What Healthfirst does

Healthfirst is a New York-based not-for-profit health plan, founded in 1993, that provides government-sponsored and individual health insurance to roughly two million members living in the New York City five boroughs (Bronx, Brooklyn, Manhattan, Queens, Staten Island), Long Island, and Westchester, Orange, Rockland, and Sullivan counties. The portfolio spans Essential Plans (state-subsidized $0-premium coverage for adults 19-64), Medicaid Managed Care, Child Health Plus, Marketplace Leaf and Leaf Premier qualified health plans, Medicare Advantage plans in HMO and PPO variants (including D-SNP products such as Life Improvement, Connection, and CompleteCare for dual-eligible members), and Managed Long-Term Care via the Senior Health Partners Plan.

The company runs a member portal (myhfny.org), a provider portal via Availity, a broker portal (myhfgroup.org), a CMS-aligned Interoperability API developer portal (devportal.healthfirst.org), and a mobile app for iOS and Android; it also partners with Teladoc for 24/7 telemedicine, DentaQuest for dental, and EyeMed for vision. Underwriting is largely capitation-based: revenue comes from NY State-funded Essential Plan and Medicaid capitation payments, federal CMS Medicare Advantage capitation, and individual premiums for Marketplace plans, with $0 premiums on Essential Plans and low copays designed to maximize enrollment among lower-income New Yorkers.

Distribution combines the NY State of Health Marketplace, a broker network, in-person community offices across the service area, and a Virtual Community Office for remote enrollment, supported by direct phone enrollment and a Spanish/Chinese local site experience. In 2025 Healthfirst's Essential Plan 1 earned a Five-Star rating from NY State of Health. In 2026 the company is launching a Community Health Worker embedding program in pediatric practices in the Bronx and Upper Manhattan with Boston Medical Center's TEAM UP Center, NYC REACH, and NYC Health + Hospitals, funded by Robin Hood and Carmel Hill Fund.

Name

Healthfirst

Legal name

Healthfirst, Inc.

Website

https://healthfirst.org

Company type

Private

Founded year

1994

Operating status

Operating

Headcount range

1,001–5,000 employees

Short description

Healthfirst is a not-for-profit New York health insurer serving roughly two million members across Medicaid, Medicare Advantage, Essential Plans, Marketplace plans, and Long-Term Care in NYC and surrounding counties.

Ownership category

akta.pro rank

Product category

Health Insurance

NAICS

Direct Health and Medical Insurance Carriers (524114)

SIC

Accident & Health Insurance (6321)

akta.pro primary industry

Integrated Physical-Behavioral-Social Care (Whole-Person) Medicaid Plans (HLAEAEAI)

akta.pro secondary industries

Medicare Supplement (Medigap) (FSAIAEAG), Medigap Member Support & Care Navigation (Advocacy/Concierge) (HLAEADAH)

Keywords

• Health insurance plans
• Medicare Advantage plans
• Medicaid managed care
• Individual family coverage
• Long-term care plans

Headquarters

HQ city

New York

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2C

Offering type

Services

Cost components

Operations, Personnel, Technology or R&D, Marketing or Sales, Infrastructure

Revenue model

1. Health Insurance Premiums: Revenue generated from member premiums across Essential Plans, Medicaid Managed Care, Child Health Plus, Marketplace Plans, Medicare Advantage, and Long-Term Care plans
2. Medicaid/Medicare Capitation: Government-funded healthcare programs providing capitated payments for enrolled members in Medicaid and Medicare plans

Pricing tiers

Go-to-market motion2 records

Distribution channels4 records

Marketing channels5 records

Core offering

Healthfirst is a not-for-profit health plan offering a portfolio of health insurance products to New York residents, including NY State Essential Plans, Medicaid Managed Care, Child Health Plus, Marketplace Qualified Health Plans (Leaf and Leaf Premier), Medicare Advantage (HMO, PPO, and D-SNP variants), and Managed Long-Term Care plans. It also provides a mobile application for member self-service and operates community offices and a Virtual Community Office for enrollment and member support.

Product overview

Healthfirst is a not-for-profit health plan serving over two million New Yorkers for more than 30 years. The company offers a comprehensive portfolio of health insurance products across three main categories: Individual & Family Plans (including Essential Plans, Medicaid Managed Care, Child Health Plus, and Marketplace Leaf/Leaf Premier Plans), Medicare Advantage Plans (including HMO and PPO options with various D-SNP variants for dual-eligible beneficiaries), and Long-Term Care Plans. The product portfolio also includes a mobile app for member self-service. Healthfirst primarily operates in New York State, serving residents of New York City, Long Island, and surrounding counties.

Differentiator

Problem solved

Functional benefit

Products and services

• Essential Plans NY State-sponsored Essential Plans providing $0 premium health insurance to qualified New Yorkers ages 19-64 across multiple income tiers (Plans 1-4 and 200-250), with $0 preventive care, low copays, dental and vision coverage, and 24/7 telemedicine access.
• Medicaid Managed Care Plan Medicaid Managed Care coverage for eligible New York State residents meeting income requirements, providing comprehensive health benefits through Healthfirst's provider network.
• Child Health Plus Affordable health coverage for children under 19 years of age in New York State, offered regardless of family income.
• Marketplace Leaf & Leaf Premier Plans Qualified Health Plan offerings available through the NY State of Health Marketplace for individuals and families not eligible for Essential Plans or Medicaid.
• Personal Wellness Plan Individual health plan option focused on wellness and preventive care benefits for New York residents.
• Life Improvement Plan (HMO D-SNP) Medicare Advantage Dual-Eligible Special Needs Plan combining Medicare and Medicaid benefits for individuals dually eligible for both programs.
• Connection Plan (HMO D-SNP) Dual-Eligible Special Needs Plan providing coordinated Medicare and Medicaid coverage for dual-eligible beneficiaries in New York.
• CompleteCare (HMO D-SNP) Comprehensive Dual-Eligible Special Needs Plan with extensive care coordination benefits for members qualifying for both Medicare and Medicaid.
• Increased Benefits Plan (HMO) Medicare Advantage HMO plan with enhanced benefits including over-the-counter (OTC) allowances, dental, vision, and prescription drug coverage.
• 65 Plus Plan (HMO) Medicare Advantage HMO plan designed for New York seniors age 65 and older with comprehensive coverage.
• Signature (HMO) Medicare Advantage HMO plan offering broad network coverage and comprehensive benefits for Medicare-eligible members.
• Signature (PPO) Medicare Advantage PPO plan with flexibility to see out-of-network providers at higher cost-share for Medicare-eligible members.
• Senior Health Partners Plan Managed long-term care plan combining hospital, medical, and prescription drug coverage with long-term care benefits for seniors needing extended care services.
• Healthfirst NY Mobile App Mobile application for iOS and Android enabling Healthfirst members to manage their health plan, access benefits information, view claims, and connect with member services.

Quantifiable outcome

• Five-Star rating from NY State of Health for Essential Plan 1 in 2025

Named customers1 record

Segments4 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Feature3 records

Partnerships

Three partnerships are on record, tiered core.

• Boston Medical Center's TEAM UP Scaling and Sustainability CentercoreStrategic or Co-development Partner · 1 January 2026Collaboration to develop and implement a Community Health Worker (CHW) embedding program in pediatric practices. The partnership supports developmental screenings, behavioral health services, and family resource connections, leveraging New York State's Medicaid CHW services benefit for children under 21. Includes pilot of comprehensive pediatric CHW training program.
• NYC REACHcoreStrategic or Co-development Partner · 1 January 2026Collaboration partner in the Community Health Worker pediatric practice embedding program, supporting developmental screenings and behavioral health services for children and families in the Bronx and Upper Manhattan.
• NYC Health + HospitalscoreStrategic or Co-development Partner · 1 January 2026Partner in the Community Health Worker embedding initiative for pediatric practices, working to close developmental and behavioral care gaps for children and families.

Scale indicators2 records

Recent moves5 records

Expansion highlights4 records

Direct peers

• Fidelis Care: Fidelis Care is a New York-focused health insurer offering Medicaid, Medicare Advantage, Child Health Plus, and Essential Plan products — direct head-to-head product and geography overlap with Healthfirst across the same NY State of Health Marketplace.
• EmblemHealth: EmblemHealth is a New York-based not-for-profit health plan serving Medicaid, Medicare, and commercial members across the same metro footprint, making it one of Healthfirst's closest comparables on product mix, mission, and regional concentration.
• MetroPlus Health Plan: MetroPlus is a New York City-based public-option health plan offering Medicaid, Medicare, and marketplace products with overlapping provider networks (NYC Health + Hospitals is a key partner), competing with Healthfirst for the same low-income and dual-eligible populations.
• Molina Healthcare: Molina is a publicly traded managed-care company focused on Medicaid, Medicare (including D-SNPs), and marketplace plans; its NY operations and dual-eligible strategy make it a directly comparable peer for Healthfirst's government-sponsored book.

Broad incumbents

• UnitedHealthcare: UnitedHealthcare is the largest US health insurer with major NY Medicare Advantage, Medicaid, and dual-eligible presence — a broad incumbent that sets competitive benchmarks on network scale, benefits, and digital member experience.
• Centene Corporation: Centene is the largest US Medicaid managed-care insurer and a major Medicare Advantage carrier, including in New York via Wellcare; it competes with Healthfirst on essentially every government-sponsored line.
• Anthem / Elevance Health: Elevance operates NY Anthem Blue Cross Blue Shield plans with Medicaid and Medicare Advantage offerings that overlap with Healthfirst's commercial, Medicaid, and MA footprint in NY.
• Aetna (CVS Health): Aetna offers Medicare Advantage and individual marketplace plans in NY and competes with Healthfirst on D-SNP and dual-eligible products, with broader portfolio and pharmacy/PBM integration via CVS Health.

Regional players

• CDPHP: CDPHP is a New York State regional health plan serving Medicaid, Medicare, and commercial members, overlapping with Healthfirst's upstate service area (e.g., Hudson Valley) on government-sponsored lines.
• Independent Health: Independent Health is a Western New York-based regional health plan with Medicaid and Medicare Advantage products, partially overlapping with Healthfirst's NY State service area on government lines.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights6 records

Customer concentration

• Xx.com/healthfirstny
• Facebookfacebook.com/HealthfirstNY
• LinkedInlinkedin.com/company/healthfirst

Revenue estimate

Valuation estimate

Number of profiles

Profiles2 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments1 record

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Healthfirst