Fallon Senior Plan Special Needs Plans
These are our plans designed for people who
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Would you like more information about Fallon Senior Plan? |
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are enrolled in both Medicare and Medicaid/a Medicare Savings Program. We have two Special Needs Plans: Fallon Senior Plan Value 1 and Fallon Senior Plan Value 2.
Both plans have a $0 monthly premium and include Medicare prescription drug coverage.
Benefits overview
Fallon Senior Plan Value 1 and Fallon Senior Plan Value 2 benefits include:
- Coordinated care by your primary care physician
- Vision care, including eyeglasses, every two years at no additional cost
- Membership in the SilverSneakers® Fitness Program at no additional cost
- A 12-consecutive-week Weight Watchers® membership
- Worldwide emergency coverage
- Dental care benefits (Fallon Senior Plan Value 1 only)
- $1,000 every three years towards hearing aids (Fallon Senior Plan Value 1 only)
- Routine podiatry services (Fallon Senior Plan Value 2 only)
Details - Fallon Senior Plan Value 1 and Fallon Senior Plan Value 2
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Fallon Senior Plan Value 1 and Fallon Senior Plan Value 2 monthly premium |
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$0 |
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Fallon Senior Plan Value 1 and Fallon Senior Plan Value 2 medical benefits
What you pay for services may differ depending on your level of Medicaid benefits. |
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Fallon Senior Plan Value 1 |
Fallon Senior Plan Value 2 |
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Inpatient hospital care |
$0 or $50 per day for
days 1 – 3.
$0 for additional days. |
$0 for each stay. |
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Skilled nursing facility care |
$0 for each stay. |
$0 for each stay. |
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Doctor office visits |
$0 or $5 per visit. |
$0 per visit. |
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Specialist office visits |
$0 or $10 per visit. |
$0 per visit. |
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Outpatient services/ surgery |
$0 per surgery. |
$0 per surgery. |
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Ambulance services |
$0 or $50 for Medicare-covered ambulance services. |
$0 for Medicare-covered ambulance services. |
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Emergency room visits (copayment waived if admitted within 72 hours for the same condition) |
$0 or $50 per visit.
Worldwide coverage. |
$0 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 or $0 to $50 copayment for Medicare-covered diagnostic radiology services. |
$0 copayment for Medicare-covered:
- lab services
- diagnostic procedures and tests
- X-rays
- therapeutic radiology services
- diagnostic radiology services. |
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Dental services |
$0 to $10 for each routine checkup
$0 to $51 for fillings. |
In general, preventive dental benefits (such as cleanings) not covered. |
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Vision services |
$0 to $10 for 1 routine eye exam every two years.
Up to 1 pair of glasses every two years. |
$0 for 1 routine eye exam every two years.
Up to 1 pair of glasses every two years. |
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Hearing services |
- $0 or $5 to $10 copay for
Medicare-covered diagnostic
hearing exams
- $0 to $10 copay for routine
hearing tests
- $0 to $10 copay for hearing
aid fitting evaluations
- $0 to $10 copay for up to 1
hearing aid(s) every three
years
$1,000 limit for hearing aids every three years. |
Hearing aids not covered.
-$0 copay for Medicare-covered
diagnostic hearing exams
- up to 1 routine hearing test(s)
every year |
| Podiatry services |
$0 or $5 copay for each visit |
$0 copay for 6 routine visits every year. |
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Fallon Senior Plan Value 1 and Fallon Senior Plan Value 2 Medicare prescription drug coverage |
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For drugs covered under Medicare Part D:
Before your yearly out-of-pocket drug costs reach $4,350, depending on your income level you pay the following for retail and mail-order prescription drugs:
- You pay a $1.10 or $2.40 copayment for generic drugs (including brand drugs treated as generic).
- You pay a $3.20 or $6.00 copayment for brand name drugs.
After your yearly out-of-pocket drug costs reach $4,350, you pay $0 for your drugs.
For drugs not covered under Medicare Part D (benzodiazepine and barbiturate therapeutic category drugs):
You pay copayments for these prescription drugs for the entire 2009 calendar year.
For up to a 30-day supply:
Tier 1: $5
Tier 2: $20
Tier 3: $40
People who live in long-term care facilities will have $0 prescription copayments. Contact the plan for details. |
Helpful documents for our special needs plans
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.
Quick reference guide:
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.
Call us toll-free at 1-888-340-5504 (TDD/TTY: 1-877-608-7677), 8 a.m. to 8 p.m., seven days a week.