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!

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 and from medical appointments

Free rides to visit friends, run errands, attend religious services, and more. Up to 140 one-way trips per year.

 

Free SilverSneakers®: includes gym membership, access to online classes, and more

 

$0 for advice or treatment from doctors by phone, mobile app, or video―24/7

 

$0 dental: crowns, dentures, imaging, implants, oral surgery, and more

 

Up to $200 per year on the Self-Care card to buy personal care items and food products>

 

$400 per year toward new fitness trackers, new cardio equipment, fitness classes, or gym memberships

 

$570 per year toward eyewear

 

Up to $600 per year on the Save Now card to buy health and hygiene products

 

A Care Team that makes sure you get the care and benefits you need

 

You also get extra benefits and services such as:

Mileage reimbursement to your friends and family who give you rides that have been pre-approved.

Up to $100 per year on the Healthy Food card —to buy fruits, veggies, meat, and more. Money is awarded when you complete certain activities like getting a flu shot, COVID-19 vaccine, or annual physical exam.

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

SilverSneakers®

  • Basic gym membership
  • Live online classes and workshops
  • On-demand video workouts and more
  • A fitness app to track your activity and watch videos on the go

New for 2023–Papa Pals!

  • A voluntary In-Home Support Services program that partners you with a Papa Pal—a carefully chosen Pal who lives in your area and who will help you with daily needs like grocery shopping, medication pickup, light housekeeping, meal preparation, help with technology, and more. 

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.

2023

2022

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.

2023

2022 

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.

2023

2022

Dental Addendum

This shows dental services that are covered when you receive them from a dentist in the NaviCare network.

2023

2022

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. WW® is a registered trademark of WW International, Inc. Adobe is a registered trademark of Adobe Systems Incorporated.

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

Low-income subsidy
The low-income subsidy table shows you what your monthly plan premium will be, if you get Extra Help from Medicare to help pay for your Medicare prescription drug plan costs. You will also find information on how to find out if you qualify for Extra Help. Note: All NaviCare members qualify for Extra Help since you must qualify for MassHealth Standard to enroll in NaviCare.