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Plans & Benefits - Practice Guidelines and Tips - 2026
Healthfirst at a Glance - Increased Benefits Plan (HMO)

A Medicare Advantage plan for eligible Medicare beneficiaries who qualify for Extra Help, also known as Low-Income Subsidy (LIS), which helps people with Medicare pay lower prescription drug costs.

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Healthfirst Plans
  
Plans & Benefits - Practice Guidelines and Tips - 2026
Healthfirst at a Glance - Leaf and Leaf Premier

Our Leaf and Leaf Premier plans offer two levels of coverage for individuals and families. They are Qualified Health Plans certified by the NYSOH marketplace.

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Healthfirst Plans
  
Plans & Benefits - Practice Guidelines and Tips - 2026
Healthfirst at a Glance - Life Improvement Plan (HMO D-SNP)

A Medicare Advantage special needs plan for individuals who are eligible for Medicare and Medicaid. Most Life Improvement Plan members have fee-for-service (FFS) Medicaid benefits administered by the New York State Department of Health.

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Plans & Benefits - Practice Guidelines and Tips - 2026
Healthfirst at a Glance - Medicaid Managed Care

A New York State-sponsored Medicaid plan for low-income individuals, families, and children.

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Healthfirst Plans
  
Plans & Benefits - Practice Guidelines and Tips - 2026
Healthfirst at a Glance - Personal Wellness Plan (PWP)

For Medicaid beneficiaries with serious mental health illness and/or substance use disorders.

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Healthfirst Plans
  
Plans & Benefits - Practice Guidelines and Tips - 2026
Healthfirst at a Glance - Signature (HMO)

A Medicare Advantage plan for those looking for hospital, medical, and prescription drug coverage all in one plan with a flexible benefit card to help pay for member cost shares.

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Healthfirst Plans
  
Plans & Benefits - Practice Guidelines and Tips - 2026
Healthfirst at a Glance - Signature (PPO)

A Medicare Advantage plan with the option to see out-of-network providers without a referral and/or prior authorization.

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Healthfirst Plans
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-126 Diabetes Cost-sharing Waiver

This policy outlines Healthfirst’s reimbursement guidelines regarding the waiver of cost-sharing for Essential Plan (EP) and Qualified Health Plan (QHP) members diagnosed with Type 1, Type 2, or Gestational Diabetes.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-123 Intensity-Modulated Radiation Therapy

This policy outlines the reimbursement guidelines for Intensity Modulated Radiation Therapy (IMRT) services provided by healthcare providers.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-122 Pasteurized Human Donor Milk Coverage

Healthfirst provides coverage for Pasteurized Human Donor Milk (PDHM) under certain programs/lines of business.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-121 Reduction Mammaplasty

This policy outlines the reimbursement criteria for Reduction Mammaplasty procedures under Healthfirst coverage.

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Reimbursement Policy
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-120 Urodynamic Studies

This policy outlines the reimbursement guidelines for healthcare providers regarding the measurement of post-voiding residual urine by ultrasound when performed in conjunction with urodynamic studies.

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Reimbursement Policy
  
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