Are you ready for the latest updates on the 2024 Medicare Plan? Healthfirst is expanding its service areas, bringing more options and improved benefits to its members. Here’s a summary of the key changes and highlights:
Service Areas Expansion:
- Suffolk: Expanded with IBP and Signature PPO.
- Westchester and Rockland: Signature PPO is expanding to these areas.
Highlights & Updates for $0 PPO:
- Reduced MOOP: $5000 IN / $8000 combined (from $7000/$11,000)
- NO DEDUCTIBLE for OON medical (previously $1000)
- Prescription drug coverage with low-cost-90-day fills for maintenance drugs and supplemental coverage for select vitamins and ED drugs
- LOWER per day inpatient copay: $350 each day for days 1-6 (changed from $502 each day for days 1-3 in 2023)
- LOWER cost sharing on outpatient services: $25 IN / $60 OON copay for diagnostic tests and x-rays; and 30% OON coinsurance (from 50%) for hospital services and ASC, and $100 copay for diagnostic radiology services (from $125)
- LOWER specialist copay: $40
Highlights & Updates for $0 HMO:
- PCP and specialist visits, with broad provider choice
- INCREASE: Eyewear benefit increased to $300 every two years
- LOWER specialist copay: $35
Highlights & Updates for $0 HMO (For Those Who Qualify for “Extra Help”):
- LOWER specialist copay $20
- $100 per quarter OTC plus card for wellness and social determinants of health:
- OTC
- Healthy Foods
- Home Utilities
- Fitness equipment & activity trackers
- Personal Emergency Response System
Highlights & Updates for $0 Special Needs Plan (For Dual Eligible):
- $0 prescription drug coverage
- $0 diabetic test strips and lancets
- INCREASE: $525 per quarter OTC Plus card for wellness and social determinants of health
Highlights & Updates for $0 Special Needs Plan (For Dual Eligible with LTSS Needs):
- Coverage for Long-Term Services and Support
- PCA/CDPAS
- Adult Day Health Care
- Private Duty Nursing
- INCREASE: Eyewear allowance to $550 per year
- INCREASE: Routine Podiatry Visits to 20 per year
- INCREASE: Supplemental Acupuncture to 40 visits/year
State Program Plan Updates:
- CHPlus – pending NYS approval: Child Health Plus effective 1/1/2024
- MCD – pending NYS approval: MCD changes for 2023
- PWP: No changes in PWP in 2024
- New Essential Plan 200-250: Plan available beginning 1/01/24, with enrollment beginning on 11/16/23
- Existing Essential Plans 1, 2, 3, and 4 will continue to be offered
- A new Essential Plan is being offered in 2024 with a $15 monthly plan premium, essential health benefits, and vision & dental $0 copay
- Eligibility criteria: Qualified individuals & eligible immigrants, income between $29,160 – $36,450, age 19-64 who do not qualify for Medicaid
Commercial Plan Updates:
- Pro EPO/Pro Plus EPO (small group plans) and Total EPO Leaf/Leaf Premier will be phased out in 2024.
- Plan termination will occur monthly, corresponding with the renewal date.
- Plan ending on 12/31/2023.
- Changes to some deductibles, MOOPs, and cost-sharing in certain metal levels.
Stay tuned for more details and updates as the new plan year approaches.
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