Fallon Senior Plan PPO plan
Our Medicare Advantage PPO plan, which is ca
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Would you like more information about Fallon Senior Plan? |
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lled Fallon Senior Plan Preferred Enhanced Rx, covers more than if you were covered by Original Medicare alone.
Our PPO provider network
With our Fallon Senior Plan Preferred (PPO) network, you have access to thousands of doctors in Central Massachusetts.
You can even go to doctors and facilities who aren't in the PPO provider network, but you may pay more than if you saw an in-network provider.
Benefits overview
Our PPO plan includes:
- Routine annual physical exams
- Worldwide emergency coverage
- Membership in the SilverSneakers® Fitness Program at no additional cost
- Weight Watchers®
- Vision care
Details - PPO plan
| Fallon Senior Plan Preferred Enhanced Rx monthly plan premium |
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$120
You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party. If you receive extra help with your Medicare premiums, your costs may be lower. |
| Fallon Senior Plan Preferred Enhanced Rx medical benefits |
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In-network |
Out-of-network |
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Deductible |
Not applicable. |
$500 annual deductible. |
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Out-of-pocket limit |
$3,350 annual out-of-pocket limit on Medicare-covered services received in-network. |
$7,500 annual out-of-pocket limit on all services received out-of-network. |
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Inpatient hospital care |
$125 per day for days 1 – 5.
$0 for additional days. |
20% of the cost for each hospital stay. |
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Skilled nursing facility care |
$20 per day for days 1 – 20.
$0 for additional days. |
20% of the cost for each skilled nursing facility stay. |
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Doctor office visits |
$20 per visit. |
$40 per visit. |
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Specialist office visits |
$25 per visit. |
$40 per visit. |
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Outpatient services/surgery |
$0 to $75 per surgery. |
20% of the cost per surgery. |
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Ambulance services |
$50 for Medicare-covered ambulance services. |
$50 for Medicare-covered ambulance services. |
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Emergency room visits (copayment waived if admitted within 72 hours for the same condition) |
$50 per visit.
Worldwide coverage. |
$50 per visit.
Worldwide coverage. |
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Diagnostic tests, X-rays, and lab services |
$0 copayment for Medicare-covered:
- lab services
- diagnostic procedures and tests
- X-rays
- therapeutic radiology services
$0 to $50 copayment for Medicare-covered diagnostic radiology services. |
20% of the cost for:
- diagnostic procedures, tests, and lab services
- therapeutic radiology services
- outpatient X-rays
- diagnostic radiology services
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Vision services |
$20 to $25 for:
- up to one routine eye exam every two years
- exams to diagnose and treat diseases of the eye
Up to one pair of glasses every two years for $0. |
$40 for eye exams.
20% of the cost for eyewear. |
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Fallon Senior Plan Preferred Enhanced Rx
Medicare prescription drug coverage |
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Deductible |
No deductible |
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Initial coverage copayments for up to a 30-day supply
(until your yearly drug costs paid by both you and Fallon Senior Plan reach $2,700) |
Tier 1: $10
Tier 2: $30
Tier 3: $55 |
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Coverage gap
(after yearly drug costs reach $2,700 and until your own costs reach $4,350) |
You pay 100% of drug costs |
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Catastrophic coverage
(after your yearly drug costs reach $4,350) |
You pay the greater of:
$2.40 for generic or a preferred brand drug and $6.00 for all other drugs, or 5% coinsurance |
Helpful documents for our Preferred Enhanced Rx PPO plan
Summary of Benefits
A summary of benefits is a booklet that compares our benefits with Original Medicare benefits. Summaries of Benefits also provide more detailed information about Fallon Senior Plan's medical benefits.
Benefits-at-a-glance for our Preferred Enhanced Rx PPO plan:
Find out more about our other Medicare Advantage Plans
SilverSneakers® is a registered trademark of Healthways. Weight Watchers® is a registered trademark of Weight Watchers International, Inc.