Prior Authorization Required" ["snf"]=> string(109) "$0.00 (days 1–20), $150.00 (days 21–100), $0.00 (days –)
Prior Authorization Required" ["pcp"]=> string(11) "$0.00 Copay" ["specialist"]=> string(12) "$20.00 Copay" ["urgent_care"]=> string(59) "$10.00 Copay
Prior Authorization Required" ["er"]=> string(68) "$0.00 - $250.00 Copay
Prior Authorization Required" ["ambulance_ground"]=> string(60) "$260.00 Copay
Prior Authorization Required" ["ambulance_air"]=> string(60) "$260.00 Copay
Prior Authorization Required" ["dental"]=> string(45) "$1,000.00 max
$1,000.00 max" ["vision"]=> string(48) "$0.00 Copay
$250.00/yr eyewear" ["hearing"]=> string(11) "Not Covered" ["rx"]=> array(2) { ["deductible"]=> string(7) "$200.00" ["tiers"]=> array(5) { [0]=> array(11) { ["order"]=> int(1) ["name"]=> string(29) "Preferred Generic*" ["deductible"]=> string(8) "Excluded" ["deductible_flag"]=> string(8) "Excluded" ["retail_30"]=> string(11) "$0.00 Copay" ["retail_90"]=> string(11) "$0.00 Copay" ["mail_30"]=> string(3) "—" ["mail_90"]=> string(11) "$0.00 Copay" ["ltc_30"]=> string(11) "$0.00 Copay" ["out_network"]=> string(11) "$0.00 Copay" ["post_oop"]=> string(11) "$0.00 Copay" } [1]=> array(11) { ["order"]=> int(2) ["name"]=> string(19) "Generic*" ["deductible"]=> string(8) "Excluded" ["deductible_flag"]=> string(8) "Excluded" ["retail_30"]=> string(12) "$15.00 Copay" ["retail_90"]=> string(12) "$45.00 Copay" ["mail_30"]=> string(3) "—" ["mail_90"]=> string(11) "$0.00 Copay" ["ltc_30"]=> string(12) "$15.00 Copay" ["out_network"]=> string(12) "$15.00 Copay" ["post_oop"]=> string(11) "$0.00 Copay" } [2]=> array(11) { ["order"]=> int(3) ["name"]=> string(15) "Preferred Brand" ["deductible"]=> string(7) "Applies" ["deductible_flag"]=> string(7) "Applies" ["retail_30"]=> string(12) "$47.00 Copay" ["retail_90"]=> string(13) "$141.00 Copay" ["mail_30"]=> string(3) "—" ["mail_90"]=> string(13) "$117.50 Copay" ["ltc_30"]=> string(12) "$47.00 Copay" ["out_network"]=> string(12) "$47.00 Copay" ["post_oop"]=> string(11) "$0.00 Copay" } [3]=> array(11) { ["order"]=> int(4) ["name"]=> string(18) "Non-Preferred Drug" ["deductible"]=> string(7) "Applies" ["deductible_flag"]=> string(7) "Applies" ["retail_30"]=> string(15) "25% Coinsurance" ["retail_90"]=> string(15) "25% Coinsurance" ["mail_30"]=> string(3) "—" ["mail_90"]=> string(15) "25% Coinsurance" ["ltc_30"]=> string(15) "25% Coinsurance" ["out_network"]=> string(15) "25% Coinsurance" ["post_oop"]=> string(11) "$0.00 Copay" } [4]=> array(11) { ["order"]=> int(5) ["name"]=> string(9) "Specialty" ["deductible"]=> string(7) "Applies" ["deductible_flag"]=> string(7) "Applies" ["retail_30"]=> string(15) "30% Coinsurance" ["retail_90"]=> string(3) "—" ["mail_30"]=> string(3) "—" ["mail_90"]=> string(3) "—" ["ltc_30"]=> string(15) "30% Coinsurance" ["out_network"]=> string(15) "30% Coinsurance" ["post_oop"]=> string(11) "$0.00 Copay" } } } ["data_status"]=> string(2) "ok" } Health First Easy Access H1099-027 (HMO-POS)H1099-027Health First Health Plans, Inc.HMOPOSVolusia, Flagler, Hardee, Highlands4700.00Data missing
🩺 Doctor’s Office Visits
| Service | 2026 | 2025 |
|---|---|---|
| Primary | Coming soon | $0.00 Copay |
| Specialist | Coming soon | $20.00 Copay |
🏥 Emergency, Urgent, and Inpatient Hospital Coverage
| Service | 2026 | 2025 |
|---|---|---|
| Emergency room care | Coming soon | $0.00 - $250.00 Copay Prior Authorization Required |
| Urgent care | Coming soon | $10.00 Copay Prior Authorization Required |
| Ground ambulance | Coming soon | $260.00 Copay Prior Authorization Required |
| Inpatient hospital care | Coming soon | $195.00 (days 1–8), $0.00 (days 9–90), $0.00 (days –) Prior Authorization Required |
| Skilled Nursing Facility | Coming soon | $0.00 (days 1–20), $150.00 (days 21–100), $0.00 (days –) Prior Authorization Required |
🦶 Foot Care
| Service | 2026 | 2025 |
|---|---|---|
| Foot Exams and Treatments (Medicare-covered) | Coming soon | 20% Coinsurance |
| Routine Foot Care | Coming soon | 0% - 20% Coinsurance Prior Authorization Required |
💆 Chiropractic Care
| Service | 2026 | 2025 |
|---|---|---|
| Medicare-covered chiropractic | Coming soon | 20% Coinsurance Prior Authorization Required |
| Routine chiropractic | Coming soon | 20% Coinsurance Prior Authorization Required |
🧠 Mental Health Services
| Service | 2026 | 2025 |
|---|---|---|
| Outpatient individual therapy | Coming soon | $15.00 Copay |
| Outpatient group therapy | Coming soon | $10.00 Copay |
| Inpatient psychiatric hospital care | Coming soon | $195.00 (days 1–8), $0.00 (days 9–90), $0.00 (days –) Prior Authorization Required |
🏋️ Rehabilitation Services
| Service | 2026 | 2025 |
|---|---|---|
| Physical therapy and speech/language therapy | Coming soon | $35.00 Copay |
| Occupational therapy | Coming soon | $30.00 Copay Prior Authorization Required |
🧰 Medical Equipment and Supplies
| Service | 2026 | 2025 |
|---|---|---|
| Diabetes supplies | Coming soon | $0.00 Copay Prior Authorization Required |
| Durable medical equipment | Coming soon | $30.00 Copay |
| Prosthetics | Coming soon | $0.00 - $35.00 Copay |
🔬 Diagnostics, Lab Services, and Imaging
| Service | 2026 | 2025 |
|---|---|---|
| Diagnostic radiology services | Coming soon | $30.00 Copay Prior Authorization Required |
| Lab services | Coming soon | $10.00 Copay Prior Authorization Required |
| Outpatient x-rays | Coming soon | $0.00 - $35.00 Copay |
| Diagnostic tests and procedures | Coming soon | $30.00 Copay |
💉 Medicare Part B Drugs
| Service | 2026 | 2025 |
|---|---|---|
| Chemotherapy | Coming soon | 10% - 20% Coinsurance Prior Authorization Required |
| Other Part B drugs (Medicare-covered) | Coming soon | 10% Coinsurance Prior Authorization Required |
Supplemental Benefits
🦷 Dental Services
| Service | 2026 | 2025 |
|---|---|---|
| Medicare Covered Preventive Dental | Coming soon | $1,000.00 max $1,000.00 max |
| Oral exam | Coming soon | Not Covered |
| Dental x-rays | Coming soon | Not Covered |
| Cleaning | Coming soon | Not Covered |
| Periodontics | Coming soon | Not Covered |
| Endodontics | Coming soon | Not Covered |
| Restorative Services | Coming soon | Not Covered |
| Dental Maximum | Coming soon | $1000.00 max |
👂 Hearing Aids and Services
| Service | 2026 | 2025 |
|---|---|---|
| Fitting/evaluation | Coming soon | $0.00 Copay |
| Hearing aids | Coming soon | $0.00 Copay |
| Hearing exam | Coming soon | $0.00 max $0.00 max |
| Hearing Maximum | Coming soon | $0.00 max |
👓 Vision Services
| Service | 2026 | 2025 |
|---|---|---|
| Medicare-covered eye exam | Coming soon | $0.00 max $0.00 max |
| Routine eye exam | Coming soon | Not Covered |
| Eyewear benefits | Coming soon | Not Covered |
| Vision Eyewear Maximum | Coming soon | $250.00/yr eyewear |
Part D Plan Premium
The Part D prescription drug plan premium is included in your overall Medicare Advantage plan cost. However, additional expenses or subsidies may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help. LIS, provided by Social Security, helps those with limited income and resources to lower or eliminate Part D costs. LIS benefits are not part of Medicare Advantage coverage.
| Basic Part D Premium: | ${part_d_basic_premium} |
|---|---|
| Supplemental Part D Premium: | ${part_d_supplemental_premium} |
| Total Part D Premium: | ${part_d_total_premium} |
| Low-Income Premium Subsidy: | ${part_d_lips_amount} |
| Low-Income Premium Subsidy Paid by CMS: | ${part_d_lips_cms_pays} |
| Low-Income Subsidy Premium: | ${part_d_lis_premium} |
For more details, visit the Social Security Extra Help program.
Prescription Drug Plan Deductible
This plan has a ${deductible} annual Part D deductible. You'll pay this deductible at the pharmacy before {carrier} starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, {name} may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic<sup>*</sup> | 30-day: $0.00 Copay 90-day: $0.00 Copay | 30-day: — 90-day: $0.00 Copay |
| Generic<sup>*</sup> | 30-day: $15.00 Copay 90-day: $45.00 Copay | 30-day: — 90-day: $0.00 Copay |
| Preferred Brand | 30-day: $47.00 Copay 90-day: $141.00 Copay | 30-day: — 90-day: $117.50 Copay |
| Non-Preferred Drug | 30-day: 25% Coinsurance 90-day: 25% Coinsurance | 30-day: — 90-day: 25% Coinsurance |
| Specialty | 30-day: 30% Coinsurance 90-day: — | 30-day: — 90-day: — |
| *Deductible does not apply. | ||