Benefits, items and services


NaviCare HMO SNP is a Medicare Advantage HMO Special Needs Plan for people over the age of 65 who live in our service area and have both Medicare and MassHealth Standard. It combines MassHealth and Medicare benefits, including Medicare Part D prescription drug coverage. For people who qualify only for MassHealth Standard, NaviCare SCO offers the same benefits as NaviCare HMO SNP.

$0 premiums and cost-sharing

As a NaviCare member, you'll have no monthly plan premium, no copayments, no coinsurance and no deductibles.

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.

What's covered

NaviCare covers MassHealth Standard and Medicare benefits, items and services such as:

  • Doctor visits—in-person and through telehealth services
  • Prescription drugs on our formulary and certain over-the-counter drugs with a prescription
  • Hospital stays
  • Rehabilitation services
  • Diagnostic hearing services, including hearing aids and batteries
  • Durable medical equipment (such as canes and wheelchairs)
  • Personal emergency response systems
  • In-home care
  • Personal care services
  • Unlimited rides to and from medical appointments
  • Dental cleanings and dentures
  • Vision services 

You also get extra benefits and services such as:

  • Rides to the pharmacy, grocery store or other approved locations  (up to 140 one-way rides per year, limit of one round-trip ride per day)
  • Up to $240 ($300 in 2020) toward the purchase of supplemental eyewear, every plan year
  • Enhanced dental services, including crowns, dentures and implants
  • Up to $100 to buy healthy food (H9001_200091_M, pdf). You can earn this money by completing healthy activities like getting a flu shot or getting your annual physical exam.
  • Up to $480 per year ($500 per year in 2020) on the Save Now card to help pay for certain health-related items like cold/allergy medications, aspirin, toothbrushes/toothpaste, probiotics, fish oil and more. You can buy these items in retail stores or order for home delivery.
  • Telehealth service that provides 24 hour/7 day-a-week access to a doctor by phone, mobile app or online at no cost to you
  • SilverSneakers® fitness program that offers free online fitness classes and on-demand workout videos, a free gym membership, and more
  • A 13-consecutive-week membership in WW® (formerly Weight Watchers)
  • Quit to Win, our program to help you stop using tobacco
  • A Navigator to help you manage your care, coordinate medical appointments and advocate for your needs 

More information about benefits, items, services and coverage

For more details on benefits, items, 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.

2021

2020

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.

2021

  • NaviCare HMO SNP Evidence of Coverage (H9001_210044_C, pdf) 
  • NaviCare HMO SNP Evidencia de cobertura (muy pronto, pdf) 
    This EOC is for members who are enrolled in Medicare Parts A and B and MassHealth Standard.
  • NaviCare SCO Evidence of Coverage (SCO_210043_C, pdf)
  • NaviCare SCO Evidencia de cobertura (muy pronto, pdf) 
    This EOC is for members with MassHealth Standard alone or MassHealth Standard and Medicare Part A OR B.

2020 

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.

2021

2020

Dental Addendum

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

2021

2020

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 Weight Watchers International, Inc. Adobe is a registered trademark of Adobe Systems Incorporated.

H9001_210083_M
The information on this page was last updated on 10/1/2020.