Healthfirst is both — it runs Medicaid plans and Medicare plans, but they are separate programs with different rules

Healthfirst is an insurance company that administers health coverage under both Medicaid and Medicare. The program you are in depends on your age, income, and disability status — not on Healthfirst itself. If you are under 65 and your income is low enough, you likely have a Healthfirst Medicaid plan. If you are 65 or older, you likely have a Healthfirst Medicare plan. Some people have both at the same time, which is called dual coverage.

The key difference: Medicaid is a joint federal and state program for people with low income. Medicare is a federal program for people 65 and older, or some younger people with disabilities. Healthfirst simply sells insurance under both programs. Your rights, your costs, and what the plan covers depend on which program you are actually in — not on the fact that Healthfirst runs it.

Key Takeaways

  • Healthfirst administers both Medicaid and Medicare plans, but they are separate programs with different may be able to access rules and coverage.
  • You are in a Medicaid plan if you are under 65 with low income; you are in a Medicare plan if you are 65 or older or have certain disabilities.
  • Your Healthfirst member card or enrollment letter will state which program you are in — look for the words "Medicaid" or "Medicare" on the document.
  • Medicaid coverage and costs vary by state, while Medicare coverage is the same nationwide regardless of which company runs your plan.
  • If you have both Medicaid and Medicare, Healthfirst may run a special dual-may be able to access plan with its own rules for copays and coverage.

How to tell which Healthfirst program you are in

Your Healthfirst member ID card or your enrollment letter will say "Medicaid" or "Medicare" on it. Read the front and back of your card carefully — the program name is usually printed clearly. If you cannot find it on the card, call the customer service number on the back and ask: "Am I in a Medicaid plan or a Medicare plan?" They will tell you in one sentence.

You can also log into your Healthfirst online account at healthfirst.org. Once you are logged in, your dashboard will show which program you are enrolled in. If you do not have an online account, you can create one using your member ID number and date of birth.

What Medicaid through Healthfirst covers

Healthfirst Medicaid plans cover doctor visits, hospital stays, prescription drugs, and preventive care at no cost or low cost. The exact copay amounts and which drugs are covered depend on your state — Medicaid rules are set by each state, not by Healthfirst. For example, a Healthfirst Medicaid plan in New York may have different copays than a Healthfirst Medicaid plan in Florida.

Most Healthfirst Medicaid plans also cover dental, vision, and mental health services, but coverage varies by state. To find out what your specific plan covers, check your plan documents or call Healthfirst customer service. You can also contact your state Medicaid office directly — they oversee Healthfirst's Medicaid plans and can answer questions about your coverage.

What Medicare through Healthfirst covers

Healthfirst Medicare plans come in two main types: Medicare Advantage (Part C) and Medigap (supplemental insurance). Medicare Advantage is an all-in-one plan that covers hospital, doctor, and prescription drug benefits. Medigap is supplemental insurance that fills gaps in Original Medicare. Both are run by Healthfirst, but they work differently and have different costs.

Medicare coverage is the same nationwide — Healthfirst cannot change what Medicare covers. However, Healthfirst can set its own copays, deductibles, and which doctors and hospitals are in the network. If you are in a Healthfirst Medicare plan, your coverage is the same as someone in a Medicare plan run by another company, but your out-of-pocket costs may be different.

Costs and copays: Medicaid versus Medicare through Healthfirst

Healthfirst Medicaid plans usually have low or no copays for doctor visits and hospital care. Many Medicaid plans charge nothing for preventive services. Prescription drug copays vary by state and by plan — some are free, others are a few dollars per prescription. You will not pay a monthly premium for Medicaid coverage.

Healthfirst Medicare plans have different costs depending on the type. Medicare Advantage plans usually have a monthly premium, copays for doctor visits, and copays for prescriptions. Medigap plans have a monthly premium but often lower copays than Medicare Advantage. Original Medicare (not run by Healthfirst) has its own costs that are set by the federal government.

What to do if you are not sure which program you are in

Call Healthfirst customer service at the number on your member card. Have your member ID ready. Tell them you want to confirm which program you are in — Medicaid or Medicare. They will tell you immediately and can also explain your coverage, copays, and how to find a doctor in your network.

If you believe you should be in a different program — for example, if you think you no longer may have access to for Medicaid — contact your state Medicaid office or your local Social Security office. They handle enrollment and may be able to access, not Healthfirst. Healthfirst only runs the plan once you are enrolled.

Dual coverage: having both Medicaid and Medicare at the same time

Some people may have access to for both Medicaid and Medicare. This usually happens if you are 65 or older with low income, or if you are younger and disabled with low income. When you have both, you are called "dual may be able to access." Healthfirst may run a special dual-may be able to access plan that coordinates benefits between the two programs.

If you are dual may be able to access, Medicare is your primary insurance and Medicaid is secondary. This means Medicare pays first, and Medicaid covers costs that Medicare does not pay. Your copays and coverage will follow both programs' rules. Healthfirst will explain how this works when you enroll, but you can also ask your state Medicaid office or call 1-800-MEDICARE for clarification.

Frequently Asked Questions

Can I switch from a Healthfirst Medicaid plan to a Healthfirst Medicare plan?

No, you cannot switch programs just because you want to. You move from Medicaid to Medicare when you turn 65 or when you have been on Social Security Disability for 24 months. Your state Medicaid office will tell you when you are no longer may be able to access for Medicaid. You will then enroll in Medicare through Social Security.

Does Healthfirst charge different copays for Medicaid and Medicare?

Yes. Medicaid copays are set by your state and are usually very low or free. Medicare copays are set by Healthfirst within federal limits and are typically higher. Even if you have both programs, the copay rules for each program apply separately.

What if my Healthfirst plan changes and I do not like the new coverage?

If you are in Medicaid, you can switch to a different Medicaid plan during open enrollment, which usually happens once a year. If you are in Medicare, you can switch plans during the Annual Enrollment Period from October 15 to December 7. Contact your state Medicaid office or call 1-800-MEDICARE to learn when you can change plans.

Is Healthfirst the same as my state's Medicaid program?

No. Healthfirst is a private insurance company. Your state's Medicaid program is run by your state government. Your state contracts with Healthfirst to run Medicaid plans on its behalf. If you have a problem with your coverage, you can complain to your state Medicaid office, which oversees Healthfirst.