Retiree solutions and Medicare group plans

At Fallon Health, we offer complete solutions for retirees. Fallon Medicare PlusTM Premier HMO is our Medicare Advantage Plan that offers two provider networks—one network includes a tailored selection of providers based in Worcester County, the other network includes thousands of providers across Massachusetts. For those looking for even more flexibility, Fallon Medicare PlusTM Freedom—with no deductibles, no referrals and access to providers nationwide.

Choose your plan

  • Fallon Medicare Plus Premier HMO
  • Fallon Medicare Plus Freedom

Fallon Medicare Plus Premier HMO

Overview

Fallon Medicare Plus Premier HMO is our Medicare Advantage Plan for retirees that offers comprehensive coverage and more benefits than members would get with Original Medicare alone.

We offer two providers networks with our Medicare Advantage HMO plans: 
Fallon Medicare Plus Central Premier and Fallon Medicare Plus Premier.

Fallon Medicare Plus Central Premier is available only to residents of Worcester County. Members receive care and services from a tailored selection of providers based in the central part of the state.

Fallon Medicare Plus Premier is available to all eligible plan members. This network includes all of our contracted providers throughout the state—from Boston to the Berkshires.

Both plans include rich benefits like:

  • Benefit Bank—a card that can be used to pay for fitness memberships, dental care, and/or eyewear.
  • Free SilverSneakers® gym membership-in addition to the Benefit Bank
  • Free 13-consecutive week Weight Watchers® membership
  • Prescription drug coverage with no coverage gap
  • Hearing aid benefit
  • Preventive and comprehensive dental care—in addition to the Benefit Bank
  • $150 toward eyewear, every year—in addition to the Benefit Bank

 

Eligibility

To be eligible for Fallon Medicare Plus Premier HMO, members must:

  • Be eligible for a Medicare group plan through an employer or a union health and wellness organization
  • Be enrolled in Medicare Part A and Part B
  • Continue to pay their Medicare Part B premium or have it paid for by another source
  • Reside within the approved service area.

Service area

To be eligible for Fallon Medicare Plus Central Premier, retirees must be a resident of Worcester County.

To be eligible for Fallon Medicare Plus Premier, retirees must live in one of the following Massachusetts counties: Barnstable, Berkshire, Bristol, Essex, Franklin, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk or Worcester. Or, they may reside in specific cities or towns that border Massachusetts, as seen in the map below.

See a larger version of this map
The Fallon Medicare Plus Premier HMO network is statewide.

Plan documents

Online tools

 

Fallon Medicare Plus Freedom

Overview

Fallon Medicare Plus Freedom is our coast-to-coast health care coverage solution for Medicare-eligible retirees, whether they live in Wellfleet or West Palm Beach.

With Fallon Medicare Plus Freedom, members get more benefits than they would with Original Medicare alone. And, with no provider network, plan members have the freedom to see any provider who accepts Medicare and is most convenient for them.

Fallon Medicare Plus Freedom acts as a secondary payer for Medicare-approved services, and covers costs not paid by Medicare for services such as:

  • Doctor office visits
  • Tests and screenings, including X-rays and labs
  • Hospital admissions
  • Durable medical equipment, including wheelchairs and oxygen
  • Emergency care inside and outside the U.S.

Fallon Medicare Plus Freedom plan options include those with and without prescription drug coverage.

Fallon Medicare Plus Freedom also includes the It Fits! benefit—a $200 annual fitness reimbursement that members can use for anything from gym memberships at the gym of their choice to yoga classes to ski lift tickets.

Eligibility

To be eligible for Fallon Medicare Plus Freedom, members must:

  • Be eligible for a Medicare group plan through an employer or a union health and wellness organization
  • Be enrolled in Medicare Part A and Part B
  • Continue to pay their Medicare Part B premium or have it paid for by another source.

Service area

Fallon Medicare Plus Freedom is available to retirees who live in the United States.

The Fallon Medicare Plus Freedom network is nationwide.

Plan documents

 

For more information

  • Contact your group’s benefits administrator.
    or
  • Contact Fallon Health by phone at: 1-866-231-3669 (TRS 711), 8 a.m.–8 p.m., seven days a week, or by email at: MedicareSalesOperations@fallonhealth.org.

* Benefits may vary by plan and employer group.

SilverSneakers® is a registered trademark of Tivity Health, Inc.

Fallon Health is an HMO plan with a Medicare contract. Enrollment in Fallon Health depends on contract renewal.