Benefits and services

NaviCare HMO combines all the benefits that are covered by Medicare and MassHealth Standard into one program. Navicare HMO also includes Medicare Part D.  When you become a member, you'll have one member card that you'll use to get all these benefits.

Premiums and copayments

As a NaviCare HMO member, you'll have no premiums and no copayments.

Low income subsidy
This table shows you what your monthly plan premium will be since you get extra help from Medicare to help pay for your Medicare prescription drug plan costs.

What's covered

With NaviCare HMO, you get complete coverage for all of your health and health-related services that include medical, prescription drug, and home and personal care services. 

NaviCare HMO covers Medicare and MassHealth Standard benefits like:

  • Doctor visits
  • Prescription and over-the-counter drugs
  • Hospital stays
  • Rehabilitation services
  • Eyeglasses and vision services
  • Dental care
  • Free transportation to and from medical and rehabilitation appointments  
  • Care management services including home support services, rehabilitative therapy, behavioral health, and substance abuse treatment

NaviCare HMO also gives you many extra benefits and services that you may need to stay healthy:

  • Your personal Navigator, who is someone who will help you with:
    • Scheduling doctor visits
    • Coordinating rides for medical and rehabilitation appointments
    • Making arrangements for in-home care services approved by your Primary Care Team
  • You'll have your own primary care team made up of your doctor, nurses, social services and a personal Nurse Case Manager and Navigator who will coordinate and manage your health care needs. You will also have a geriatric support service coordinator who will help arrange for community services. Your primary care team will work with you to develop your own flexible care plan which will include specialized services that you need to stay healthy.  You'll have 24 hour-a-day, 7-day-a-week access to your primary care team, and if you need your primary care team to come to you, they'll even make home visits.
  • A centralized electronic record of your up-to-date health, medical and drug information which will make it easier for your primary care team to manage and coordinate your health care
  • Caregiver support
  • SilverSneakers®, a health and fitness program
  • A 12-consecutive-week membership in Weight Watchers®
  • Quit to Win, our stop smoking program

For more details on benefits, services and coverage, you can download the documents below:

Summary of benefits
A summary of benefits is a booklet that provides details on plan benefits.

Evidence of Coverage
An evidence of coverage (EOC) is a booklet that we provide once you become a member. It’s part of your contract with us and it describes your complete benefits as well as how to use the plan. You can also find information about grievance, coverage determination, exceptions and appeals processes in your plan's evidence of coverage.

  • Medicare Advantage Evidence of Coverage (pdf, 1.3MB)
    This EOC is for members who are enrolled in both Medicare and MassHealth Standard.
  • MassHealth-only Evidence of coverage (pdf, coming soon)
    This EOC is for members who are enrolled in MassHealth Standard but are not enrolled in Medicare.

You must receive all routine care from plan providers.

SilverSneakers® is a registered trademark of Healthways. Weight Watchers® is a registered trademark of Weight Watchers International, Inc.

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