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Plan H3359-001-0: Healthfirst 65 Plus Plan (HMO) – 2025 Coverage Details

This page provides coverage, cost, and availability details for Healthfirst Medicare Plan’s H3359-001-0 Medicare Advantage plan for 2025.

CMS 2025 Rating: ☆☆☆☆☆*

*CMS rated this Healthfirst Medicare Plan plan (H3359-001-0) 4.5 (Good+) out of 5 stars.

Best Insurance Company Ranking
* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. The Healthfirst Medicare Plan logo is a registered trademark.[2] Its use by MedicareWire is strictly for editorial purposes. This is not a solicitation of insurance.

Healthfirst 65 Plus Plan Basic Plan Details

Plan ID
H3359-001-0
Plan Type
HMO
Plan Year
2025
Premium
$0.00/mo
Plus your Medicare Part B premium.
Health Plan Deductible
$0.00
Out-of-Pocket Maximum
9,350.00 /yr (in-network)
Part B Reduction
$0.00/mo
Drug Plan Benefit
Enhanced, $590.00 deductible
Supplemental Benefits
Vision, Hearing
Availability
See List
Insured By
Healthfirst Medicare Plan
Summary of Benefits

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Health Plan Out-of-Pocket Costs

This Healthfirst Medicare Plan Part C plan has cost-sharing. These are costs you pay out-of-pocket when you use approved health services. The following table summarizes the most common in-network out-of-pocket costs in plan H3359-001-0.

NOTE: Certain preventive services are covered 100% by the plan as a Part B benefit.

Doctor's Office Visits

Primary
Not Covered
Specialist
$25 Copay
Prior Authorization Required

Emergency, Urgent, and Inpatient Hospital Coverage

Emergency room care
$110 Copay
Urgent care
$45 Copay
Ground ambulance
$275 Copay
Inpatient hospital care
$460.00 per day for days 1 through 5
$0.00 per day for days 6 and beyond
Skilled Nursing Facility
$0.00 per day for days 1 through 20
$214.00 per day for days 21 and beyond

Foot Care

Foot Exams and Treatments (Medicare-covered)
$25 Copay
Prior Authorization Required
Routine Foot Care
$25 Copay
Prior Authorization Required

Chiropractic Care

Medicare-covered chiropractic
$15 Copay
Prior Authorization Required
Routine chiropractic
Not Covered

Mental Health Services

Outpatient individual therapy
Not Covered
Outpatient group therapy
Not Covered
Inpatient psychiatric hospital care
$390.00 per day for days 1 through 5
$0.00 per day for days 6 and beyond

Rehabilitation Services

Physical therapy and speech and language therapy
$15 Copay
Prior Authorization Required
Occupational therapy
$15 Copay
Prior Authorization Required

Medical Equipment and Supplies

Diabetes supplies
Not Covered
Durable medical equipment
20% Coinsurance
Prior Authorization Required
Prosthetics
20% Coinsurance

Diagnostics, Lab Services, and Imaging

Diagnostic radiology services
$60 Copay
Prior Authorization Required
Lab services
Not Covered
Outpatient x-rays
Not Covered
Diagnostic tests and procedures
Not Covered

Medicare Part B Drugs

Chemotherapy
20% Coinsurance
Other Part B drugs (Medicare-covered)
20% Coinsurance

Dental Services

Medicare Covered Preventive Dental
Not Covered
Oral exam
$0
Dental x-rays
$0
Cleaning
$0
Periodontics
Not Covered
Endodontics
Not Covered
Restorative Services
Not Covered
Maximum dental benefit
$2,000.00 (Every year)

Hearing Aids and Services

Fitting/evaluation
Covered
Limits may apply
Hearing aids
Not Covered
Hearing exam
Covered
Limits may apply

Vision Services

Medicare-covered eye exam
Routine eye exam
Covered
Limits may apply
Eyewear benefits
None

Get a copy of the Healthfirst 65 Plus Plan Summary of Benefits.

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Do you have questions about costs in this plan? Call 1-855-728-0510 (TTY 711) to speak with a licensed insurance agent and learn more about this plan and other plans on this site (Mon-Fri 5am-6pm, Sat 6am-5pm PT).

Prescription Drug Costs & Benefits

Healthfirst 65 Plus Plan includes enhanced benefit Medicare Part D. Enhanced benefits offer greater coverage than basic, typically providing lower cost-sharing, broader drug coverage, and additional benefits, such as covering drugs not included in the standard formulary. These plans usually have higher premiums due to the extra coverage and flexibility they provide, but they cover a larger percentage of overall drug costs.

As of 2023, approximately 75% of people on Medicare are enrolled in enhanced plans.

Prescription Drug Premium with Extra Help

Extra Help is a Social Security program that helps people with limited income and resources lower or cut Part D costs. The following table outlines premium assistance details with Extra Help.

Low Income Premium Subsidy:${part_d_lips_amount}
Low Income Premium Subsidy CMS Pays:$0.00
Low Income Subsidy Premium:$0.00

If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.

Prescription Drug Deductible

The Medicare Part D annual deductible with this plan is $590.00. You must pay this amount at the pharmacy before Healthfirst Medicare Plan begins paying its share.

Prescription Drug Out-of-Pocket Costs

In addition to the plan's monthly premium and deductible, Healthfirst 65 Plus Plan has out-of-pocket costs you must pay when you pick up your prescriptions.

Drug Tier Retail Mail Order
Preferred Generic*$0.00$0.00
Generic*$15.00$15.00
Preferred Brand*$35.00$35.00
Non-Preferred Drug50.00%50.00%
Specialty Tier25.00%25.00%
*The Part D deductible does not apply.

Citations & References