Is Healthfirst Medicaid or Medicare? Understanding Which Program You Have

Healthfirst offers both Medicaid and Medicare plans, so the answer depends on which plan you chose or were enrolled in

Healthfirst is an insurance company that sells coverage under both programs. If you have a Healthfirst plan, you are enrolled in either Medicaid or Medicare — not both at the same time, though some people do have both types of coverage through different insurers. The easiest way to know which one you have is to look at your insurance card or your welcome letter from Healthfirst. The card will say "Medicaid" or "Medicare" clearly on it.

Healthfirst operates in New York, New Jersey, and Connecticut. The company manages plans for people who may have access to for Medicaid (the state and federal program for people with lower incomes) and for people who are 65 or older or have certain disabilities (Medicare). Your enrollment in one or the other depends on your age, income, and whether you meet your state's Medicaid rules.

Key Takeaways

Your Healthfirst card will clearly state whether you have Medicaid or Medicare coverage.
Medicaid through Healthfirst is for people under 65 with lower incomes; Medicare through Healthfirst is for people 65 and older or those with certain disabilities.
Some people have both Medicaid and Medicare (called dual coverage), but they would be enrolled in separate plans, possibly through different insurers.
You can contact Healthfirst directly by phone or log into your online account to confirm which program your plan belongs to.

How to tell which program your Healthfirst plan covers

The fastest way is to look at your insurance card. Medicaid cards typically say "Medicaid" or the name of your state's Medicaid program (such as "New York Medicaid" or "Medicaid Managed Care"). Medicare cards say "Medicare" and include a Medicare claim number that starts with a letter.

If you cannot find your card, check any welcome letter or enrollment confirmation you received from Healthfirst when you first signed up. These documents always state which program the plan covers. You can also log into your Healthfirst online account — the dashboard will show your plan type and coverage details. If you do not have an online account set up, you can create one on the Healthfirst website using your member ID.

If you still are not sure, call Healthfirst customer service. The phone number is on any mail you have received from them, or you can find it on the Healthfirst website for your state. Have your member ID ready when you call.

What Medicaid through Healthfirst covers

Healthfirst Medicaid plans cover doctor visits, hospital care, prescription drugs, and preventive services like screenings and vaccines. Coverage and costs vary by plan and by state, since Medicaid is run jointly by states and the federal government. In New York, for example, Healthfirst offers several Medicaid managed care plans with different networks of doctors and hospitals.

Medicaid through Healthfirst is for people who meet income and other requirements set by their state. In most cases, you must be under 65 years old, though some states cover older adults under Medicaid if their income is very low. If you turn 65 while enrolled in Medicaid, you may be moved to Medicare automatically, or you may need to switch plans.

What Medicare through Healthfirst covers

Healthfirst Medicare plans are for people 65 and older, or for younger people who receive Social Security Disability Insurance (SSDI) or have end-stage renal disease. Healthfirst offers both Medicare Advantage plans (which bundle hospital, doctor, and prescription drug coverage into one plan) and Medigap plans (which supplement Original Medicare coverage).

Medicare Advantage plans through Healthfirst typically include prescription drug coverage, dental, vision, and hearing benefits — things Original Medicare does not cover. Medigap plans help pay for costs that Original Medicare leaves you responsible for, such as copayments and coinsurance. Which type of plan you have depends on how you enrolled and what was available to you when you signed up.

What happens if you have both Medicaid and Medicare

Some people are covered by both programs at the same time. This is called dual coverage or being "dual may be able to access." It happens when someone is 65 or older (or disabled and receiving SSDI) and also has income low enough to may have access to for Medicaid in their state. If this describes you, you would have a Medicare card and a Medicaid card, and you might be enrolled in plans from different insurers.

Healthfirst does offer some plans specifically designed for people with dual coverage, which coordinate benefits between Medicaid and Medicare. If you think you might may have access to for both programs, contact your state's Medicaid office or call 1-800-MEDICARE to find out. A caseworker can help you understand your coverage and make sure you are enrolled in plans that work well together.

How to contact Healthfirst if you are unsure

Healthfirst has customer service phone lines for both Medicaid and Medicare members. The number you call depends on which program you are enrolled in, so start by checking your card or recent mail to see which one it is. Once you know, call the number listed for that program.

You can also visit the Healthfirst website and use the "Contact Us" page to find the right phone number for your state and program. Many Healthfirst members can also log into their online account to message customer service or view their plan details. Response times are usually faster during business hours on weekdays.

Frequently Asked Questions

Can I switch from Healthfirst Medicaid to Healthfirst Medicare?

If you turn 65 while enrolled in Healthfirst Medicaid, you will become may be able to access for Medicare. You may be able to stay with Healthfirst by switching to a Healthfirst Medicare plan, or you can choose a different Medicare plan. Your state's Medicaid program will contact you about the transition. You have options, so do not assume you must stay with Healthfirst.

What if my Healthfirst card does not clearly say Medicaid or Medicare?

Call the customer service number on your card and ask directly. Have your member ID ready. The representative can tell you in less than a minute which program your plan covers and answer any questions about your benefits.

If I have Healthfirst Medicaid, can I also have a Medicare plan?

Not at the same time through Healthfirst. However, if you are 65 or older and have Medicaid, you may be may be able to access for Medicare as well. In that case, you would need to enroll in a Medicare plan (which could be through Healthfirst or another insurer) and keep your Medicaid coverage separate.

Does Healthfirst Medicaid work the same way in New York, New Jersey, and Connecticut?

Healthfirst operates in all three states, but Medicaid rules and covered services vary by state. Your Healthfirst Medicaid plan will follow your state's rules. If you move to a different state, you will need to enroll in that state's Medicaid program, which may or may not include Healthfirst plans.

How do I know if I may have access to for Medicaid or Medicare?

Medicare is based on age (65 or older) or disability status. Medicaid is based on income and other factors set by your state. Contact your state's Medicaid office or call 1-800-MEDICARE to learn what you might may have access to for. They can walk you through the rules for your situation.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.