Eligibility, cost and service area

Who is eligible?

To be eligible to join Fallon Health Weinberg-HMO SNP, you must:

  • Be 21 years of age and older
  • Have Medicare Parts A and B
  • Have full New York State Medicaid benefits
  • Live in the service area
  • Not be diagnosed with End-Stage Renal Disease (ESRD) at the time of enrollment

Fallon Health Weinberg-HMO SNP can be a good fit for people who:

  • Will appreciate the convenience of having all their care coordinated through a single Care Team.
  • Have or are willing to change to a Primary Care Provider in the Fallon Health Weinberg-HMO SNP network.

Premiums and cost-sharing

As a Fallon Health Weinberg-HMO SNP member, you have $0 premium, $0 copayments, no deductibles and no coinsurance for covered medical services. Depending on your level of "Extra Help" from Medicare for your Part D prescription drug costs, you may pay minimal copayments for your prescription drugs or nothing at all.

The amount of extra help you get will determine your monthly plan premium as a member of our plan. Because all members of Fallon Health Weinberg-HMO SNP quality for the 100% level of extra help, you will pay $0 for your premium.

Your Level of extra help

Monthly Premium for Fallon Health Weinberg-HMO SNP

100%

$0

75%

$10.30

50%

$20.50

25%

$30.80

*This does not include any Medicare Part B premium you may have to pay.

Fallon Health Weinberg-HMO SNP's premium includes coverage for both medical services and prescription drug coverage.

If you aren’t getting extra help, you can see if you qualify by calling:

  • 1-800-Medicare; TTY users call 1-877-486-2048 (24 hours a day/7 days a week),
  • Your State Medicaid Office, or
  • The Social Security Administration at 1-800-772-1213. TTY users should call 1-800-325-0778 between 7 a.m. and 7 p.m., Monday through Friday.

Service area

Fallon Health Weinberg-HMO SNP service area mapFallon Health Weinberg-HMO SNP service area includes Erie and Niagara counties, New York.

Fallon Health Weinberg is an HMO plan with a Medicare contract and a coordination of benefits agreement with the New York State Department of Health. Enrollment in Fallon Health Weinberg depends on contract renewal. Fallon Health Weinberg-HMO SNP is available to anyone age 21 and older who has Medicare Parts A & B, full Medicaid benefits and lives in the service area. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year. Copays may vary based on the level of Extra Help you receive. Please contact the plan for further details. You must continue to pay your Medicare Part B premium (unless your part B premium is paid for you by Medicaid or another third party). The provider network may change at any time. You will receive notice when necessary.

H2470_W_2017_7 Approved 10182016
The information on this page was last updated on 10/1/2017.

Find a doctor

Looking for a doctor? Need to see if your current doctor is in our network?

Search online

Download the Provider and Pharmacy Directory (H2470_W_2017_26_r1_NM, pdf)

Contact us

Information before enrolling:
1-855-561-7248 (TTY 711)
8 a.m.–8 p.m., Monday–Friday
(Oct. 1–Feb. 14, seven days a week)

Customer Service:
1-855-561-7247 (TTY 711)
8 a.m.–8 p.m., Monday–Friday
(Oct. 1–Feb. 14, seven days a week)

Find a doctor

Are you looking for a doctor, hospital, pharmacy, or other community service providers?

Find a doctor online ► or
Download the whole Fallon Health Weinberg-HMO SNP Provider and Pharmacy Directory (H2470_W_2017_26_r1_NM, pdf)

Member information

2017 Summary of Benefits (H2470_W_2017_6_r1 Accepted 10152016) ►

2017 Evidence of Coverage (H2470_W_2017_1 Accepted 09122016, pdf) ►

About the Medication Therapy Management Program

Covered medications

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