Is Healthfirst Medicaid? What Each Healthfirst Plan Actually Is, and How to Tell Which One You Have

Is Healthfirst Medicaid or private insurance?

Healthfirst is a health insurance company, and Medicaid is one of the programs it administers. When a card says “Healthfirst”, the company paying the claims is Healthfirst, but the rules, the cost and the benefits come from whichever program you qualified for.

That distinction is why the question has no single yes-or-no answer. A Healthfirst member may be on Medicaid, on the Essential Plan, on a child’s Child Health Plus policy, on a marketplace Leaf plan bought with tax credits, or on a Medicare Advantage plan. All five carry the same logo.

Healthfirst was created by a consortium of New York City hospitals and health systems, which is why its network is built around community and safety-net hospitals. What Healthfirst is, and how to check your doctor.

Which Healthfirst plans are Medicaid?

Two of them, plus the plans that combine Medicaid with Medicare. Healthfirst’s own site lists its products under two menus, Individual and Family, and Medicare and Long-Term Care.

The Personal Wellness Plan includes all Medicaid benefits plus services such as community support, peer and family supports and crisis management. To join it you must already be in a Medicaid managed care plan, be identified by New York State as HARP-eligible, and have Medicaid as your only insurance.

What does Healthfirst Medicaid cost and cover?

Healthfirst’s Medicaid Managed Care page lists a $0 monthly premium, a $0 individual deductible and $0 copays for the services it shows, including checkups, primary care and specialist visits, urgent care, the emergency room, hospital stays and telemedicine. It is for New Yorkers who meet Medicaid’s income rules, with no age requirement.

Covered services include preventive care, doctor and hospital care, mental health treatment and maternity care, with automatic enrollment of newborns. Dental is included: checkups, cleanings, X-rays and fillings, with no referral needed to see a dentist. Vision and hearing are included too, as is transportation to covered appointments. Finding a dentist who takes your Medicaid plan.

The benefit package is not Healthfirst’s to design. New York sets what Medicaid covers, so every Medicaid managed care plan covers the same services. What Healthfirst decides is the network: which doctors, hospitals and pharmacies you can use. That is the only real reason to choose it over another plan. Healthfirst vs MetroPlus.

Healthfirst’s Medicaid plan serves the five boroughs, Long Island, and Westchester, Orange, Rockland and Sullivan counties. In the state’s 2024 plan profiles, Healthfirst PHSP had 1,238,371 Medicaid managed care members, down 7% from 2023.

Is the Healthfirst Essential Plan Medicaid?

No. The Essential Plan is a separate state-run plan for adults 19 to 64 whose income is just above the Medicaid line, up to 200% of the federal poverty level, which is $31,920 a year for one person in 2026. It costs $0 a month with no deductible, but it is not Medicaid and does not cover long-term care.

You do not choose between the two. One NY State of Health application places you by income, age and immigration status. If your income drops, you move to Medicaid; if it rises, you move to the Essential Plan or a marketplace plan, often with the same carrier. Healthfirst Essential Plan in detail · Essential Plan vs Medicaid.

Is Healthfirst Child Health Plus Medicaid?

No. Child Health Plus is New York’s separate program for children under 19, with family income limits far above Medicaid’s and no immigration status requirement. It is free up to 222% of the poverty level; above that the premium is $15, $30, $45 or $60 per child a month depending on income. A child can be on Children’s Medicaid or Child Health Plus, depending on family income, and Healthfirst offers both. Child Health Plus.

Is Healthfirst Medicare or Medicaid?

Healthfirst sells both kinds of plans. Its Medicare Advantage plans are Medicare. Its dual-eligible special needs plans are for people who have Medicare and Medicaid at the same time and coordinate the two. Healthfirst leads Medicare Advantage enrollment in the Bronx, Brooklyn, Manhattan and Queens. Medicare Advantage in NYC by borough · Being dual eligible.

How do I tell which Healthfirst plan I have?

The plan name on your card tells you, and the member phone number on the back confirms it. Do not rely on the logo.

The state card matters because people in a Medicaid managed care plan keep it. The state Health Department says members use their Medicaid benefit card for services the plan does not cover. The New York Medicaid card explained.

What to say on the phone to Healthfirst or a doctor’s office:

“My card says Healthfirst. Which exact plan is this: Medicaid Managed Care, the Essential Plan, Child Health Plus, a Leaf plan or Medicare? And is Dr. [name] in network for that exact plan and taking new patients?”

How do I join or leave Healthfirst Medicaid?

You apply for the program first and choose the plan second. Most people under 65 apply through NY State of Health, online or at 1-855-355-5777, and choose Healthfirst as their plan. Healthfirst’s own enrollment line is 1-844-488-1486 (TTY 1-888-542-3821), and its page also points to free certified enrollment assistors. People 65 and older or applying on disability apply through the city’s Human Resources Administration instead. Which door is yours.

Medicaid takes applications year-round, so there is no season to wait for. If Healthfirst’s network turns out wrong for you, you can change plans; in the year-round programs you are not locked in until an enrollment period opens.