Fallon Senior Plan Q & A
Question:
What is the difference between Medicare Parts A and B?
Answer:
You become eligible for Medicare by age or disability. Medicare Part A helps to cover inpatient care in hospitals and skilled nursing care facilities. Most people do not have to pay a monthly payment for Part A because they or their spouses paid Medicare taxes while working.
The Medicare Part B premium helps to cover doctors’ services and outpatient hospital care. Most people will pay $93.50* which is the standard monthly Part B premium. Some people will have to pay a higher premium because of their yearly income (over $80,000 for singles, $160,000 for married couples). For more information on Part B premiums based on income, call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. This amount is automatically taken out of your monthly Social Security check before you receive it. More information about Original Medicare (Part A and B) benefits, deductibles and copayments is available on the Medicare Web site.
* This is the 2007 Medicare cost sharing amount and will change effective January 1, 2008. Social Security will notify you of the new 2008 Medicare Part B premium, deductible and Part A cost sharing amounts prior to January 1, 2008.
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Question:
What is Medicare prescription drug coverage?
Answer:
Medicare prescription drug coverage, also known as Medicare Part D, provides benefits for prescription drugs. It is available to everyone who is eligible for Medicare Parts A and/or B.
Common questions about Medicare Part D
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Question:
How can I get help with paying for my Medicare prescription drug plan costs?
Answer:
If you qualify for extra help with your Medicare prescription drug plan costs, your monthly premium and your drug costs could be lower.
You can see if you qualify by calling:
- 1-800-MEDICARE (1-800-633-4227) (TDD/TTY: 1-877-486-2048)
24 hours a day/seven days a week
- The Massachusetts Medicaid office at 1-800-841-2900 (TDD/TTY: 1-800-497-4648)
- The Social Security Administration at 1-800-772-1213 (TDD/TTY 1-800-325-0778) between 7 a.m. and 7 p.m., Monday through Friday.
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Question:
Is Fallon Senior Plan a supplemental plan?
Answer:
No, Fallon Senior Plan is a Medicare Advantage health plan.
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Question:
What is the difference between Fallon Senior Plan and Original Medicare?
Answer:
Fallon Senior Plan provides more benefits than Original Medicare alone. Our plans include benefits such as:
- $0 copayments for preventive exams such as mammograms, prostate screenings and flu vaccines
- Preventive dental care (except for Fallon Senior Plan Value 2 and Fallon Senior Plan Preferred Enhanced Rx)
- Worldwide emergency coverage.
- SilverSneakers® Fitness Program at no extra cost
- One 12-consecutive-week membership in Weight Watchers® each calendar year
Copayments may be required for some services. Complete benefit information is available in our respective Summary of Benefits.
If you are a member of Fallon Senior Plan through your or your spouse’s current or former employer, your benefits may vary. Please contact your benefits administrator for more information.
SilverSneakers® is a registered trademark of Healthways. Weight Watchers® is a registered trademark of Weight Watchers International, Inc.
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Question:
Is Fallon Senior Plan available to people with Medicare throughout Massachusetts?
Answer:
No, Fallon Senior Plan is only available to people who live in the Fallon Senior Plan service area.
Fallon Senior Plan service area
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Question:
How can I enroll in Fallon Senior Plan?
Answer:
We can accept your application in person, through the mail or via fax. If it’s more convenient, we can offer you an in-home appointment. To set up an in-home sales appointment, call us at 1-888-377-1980 (TDD/TTY: 1-877-608-7677), seven days a week from 8 a.m. to 8 p.m., or via fax 1-508-757-0572.
Learn how to enroll
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Question:
What are the monthly plan premiums for Fallon Senior Plan?
Answer:
The following are our monthly plan premiums.
Fallon Senior Plan’s no drug plans:
Fallon Senior Plan Saver—$0
Fallon Senior Plan Standard—$72
Fallon Senior Plan Plus—$132
Fallon Senior Plan’s drug plans:
Fallon Senior Plan Saver Basic Rx—$28
Fallon Senior Plan Saver Enhanced Rx—$47
Fallon Senior Plan Standard Basic Rx—$100
Fallon Senior Plan Standard Enhanced Rx—$119
Fallon Senior Plan Plus Basic Rx—$160
Fallon Senior Plan Plus Enhanced Rx—$179
Fallon Senior Plan Preferred Enhanced Rx—$212
Fallon Senior Plan’s drug plans for people enrolled in both Medicare and Medicaid/Medicare Savings Program:
Fallon Senior Plan Value 1—$0
Fallon Senior Plan Value 2—$0
You must continue to pay your Part B premium if not otherwise paid for under Medicaid or by another third party.
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Question:
What are Fallon Senior Plan Value 1 and Fallon Senior Plan Value 2?
Answer:
Fallon Senior Plan Value 1 and Fallon Senior Plan Value 2 are plans for people who dually eligible for both Medicare and Medicaid/a Medicare Savings Program.
View eligibility for Fallon Senior Plan Value 1 and Fallon Senior Plan Value 2
Fallon Senior Plan service area
View information about Fallon Senior Plan Value 1 and Fallon Senior Plan Value 2
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Question:
What is the prescription coverage for plans with Basic Rx and Enhanced Rx?
Answer:
Our plans with Basic Rx coverage include the standard Medicare prescription drug coverage. The Enhanced Rx plans provide the same coverage as the Basic Rx plans but have no upfront deductible.
Learn about our Part D coverage
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Question:
What is the vision service benefit? And would I have to wait two years to take advantage of the eye exam/eyeglass benefit?
Answer:
Once you have become a Fallon Senior Plan member, you may use the eye exam/eyeglass benefit immediately.
The Fallon Senior Plan vision services benefit includes:
- Medicare-covered eyewear (one pair of eyeglasses or contact lenses after each cataract surgery)
- One pair of eyeglasses every two years from a selection of designated frames and standard lenses, which include bifocals and multifocals.
There is no referral necessary for eyewear with any Fallon Senior Plan network providers. Copayments may apply for each Medicare-covered eye exam (diagnosis and treatment for diseases and conditions of the eye).
Complete benefit and copayment information is available in our Summary of Benefits booklets.
If you are a member of Fallon Senior Plan through your or your spouse’s current or former employer, your benefits may vary. Please contact your benefits administrator for more information.
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Question:
If I choose a Fallon Medical Center doctor, will I see the doctor I choose or will I be placed with whichever doctor is on-call at the medical center?
Answer:
The doctor that you choose will be the doctor that you receive most of your care from with the exception of urgent care visits, emergency care, care from specialists and out-of-area dialysis.
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Question:
My specialist is at a Boston hospital. May I continue to see this specialist if I join Fallon Senior Plan?
Answer:
Fallon Senior Plan has a network of providers. When you join, you must choose a primary care physician who will manage your routine health care needs and will refer you to specialists as needed. You must have a referral from your primary care physician to see a specialist. The exception is Fallon Senior Plan Preferred Enhanced Rx, our PPO plan, which does not require referrals. Members of Fallon Senior Plan Preferred Enhanced Rx may see out-of-network providers, but will pay a higher cost for the services received. For more information, please contact us.
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Question:
Where and how will I receive my care from Fallon Senior Plan, including out-of-area dialysis?
Answer:
With all of our Fallon Senior Plan Saver, Standard, Plus and Value plans, care must be provided or arranged by network providers, except in emergent or urgent care situations or for out-of-area dialysis services. Copayments may be required for some services. With our Fallon Senior Plan Preferred Enhanced Rx plan, to receive benefits at a lower cost, you must receive all of your health care from Fallon Senior Plan Preferred network providers, except in emergent or urgent care situations or for out-of-area dialysis services. If you are a member of Fallon Senior Plan Preferred Enhanced Rx and you go to an out-of-network provider for care that is not an emergency, not urgent nor out-of-area dialysis services, you may be responsible for a higher cost-sharing amount. Copayments are required for some services.
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Question:
I am a member of Fallon Senior Plan through my or my spouse’s current or former employee. What are my benefits?
Answer:
Because you are a member of Fallon Senior Plan through your or your spouse’s current or former employer, your benefits may vary. Please contact your benefits administrator for more information.
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* This is the 2007 Medicare cost sharing amount and will change effective January 1, 2008. Social Security will notify you of the new 2008 Medicare Part B premium, deductible and Part A cost sharing amounts prior to January 1, 2008.
Call us toll-free at 1-888-377-1980 (TDD/TTY: 1-877-608-7677), 8 a.m. to 8 p.m., seven days a week.