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 over $800 per year on the Save Now card to buy food as well as health and personal care items.
Each calendar quarter, $212 is preloaded onto the card for you to buy items to keep you healthy. You can use $162 to spend on cold/allergy medicine, pain relievers, probiotics, and more. Plus, another $50 to buy food and personal care items such as soap, shampoo, fruits, veggies, and more. That’s $848 per year to buy items you need!
Make your purchases at stores like CVS Pharmacy, Family Dollar, and Walmart. You can also order items by mail, 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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Unlimited free rides to and from medical appointments and places where you receive health care.
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✔ |
✔ |
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Free rides to visit friends, run errands, attend religious services, and more (up to 140 one-way trips per year) and mileage reimbursement to your friends and family who give you rides that have been pre-approved.
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✔
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✔
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Free SilverSneakers®: includes gym membership, access to online classes, and more
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✔
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$0 for advice or treatment from doctors by phone, mobile app, or video―24/7
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✔
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$0 dental: crowns, dentures, imaging, implants, oral surgery, and more
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✔
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$848 per year, on the Save Now card, to buy food, and items for your health and personal care
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✔
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$570 per year toward eyewear
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✔
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$400 per year toward new fitness trackers, new cardio equipment, fitness classes, or gym memberships
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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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You also get extra benefits and services such as:
Free vision exams
Telehealth
- Visits with your primary care provider, specialist, or other health care providers
- 24/7 access to doctors by phone, internet, or mobile device
- 24/7 access to registered nurses who will recommend where you should receive care or will connect you to your doctor
And more!
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.
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 also 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.
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.
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. SilverSneakers is a registered trademark of Tivity Health, Inc. © 2023 Tivity Health, Inc. All rights reserved. Adobe is a registered trademark of Adobe Systems Incorporated.
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The information on this page was last updated on 10/1/2023.