2023 Fallon Medicare Plus Saver No Rx HMO (HMO)

Fallon Medicare Plus Saver No Rx HMO (HMO) H9001-039 is a 2023 Medicare Advantage Plan or Part-C by Fallon Health available to residents in Massachusetts. This plan does not provide extra prescription drug (Part-D) coverage. Fallon Health Fallon Medicare Plus Saver No Rx HMO (HMO) has a monthly premium of $35.00 and has an in-network maximum out-of-pocket limit of $7,550 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $7,550 out-of-pocket. This can be an extremely nice safety net.

Fallon Health works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Fallon Medicare Plus Saver No Rx HMO (HMO) you still retain Original Medicare. But you will get extra Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Fallon Health and not Original Medicare. With 2023 Medicare Advantage Plan you are always covered for urgently needed and emergency care. Plus, you receive all the benefits of Original Medicare from Fallon Health except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in Massachusetts.



2023 Fallon Health Medicare Advantage Plan Overview

Name:Fallon Medicare Plus Saver No Rx HMO (HMO)
Plan ID:H9001 039 0
Provider:Fallon Health
Year:2023
Type:Local HMO *
Combined Premium (C+D):$35.00/mo
MOOP:$7,550/yr
Similar Plan: H9001-040




What type of plan is Fallon Medicare Plus Saver No Rx HMO (HMO)

Fallon Medicare Plus Saver No Rx HMO (HMO) is a Local HMO *. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your primary care physician will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your primary care physician approval, called a referral. Services received from an out-of-network provider are not typically covered.

How much does Fallon Medicare Plus Saver No Rx HMO (HMO) cost?


Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Fallon Health charges a $35.00 premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.


MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Fallon Medicare Plus Saver No Rx HMO (HMO) by Fallon Health MOOP is $7,550. Once you spend $7,550 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.





2023 Summary of Benefits


The benefit information provided is a summary of what Fallon Medicare Plus Saver No Rx HMO (HMO) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Fallon Health helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.

Wellness programs (e.g., fitness, nursing hotline)Covered



Contact lenses


Vision$0 copay



Eyeglass frames


Vision$0 copay



Eyeglass lenses


Vision$0 copay



Eyeglasses (frames and lenses)


Vision$0 copay



Other


VisionNot covered



Routine eye exam


Vision$40 copay



Upgrades


Vision$0 copay




Transportation$35 copay
Skilled Nursing Facility$0 per day for days 1 through 20
$150 per day for days 21 through 44
$0 per day for days 45 through 100



Occupational therapy visit


Rehabilitation services$20 copay



Physical therapy and speech and language therapy visit


Rehabilitation services$20 copay



Cleaning


Preventive dentalCovered under office visit



Dental x-ray(s)


Preventive dentalCovered under office visit



Fluoride treatment


Preventive dentalCovered under office visit



Office visit


Preventive dental$25.00



Oral exam


Preventive dentalCovered under office visit




Preventive care$0 copay
Outpatient hospital coverage$275 copay per visit
In-Network Other health plan deductibles?No
Optional supplemental benefitsNo



Inpatient hospital - psychiatric


Mental health services$300 per day for days 1 through 5
$0 per day for days 6 through 90



Outpatient group therapy visit


Mental health services$40 copay



Outpatient group therapy visit with a psychiatrist


Mental health services$40 copay



Outpatient individual therapy visit


Mental health services$40 copay



Outpatient individual therapy visit with a psychiatrist


Mental health services$40 copay



Chemotherapy


Medicare Part B drugs20% coinsurance



Other Part B drugs


Medicare Part B drugs20% coinsurance



Diabetes supplies


Medical equipment/supplies$0 copay



Durable medical equipment (e.g., wheelchairs, oxygen)


Medical equipment/supplies20% coinsurance per item



Prosthetics (e.g., braces, artificial limbs)


Medical equipment/supplies20% coinsurance per item




Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$7,550 In-network
Inpatient hospital coverage$300 per day for days 1 through 5
$0 per day for days 6 through 90



Fitting/evaluation


HearingNot covered



Hearing aids


Hearing$695-2,645 copay



Hearing exam


Hearing$40 copay




Health plan deductible$0
Ground ambulance$200 copay



Foot exams and treatment


Foot care (podiatry services)$40 copay



Routine foot care


Foot care (podiatry services)Not covered



Emergency


Emergency care/Urgent care$90 copay per visit (always covered)



Urgent care


Emergency care/Urgent care$25 copay per visit (always covered)



Primary


Doctor visits$25 copay per visit



Specialist


Doctor visits$20-40 copay per visit



Diagnostic radiology services (e.g., MRI)


Diagnostic procedures/lab services/imaging$250 copay



Diagnostic tests and procedures


Diagnostic procedures/lab services/imaging$0 copay



Lab services


Diagnostic procedures/lab services/imaging$0 copay



Outpatient x-rays


Diagnostic procedures/lab services/imaging$0 copay



Diagnostic services


Comprehensive dental$6-40 copay



Endodontics


Comprehensive dental$34-990 copay



Extractions


Comprehensive dental$37-506 copay



Non-routine services


Comprehensive dentalNot covered



Periodontics


Comprehensive dental$80-953 copay



Prosthodontics, other oral/maxillofacial surgery, other services


Comprehensive dental$0-865 copay



Restorative services


Comprehensive dental$31-856 copay




In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?No




Fallon Medicare Plus Saver No Rx HMO (HMO) Reviews


Is Fallon Medicare Plus Saver No Rx HMO (HMO) a good plan? Fallon Medicare Plus Saver No Rx HMO (HMO) received a 4.5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare Fallon Medicare Plus Saver No Rx HMO Reviews among several different plans.

2022 Overall Rating
Part C Summary Rating
Part-D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing


Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Monitoring Physical Activity


Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Pain Assessment
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Controlling Blood Pressure
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy


Member Experience with H9001-039 Health Plan

Total Experience Rating
Getting Needed Care
Getting Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints and Changes in Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement


Health Plan Customer Service Rating for Fallon Health

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language


Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language


Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement


Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs


Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes


Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for Fallon Medicare Plus Saver No Rx HMO (HMO) requires you to live in that plan’s service area. The service area is listed below:



Go to top

How much does Fallon Medicare Plus Saver No Rx HMO (HMO) cost?

Fallon Health charges a $35.00 monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage. The premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

How much is Fallon Medicare Plus Saver No Rx HMO (HMO) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Fallon Medicare Plus Saver No Rx HMO (HMO) by Fallon Health MOOP is $7,550. Once you spend $7,550 you will pay nothing for Part A or Part B covered services.

What type of plan is Fallon Medicare Plus Saver No Rx HMO (HMO)?

Fallon Medicare Plus Saver No Rx HMO (HMO) is a Local HMO *. With a health maintenance organization you will be required to receive most of your health care from an in-network provider. HMOs require that you select a primary care physician (PCP).

Is Fallon Medicare Plus Saver No Rx HMO (HMO) a good plan?

Fallon Medicare Plus Saver No Rx HMO (HMO) received a 4.5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance.



Source:CMS. Data as of Oct 1, 2022.

Last updated on

Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer extra cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

      Site Search:

MedicareHelp.org is a privately-owned Non-governmental agency. The government website can be found at HealthCare.gov.

Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. Enrollment depends on the plan’s contract renewal.

Every year, Medicare evaluates plans based on a 5-star rating system.