Benefits, items and services
NaviCare HMO SNP is a Medicare Advantage Health Maintenance Organization Special Needs Plan that combines MassHealth Standard benefits 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.
Premiums and cost-sharing
As a NaviCare member, you'll have no monthly premiums, no copayments, no coinsurance and no deductibles.
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.
NaviCare covers MassHealth Standard and Medicare benefits, items and services such as:
You also get extra benefits and services such as:
- Free eyewear, plus $400 each year towards additional eyewear and vision services
- Enhanced dental services, including crowns and root canals
- Free rides to the gym, fitness classes, the grocery store, church and other places (up to 80 round-trip rides per year, limit of one round-trip ride per day)
NEW FOR 2017 Savings card that you can use to buy certain over-the-counter items at no cost
NEW FOR 2017 24 hour/7 day-a-week access to a doctor by phone or internet
- Free gym membership through SilverSneakers® and up to $200 reimbursement for another qualified fitness facility or fitness classes (H9001_N_2015_102 Approved 01072015, pdf)
- A 13-consecutive-week membership in 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 arrange in-home services
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.
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 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.
NaviCare HMO SNP Evidence of Coverage (H9001_N_2017_ 2 Accepted 09222016, pdf)
NaviCare HMO SNP Evidencia de cobertura (muy pronto)
This EOC is for members who are enrolled in Medicare Parts A and B and MassHealth Standard.
NaviCare SCO Evidence of Coverage (SCO_2017_3 Approved 09302016, pdf)
NaviCare SCO Evidencia de cobertura (muy pronto)
This EOC is for members with MassHealth Standard alone or MassHealth Standard and Medicare Part A OR B.
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, 2017.
This shows dental services that are covered when you receive them from a dentist in the NaviCare network.
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. 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 Formulary and/or provider network may change at any time. You will receive notice when necessary. SilverSneakers® is a registered trademark of Healthways. Weight Watchers® is a registered trademark of Weight Watchers International, Inc. Adobe is a registered trademark of Adobe Systems Incorporated.
H9001_N_2017_16 Approved 10142016
The information on this page was last updated on 10/1/2016.