Benefits, items and services


NaviCare SCO is a Senior Care Options program for people age 65 and older, who live in our service area and who have MassHealth Standard. It combines MassHealth and Medicare benefits, including prescription drug coverage. For people who have Medicare Parts A and B, in addition to MassHealth Standard, NaviCare HMO SNP is a Medicare Advantage HMO Special Needs Plan that offers the same benefits as our SCO plan along with Medicare Part D prescription drug coverage. As a NaviCare member, you can’t be enrolled in another health insurance plan, except Medicare.

$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. Note: All NaviCare members qualify for Extra Help since you must qualify for MassHealth Standard to enroll in NaviCare.


What's covered

NaviCare covers Medicare and MassHealth Standard 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
  • Dental cleanings and dentures
  • Vision services 
  • Unlimited free rides to and from medical appointments and places where you receive health care

You also get extra benefits and services such as:

  • Free rides to visit friends, run errands, attend religious services and more. Get rides from Fallon’s partner service, or your own friends and family who can receive reimbursement for mileage of pre-approved rides.
  •  INCREASED AMOUNT FOR 2022!  Up to $570 ($240 in 2021), every year, for up to two pairs of new eyeglasses, frames, lenses or contacts.
  • $0 dental, including imaging, crowns, dentures, implants and more
  • Earn up to $100 a year on the Healthy Food card to buy fruits, veggies, meat and more. Money is awarded when you complete certain activities like getting a flu shot or annual physical exam. Learn more. (H8928_220206_C, pdf). 
  •  INCREASED AMOUNT FOR 2022!  Up to $600 a year ($480 a year in 2021) on the Save Now card to buy things like toothbrushes, pain relievers, probiotics and more. You can buy these items in retail stores or order for home delivery from NationsOTC at NationsOTC.com. (This link takes you away from the NaviCare website.) The NationsOTC website does not work on Internet Explorer. Please use one of these browsers instead: Microsoft Edge, Mozilla Firefox, Apple Safari, iOS Safari or Google Chrome. To check your Save Now card balance, call 1-833-746-7682 (TTY 711), Monday–Friday, 8 a.m.–8 p.m.
  • Telehealth service that provides provides 24-hour/7 day-a-week access to a doctor by phone, mobile app or online at no cost to you. 
  • SilverSneakers®, a program that offers free online fitness classes and on-demand workout videos, a free gym membership, and more. (This link takes you away from the NaviCare website.)
  • 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 view or download any of the documents below.

Summary of Benefits

2022

A Summary of Benefits is a booklet that provides details on plan benefits.

2021

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.

2022 

  • NaviCare HMO SNP Evidence of Coverage (H8928_220001_C, pdf) 
  • NaviCare HMO SNP Evidencia de cobertura (H8928_220001SP_C, 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_220002_C, pdf)
  • NaviCare SCO Evidencia de cobertura (SCO_220002SP_C, muy pronto) 
    This EOC is for members with MassHealth Standard alone or MassHealth Standard and Medicare Part A OR B.

2021

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.

2022

2021

Dental Addendum

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

2022

2021

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.

H8928_220180_M
The information on this page was last updated on 10/1/2021.