one Learn about NaviCare

With NaviCare®, you get covered Medicare and MassHealth Standard benefits, items and services—plus more. We also coordinate all your care for you! You get personalized care, from your own Care Team, which includes a Navigator and Nurse Case Manager or Advanced Practitioner who are assigned to you. We want to help you meet your health goals. And when you’re a member of NaviCare HMO SNP or NaviCare SCO, you receive all the care and services you need at no cost to you.

Care designed just for your needs

Getting the right care at the right time is important for your good health. As a NaviCare member, you'll have a care plan designed to help you meet your health goals. Based on your health care needs, you may receive: 

  • A personalized, in-home care plan with support services and medical care
  • Assistance with bathing, dressing and home meal preparation
  • Adult day health program providing recreational and social activities

The cost

There is no cost to you. With NaviCare, there are no monthly premiums, no copayments, no coinsurance, and no deductibles.

The benefits

With NaviCare, you get benefits, items and services covered by Medicare and MassHealth Standard—and much more, at no cost to you. 
Learn more about your benefits »  

Your Care Team

When you’re a member of NaviCare, you have a team of experts who are dedicated to helping you meet your health goals. Your Care Team reviews your care plan regularly, based on information in a secure, shared electronic record.  And because the members of your Care Team have up-to-date information about your complete care plan, they can help you make better decisions about your care.

Each member of your Care Team has a different role:

Navigator

  • Organizes your benefits and services
  • Arranges rides to and from medical appointments
  • Advocates for your needs

Nurse Case Manager (or Advanced Practitioner)

  • Assesses your clinical needs
  • Teaches you about your medications and conditions
  • Makes sure you get the care you need at the time
    of care transition, like when you are discharged from a medical facility

Geriatric Support Service Coordinator (if needed)

  • Evaluates and coordinates your need for in-home
    services
  • Helps you with your MassHealth paperwork
  • Connects you with helpful resources

Primary Care Provider

  • Directs your care
  • Provides routine medical services
  • Refers you to specialists

Behavioral Health Case Manager (as needed)

  • Coordinates services to address your mental health
    and substance use disorder needs
  • Coordinates with your team and mental health
    and substance use providers

Facility liaison (if needed)

  • Connects your team with the staff at your
    long-term-care, rest home, or assisted living facility

NaviCare's service area

NaviCare’s service area includes the entire state of Massachusetts except Dukes and Nantucket Counties. 

Learn more at an informational meeting

Get questions answered in person at one of our informational meetings near you. See the schedule of meetings »

Next steps

 

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. NaviCare SCO is available to anyone age 65 and older who has MassHealth Standard and lives in the service area. Individuals who also have Medicare Parts A and B may enroll in NaviCare HMO SNP. This information is not a complete description of benefits. Contact the plan for more information. Limitations and restrictions may apply. Benefits may change on January 1 of each year. You must continue to pay your Medicare Part B premium unless the Commonwealth of Massachusetts pays this premium for you. The provider network may change at any time. You will receive notice when necessary.

H9001_N_2018_10 Approved 10192017
The information on this page was last updated on 10/1/2017.

Next steps