements. Choose the plan that best fits your health needs and preferences.

→ When can I enroll in Healthfirst Medicare Advantage Plans 2026?

You can enroll in Healthfirst Medicare Advantage Plans during your Initial Enrollment Period around your 65th birthday, the Annual Enrollment Period from October 15 to December 7, or during Special Enrollment Periods if you meet specific qualifications.

→ What additional benefits could Healthfirst Medicare Advantage Plans offer compared to Original Medicare?

Some Healthfirst Medicare Advantage Plans may offer additional benefits such as dental, vision, and hearing coverage, and sometimes along with prescription drug plans, potentially enhancing your healthcare experience.

→ How might the costs of Healthfirst Medicare Advantage Plans compare to Original Medicare?

Certain Healthfirst Medicare Advantage Plans might offer lower out-of-pocket costs, low monthly premiums, and sometimes additional benefits not provided by Original Medicare, possibly making them a cost-effective option for many beneficiaries.