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.
Covered benefits for 2026
NaviCare includes all MassHealth Standard and Medicare benefits, plus a lot more—at no cost to you! You get $1,500 per year on the Save Now card to buy items to help keep you healthy.
Each calendar quarter, we load $375 onto the card for you to spend on cold/allergy medicine, pain relievers, probiotics, and more. You’ll get a total of $1,500 to use at stores like CVS Pharmacy, Dollar General, and Target. 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 appointment
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✔ |
✔ |
| 48 one-way rides to the pharmacy |
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| 100 one-way rides to run errands, attend religious services, and more— for members who qualify for Special Supplemental Benefits for the Chronically Ill.*
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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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$400 per year to pay for fitness classes, a new fitness tracker, new cardiovascular fitness equipment, or a fitness/gym membership
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✔
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$403 a year to buy prescription eyewear
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✔ |
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| $1,500 a year to buy health and personal care items |
✔
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An entire Care Team that makes sure you get the care
and benefits you need
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✔
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Transportation
As a member, you can get free rides to and from your medical
appointments, 48 one-way rides to the pharmacy, mileage reimbursement for friends and family who give you rides when pre-approved, and—for members who have a qualifying chronic condition—100 one-way rides to run errands, visit friends, and more. You'll need to contact CTS, our transportation partner, at least 2 business days in advance to schedule your ride.
You'll need to know your Fallon Health member ID number, the day and time you'll need a ride, and the addresses for where to pick you up and where you're going.
Call CTS at
1-833-824-9440 (TRS 711), Monday–Friday, 8 a.m.–6 p.m.
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): each calendar quarter, $200 of your Save Now dollars will be set aside for healthy food and $175 for you to buy health and personal care items.* 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.
Member Handbook
A Member Handbook, otherwise known as the 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 9, and the exception process for prescription drugs in chapter 5. You can also visit the coverage decisions, appeals, and grievances page.
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.
Covered benefits for 2025
NaviCare includes all MassHealth Standard and Medicare benefits, plus a lot more—at no cost to you!
You get $1,100 per year on the Save Now card to buy items to help keep you healthy.
Each calendar quarter, we load $275 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.
|
Benefits
|
With NaviCare
|
With MassHealth Standard and
Medicare alone
|
|
$0 hospital stays and services
|
✔
|
✔
|
|
$0 lab tests and X-rays
|
✔
|
✔
|
|
$0 doctor visits and screenings
|
✔
|
✔
|
|
$0 hearing tests and hearing aids
|
✔
|
✔
|
|
$0 adult day health
|
✔
|
✔
|
|
$0 in-home care
|
✔
|
✔
|
|
$0 prescriptions and certain over-the-counter items with a prescription
|
✔
|
✔
|
|
Free rides to 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.
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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 care
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✔
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$400 per year to pay for fitness classes, a new fitness tracker, new cardiovascular fitness equipment, or a fitness/gym membership
|
✔
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|
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$403 toward prescription eyewear every year
|
✔ |
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$1,100 to buy items that help keep you healthy
|
✔
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|
|
A Care Team that makes sure you get the care and benefits you need
|
✔
|
|
Transportation
As a member, you can get free rides to and from your medical appointments, plus up to 130 one-way non-medical rides per year. You'll need to contact CTS, our transportation partner, at least 2 business days in advance to schedule your ride. You'll need to know your Fallon Health member ID number, the day and time you will need a ride, and the addresses for where to pick you up and where you are going.
Call CTS at 1-833-824-9440 (TRS 711), Monday through Friday,
from 8 a.m. to 6 p.m.
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.
Evidence of Coverage
The 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. You can also visit the coverage decisions, appeals, and grievances page.
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
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.)
NaviCare is a Dual Special Needs Plan (D-SNP) with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare and does not have any other comprehensive health insurance, except Medicare.
* This 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.
** Teladoc Health, Inc. All rights reserved.
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The information on this page was last updated on 10/1/2025.