Fallon Senior Plan Saver (HMO) By Fallon Senior Plan or NaviCare
Fallon Senior Plan Saver (HMO) is a 2014 Medicare Advantage ("Part C" or "MA Plan") plan by Fallon Senior Plan or NaviCare. This plan from Fallon Senior Plan or NaviCare works with Medicare to give you significant coverage beyond Part A and Part B benefits. If you decide to sign up for Fallon Senior Plan Saver (HMO) you still retain Original Medicare. But you will get additional Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from Fallon Senior Plan or NaviCare and not Original Medicare. With Medicare Advantage plans your always covered for urgently needed and emergency care and you receive all of the benefits of Original Medicare from this plan except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.
2014 Medicare Advantage Plan Details
| Plan Name: | Fallon Senior Plan Saver (HMO) |
|---|---|
| Plan ID: | H9001-029 |
| Provider: | Fallon Senior Plan or NaviCare |
| Plan Year: | 2014 |
| Plan Type: | Local HMO * |
| Monthly Premium C+D: | $53.00 |
| MOOP: | $6,700 |
Coverage Area for Fallon Senior Plan Saver (HMO)
(Click county to compare all available plans)
The Fallon Senior Plan Saver (HMO) H9001-029 is available to residents in Massachusetts, and has a in-network Maximum Out-of-Pocket limit of $6,700 MOOP. This means that if you get sick or need a high cost procedure your co-pays are capped. If you enroll in Fallon Senior Plan Saver (HMO) plan you will stop paying co-pays for the rest of the year once you pay out of pocket $6,700 This is a very nice safety net. This plan does not provide additional Medicare prescription drug (Part-D) coverage.
Fallon Senior Plan Saver (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 PCP will serve as your personal doctor to provide all of your basic healthcare services. If you need special care for a physician specialist, your primary care physician will make the arrangements and tell you where you can go in the network. You will need your PCPs okay, called a referral. Without getting a referral or services received from out-of-network providers are not typically covered by the plan.
Ratings for Fallon Senior Plan Saver (HMO) H9001
| 2014 Overall Rating | ||
|---|---|---|
| Part C Summary Rating | ||
| Total Experience Rating | ||
| Complaints, Improvements | ||
| Total Customer Service Rating | ||
| Total Preventative Rating | ||
| Chronic And Long Term Care |
Member Experience Rating for Fallon Senior Plan Saver (HMO)
| Total Experience Rating | ||
|---|---|---|
| Getting Needed Care | ||
| Timely Care and Appointments | ||
| Customer Service | ||
| Health Care Quality | ||
| Rating of Health Plan | ||
| Care Coordination |
Member Complaints, Problems Getting Service and Improvements in Health Plans
| Total Rating | ||
|---|---|---|
| Members Leaving the Plan | ||
| Complaints about Health Plan | ||
| Access to Service | ||
| Performance Problems | ||
| Health Plan Quality Improvement |
Customer Service Rating for Fallon Senior Plan Saver (HMO)
| Total Customer Service Rating | ||
|---|---|---|
| Timely Decisions About Appeals | ||
| Reviewing Appeals Decisions | ||
| Call Center |
Staying Healthy, Screening, Testing, & Vaccines
| Total Preventative Rating | ||
|---|---|---|
| Breast Cancer Screening | ||
| Colorectal Cancel Screening | ||
| Cardiovascular Screening | ||
| Diabetes Care | ||
| Glaucoma Testing | ||
| Annual Flu Vaccine | ||
| Improving Physical | ||
| Improving Mental Health | ||
| Monitoring Physical Activity | ||
| Adult BMI Assessment |
Ratings For Managing Chronic And Long Term Care
| Total Rating | ||
|---|---|---|
| Medication Review | ||
| Functional Status Assessment | ||
| Pain Screening | ||
| Osteoporosis Management | ||
| Diabetes Care - Eye Exam | ||
| Diabetes Care - Kidney Disease | ||
| Diabetes Care - Blood Sugar | ||
| Diabetes Care - Cholesterol | ||
| Controlling Blood Pressure | ||
| Rheumatoid Arthritis | ||
| Improving Bladder Control | ||
| Reducing Risk of Falling | ||
| Plan - Cause Readmissions |
Source: CMS.
Plans as of September 3, 2013.
Star Rating as of September 27, 2013.
For More Information on Ratings Please See the CMS Tech Notes Here.
Plans are subject to change as contracts are finalized.
Includes 2014 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.
