Benefits and services
$0 premiums and cost-sharing
With Fallon Health's NaviCare, you get the care and services you need to stay healthy. And, you'll get the "extras" that you want—all at no cost to you.
What's covered
NaviCare includes all MassHealth Standard and Medicare benefits, plus a lot more—at no cost to you!
You get $1,100 per year ($848 in 2024) on the Save Now card to buy items to help keep you healthy.
Each calendar quarter, we load $275 ($212 in 2024) onto the card for you to spend on cold/allergy medicine, pain relievers, probiotics, and more. In 2025 you’ll get a total of $1,100 to use at stores like CVS Pharmacy, Dollar General, and Walmart. You can also order items by phone or online, with free home delivery.
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Benefits
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With NaviCare
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With MassHealth Standard and
Medicare alone
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$0 hospital stays and services
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✔
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✔
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$0 lab tests and X-rays
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✔
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✔
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$0 doctor visits and screenings
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✔
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✔
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$0 hearing tests and hearing aids
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✔
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✔
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$0 adult day health
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✔
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✔
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$0 in-home care
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✔
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✔
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$0 prescriptions and certain over-the-counter items with a prescription
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✔
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✔
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Free rides to and from medical appointments
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✔ |
✔ |
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Free rides to visit friends, run errands, attend religious services, and more. Up to 130 one-way trips per year (140 trips in 2024).
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✔
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✔
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$0 for advice or treatment from doctors by phone, mobile app, or video―24/7―with Teladoc
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✔
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$0 dental services, including crowns, dentures, imaging, implants, oral surgery, and more
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✔
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$1,100 per year ($848 in 2024) on the Save Now card to buy items to keep you healthy
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✔
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$403 per year ($570 in 2024) toward eyewear
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✔ |
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$400 per year toward new fitness trackers, new cardio equipment, or a fitness/gym membership
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✔
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A Care Team that makes sure you get the care and benefits you need
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✔
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Special Supplemental Benefits for the Chronically Ill
If you have certain chronic conditions, you may qualify for Special Supplemental Benefits for the Chronically Ill (SSBCI). If you qualify, each calendar quarter, you can use up to $100 of your Save Now card funds to purchase healthy food. This benefit provides you flexibility in how you use your Save Now card dollars. It doesn’t provide additional money on your Save Now card.
This benefit is only for qualified members who have certain chronic conditions. Not all members qualify. To find out if you’re eligible for this benefit, call your Fallon Health Navigator.
More information about benefits, items, services, and coverage
For more details on benefits, items, services, and coverage, you can view or download any of the documents below.
Summary of Benefits
A Summary of Benefits is a booklet that provides details on plan benefits.
2025
2024
Evidence of Coverage
An Evidence of Coverage (EOC) is part of your contract with us. It describes your complete benefits as well as how to use the plan. You can find information about our grievance, coverage determination, and appeal (and exceptions for Part D) processes in chapter 8, and the exception process for prescription drugs in chapter 5, respectively, in your Evidence of Coverage. You can also visit the coverage decisions, appeals, and grievances page.
2025
2024
Annual Notice of Changes (ANOC)
An ANOC is a document which explains any changes in your coverage, costs, or service area that will be effective on January 1.
2025
- NaviCare HMO SNP ANOC (H8928_250004_M, pdf)
Aviso anual de cambios de NaviCare HMO SNP (muy pronto, pdf)
- NaviCare SCO ANOC (SCO_250005_M, pdf)
Aviso anual de cambios de NaviCare SCO (muy pronto, pdf)
2024
To view the PDF files above, you may need to download a free copy of Adobe® Acrobat Reader software on your computer. (This link takes you away from the NaviCare website.)
Fallon Health is an HMO plan with a Medicare contract and a contract with the Massachusetts Medicaid program. Enrollment in Fallon Health depends on contract renewal. NaviCare is a voluntary program in association with MassHealth/EOHHS and CMS.
The $100 (per calendar quarter) food benefit is part of a special supplemental program for the chronically ill. To qualify, enrollees must have chronic-condition diagnoses documented with Fallon Health, such as cardiovascular disorders, chronic and disabling behavioral health conditions, chronic lung disorders, diabetes, and neurologic disorders. This is not a complete list of eligible chronic conditions. Not all members with an eligible condition will qualify. Other eligibility and coverage criteria also apply.
H8928_250111_M
The information on this page was last updated on 10/1/2024.