Learn about NaviCare

NaviCare SCO is a Senior Care Options program for people age 65 and older, who live in our service area, and who have MassHealth Standard. It combines MassHealth (Medicaid) and Medicare benefits, including prescription drug coverage. For people who have Medicare Parts A and B, in addition to MassHealth Standard, NaviCare HMO SNP is a Medicare Advantage HMO Special Needs Plan that offers the same benefits as our SCO plan along with Medicare Part D prescription drug coverage. As a NaviCare member, you can’t be enrolled in another health insurance plan, except Medicare.

More benefits for $0

NaviCare includes all MassHealth Standard and Medicare benefits, plus a lot more—at no cost to you! 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. Learn more about your benefits »   

Your Care Team

As a NaviCare member, you’ll have an entire team dedicated to making sure you get the care you need, when you need it. And, your Navigator can save you time by helping you make doctor appointments. Members of your team may include a: 

Navigator

  • Educates you about your benefits and services
  • Helps you get care and services
  • Helps you make medical appointments

Primary Care Provider

  • Directs your care
  • Provides medical services

Nurse Case Manager (or Advanced Practitioner)

  • Evaluates your clinical and daily needs
  • Teaches you about your medications 
  • Makes sure you get the care and services you need after a stay in a medical facility

Behavioral Health Case Manager (as needed)

  • Coordinates services to support your emotional health and well-being

Geriatric Support Services Coordinator (if needed)

  • Connects your needed in-home services

Clinical pharmacist (if needed)

  • Calls or visits you after you a hospitalization to review your medications and work with your medical providers

Eligibility and service area

As a NaviCare member, you can’t be enrolled in another health insurance plan, except Medicare. Additionally, to qualify you must:

  • Be age 65 or older
  • Have, or be eligible for MassHealth Standard*
  • Live in the NaviCare service area, which includes all of the cities and towns in Massachusetts except those in Nantucket and Dukes counties.

*If you have only MassHealth Standard, you can join NaviCare SCO. If you also have Medicare Parts A and B, you can enroll in NaviCare HMO SNP. Both plans offer the same coverage and benefits.

Not sure if you qualify for MassHealth Standard? Our team will help you determine if you’re eligible—or re-apply if you have lost coverage.

Learn more at an informational meeting

Join us at a presentation and get your questions answered by a member of our local team. Can’t make one of our live presentation times? No problem. You can call us to schedule a one-on-one meeting. See the schedule of presentations »

Next steps

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.

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The information on this page was last updated on 10/1/2022.

Next steps