Healthfirst is a Medicaid health plan, not Medicaid itself
Healthfirst is a private insurance company that contracts with New York State to deliver Medicaid coverage. When you enroll in Healthfirst, you are choosing one of several managed care plans available to Medicaid members in New York. Medicaid is the government program; Healthfirst is the organization that manages your care and pays your doctors under that program.
You do not pay Healthfirst a premium — Medicaid pays them on your behalf. Your out-of-pocket costs depend on your income and the specific services you use, but most primary care visits and preventive services are free to Medicaid members regardless of which plan they choose.
Healthfirst operates in New York City, Westchester County, and parts of Long Island. If you live outside these areas, Healthfirst may not be available to you, and you would choose from other Medicaid plans in your region or stay in the fee-for-service program where the state pays providers directly.
Key Takeaways
- Healthfirst is a managed care plan that delivers Medicaid benefits in New York; it is not a separate program you apply for.
- You choose Healthfirst during your Medicaid enrollment or during the annual open enrollment period in November and December.
- Healthfirst covers the same services as all New York Medicaid plans: doctor visits, hospital care, prescription drugs, mental health services, and dental care.
- You pay nothing for most primary care and preventive services; copays for other services depend on your income level.
- Healthfirst has its own network of doctors and hospitals, so you should check whether your current providers are in-network before enrolling.
How to enroll in Healthfirst Medicaid
If you are already enrolled in New York Medicaid, you may be in Healthfirst already — the state assigns you to a plan if you do not choose one yourself. To find out which plan you are in, call the number on your Medicaid card or log into your account on the New York State Department of Health website.
If you want to switch to Healthfirst or choose it for the first time, you can do so during the annual open enrollment period, which runs from November 15 through December 31 each year. You can also switch plans if you have a may have access to life event, such as moving to a new address, losing other insurance, or having a baby. Outside of these windows, you are locked into your current plan for the year.
To enroll, contact the New York State Department of Health at 1-800-541-2831, use the online portal at mybenefits.ny.gov, or visit your local Medicaid office in person. You will need to tell them you want Healthfirst and confirm your address and income information.
What Healthfirst covers under Medicaid
Healthfirst covers all the services that New York Medicaid covers: doctor visits, emergency room care, hospital stays, prescription drugs, mental health and substance use treatment, dental care, vision care, and medical equipment. The specific copays and coverage rules are set by New York State, not by Healthfirst, so you pay the same amount whether you are in Healthfirst or another Medicaid plan.
Some services require prior authorization, meaning Healthfirst must approve them before you receive them. This applies to certain surgeries, imaging tests, and specialist referrals. Your doctor's office usually handles this step, but you can call Healthfirst directly if you want to check the status of a request.
Healthfirst also offers supplemental benefits beyond the standard Medicaid package, such as fitness programs, over-the-counter medication allowances, and transportation to medical appointments. These vary by plan and income level, so ask Healthfirst what is included in your specific plan.
Healthfirst's provider network and finding doctors
Healthfirst maintains its own network of doctors, hospitals, and specialists. You must use in-network providers to avoid higher out-of-pocket costs, with rare exceptions for emergency care. If your current doctor is not in the Healthfirst network, you will need to find a new primary care doctor or pay out-of-network rates.
Before you enroll in Healthfirst, search their provider directory on the Healthfirst website or call 1-888-343-3547 to confirm that your doctors are in-network. If your main doctor is not, you can either choose a different plan or ask your doctor's office whether they plan to join Healthfirst's network in the near future.
Once you are enrolled, you must choose or be assigned a primary care doctor. This doctor coordinates your care and provides referrals to specialists. If you do not choose one, Healthfirst will assign you one automatically, usually within 30 days of your enrollment date.
Copays and out-of-pocket costs with Healthfirst Medicaid
Most preventive services — annual checkups, cancer screenings, vaccinations, contraception — are free with no copay. Primary care visits to your doctor typically cost $0 to $3 depending on your income. Specialist visits, urgent care, and emergency room visits may have copays ranging from $0 to $15, again based on your income level.
Prescription drug copays are usually $0 to $3 for generic drugs and $0 to $5 for brand-name drugs, but some high-cost medications may have higher copays or require prior authorization. Hospital stays have no copay. Dental and vision services are covered, though some routine services may have small copays or annual limits.
If your income is very low, you may pay $0 for most services. As your income rises within the Medicaid range, your copays increase slightly. Healthfirst will send you a summary of your copays when you enroll, or you can call them to ask about costs for a specific service.
Switching away from Healthfirst or changing your plan
You can switch to a different Medicaid plan during the annual open enrollment period in November and December, or if you have a may have access to life event such as moving, losing insurance, or a change in household size. You cannot switch plans in the middle of the year without a may have access to reason.
If you want to leave Healthfirst, contact the New York State Department of Health at 1-800-541-2831 or use mybenefits.ny.gov. You will need to choose a new plan or request the fee-for-service program, where the state pays providers directly instead of using a managed care plan. Your new coverage will start on the first day of the following month.
If you move out of the Healthfirst service area (New York City, Westchester, or parts of Long Island), you will be automatically switched to a plan that serves your new location. The state will notify you of the change and your new plan's details.
Frequently Asked Questions
Do I have to choose Healthfirst, or can I stay in fee-for-service Medicaid?
You can choose fee-for-service Medicaid, where the state pays providers directly and you can see any Medicaid-accepting doctor. However, most people in New York are assigned to a managed care plan like Healthfirst if they do not actively choose one. You can request fee-for-service during open enrollment or if you have a may have access to life event.
What happens to my Healthfirst coverage if I move?
If you move within the Healthfirst service area, your coverage continues. If you move outside the service area, you will be switched to a Medicaid plan that serves your new location. The state will send you a notice with your new plan's information. Your coverage does not lapse during the switch.
Can my Healthfirst doctor refuse to see me because I have Medicaid?
No. Doctors in Healthfirst's network have agreed to accept Medicaid patients. If a doctor refuses to see you or treats you differently because of your insurance, you can file a complaint with Healthfirst or the New York State Department of Health.
Does Healthfirst cover telehealth visits?
Yes. Healthfirst covers telehealth visits with in-network doctors, usually with the same copay as an in-person visit. Many doctors now offer virtual appointments, especially for routine follow-ups. Ask your doctor's office whether they offer telehealth when you schedule.
What if I disagree with Healthfirst's decision to deny coverage for something?
You have the right to appeal. Healthfirst must tell you in writing why they denied coverage and how to file an appeal. You can also file a complaint with the New York State Department of Health if you believe Healthfirst made an unfair decision. Appeals usually take 30 to 60 days.