Healthfirst Medicare Advantage: New York's Provider-Sponsored Powerhouse

Healthfirst is a large not-for-profit, provider-sponsored Medicare Advantage plan in New York, owned by a group of New York hospitals rather than by shareholders. Its defining features are its strong New York City presence, its large dual-eligible book, and its provider-sponsored structure, which ties it directly to the hospitals delivering care. It has generally strong New York star ratings, and if you live in the downstate area it is often one of the leading Medicare Advantage choices, so it is worth understanding what it does well and where a regional plan has limits.

Bryce's Take

Healthfirst is often a leading choice in New York City, and it is one of the first plans I look at for dual-eligible members downstate, because its dual book is large and well run and the ratings are generally strong. The provider-sponsored structure ties it to real hospitals, which helps. As always, I confirm your doctors are in-network and check the star rating for the exact plan in your county, since even a strong plan only works for you if your providers are actually in it and the rating holds up locally.

Overview of Healthfirst

Healthfirst offers Medicare Advantage plans concentrated in New York City and the downstate area, backed by a group of New York hospitals that own the plan. Its provider-sponsored structure connects it directly to those hospitals, and it has a large book of business serving dual-eligible members who qualify for both Medicare and Medicaid. Plans include the dental, vision, hearing, and Part D coverage common to Medicare Advantage, along with deep downstate networks. The footprint is regional, centered on New York, so availability is specific to the counties it serves.

Strengths

Healthfirst's biggest strengths are its strong New York City presence, its large and well-run dual-eligible book, and its provider-sponsored structure, which ties it to the hospitals delivering care and supports coordination. As a not-for-profit owned by New York hospitals, it reinvests rather than answering to shareholders, and its star ratings in New York have generally been strong. For dual-eligible members in the downstate area in particular, Healthfirst is often one of the leading options, backed by deep local networks and a solid quality track record.

Weaknesses

Healthfirst is a regional carrier, so it is essentially a New York option and is not available elsewhere. Its plans carry the usual network structures, referrals, and prior authorization common to Medicare Advantage. Star ratings and benefits vary by specific plan and county, and its provider-sponsored structure naturally emphasizes its owning hospitals' networks, so members should confirm that their own doctors participate. For people outside New York or who want a broad national network, it is not the right fit.

How big is Healthfirst, really?

Healthfirst is a large not-for-profit plan with revenue in the range of $17 to $19 billion as of 2024 across its lines of business, making it one of the larger provider-sponsored plans in the country even though it operates regionally. Its Medicare Advantage and dual-eligible membership is concentrated in the New York City area rather than spread nationally. The practical takeaway is a large, financially substantial regional nonprofit rather than a national insurer. These figures are approximate, reflect where things stood as of 2024, and shift every year, so treat them as a sense of scale rather than precise current numbers.

What members actually say

Healthfirst is often regarded as one of the leading Medicare Advantage choices in New York City, particularly for dual-eligible members, and its generally strong star ratings back that up. Member sentiment tends to be solid in the downstate area, helped by deep local networks and the provider-sponsored structure. As with any regional plan, ratings vary by specific plan and county, so it is worth checking the exact plan you are considering. The most common concerns are the usual ones, namely network limits, referrals, and prior authorization.

The trend: is Healthfirst adding or cutting benefits?

Healthfirst is a large, financially substantial nonprofit with strong New York ratings that earn bonus payments, which cushions it somewhat, but it is not exempt from the wider pressures reshaping Medicare Advantage. Like nearly every carrier it has been adjusting benefits for the 2025 and 2026 plan years under the industry-wide squeeze created by CMS rate changes, the phase-in of the v28 risk-adjustment model, and rising medical costs, pressures that pushed carriers broadly to trim supplemental benefits, raise out-of-pocket maximums, and in some cases exit counties. Because plan benefits reset every Annual Enrollment Period, the only reliable way to know what a specific Healthfirst plan offers for the coming year is to compare its current details for your county, which is what a call with Bryce is for.

Who Healthfirst tends to fit well

Healthfirst fits members in New York City and the downstate area, and it is especially strong for dual-eligible members who qualify for both Medicare and Medicaid, given its large dual-eligible book and provider-sponsored networks. It is essentially a New York option and is not available elsewhere, and it is a weaker fit for people who want a broad national network, for whom another plan or Original Medicare with a Medigap plan may be better.

Bryce Casson

Licensed Independent Medicare Broker

Bryce Casson is an independent Medicare insurance broker who works with every major carrier. He does not represent any single insurer, which means his recommendations are based on what actually fits each client's situation, not on commissions or quotas.