Compare our Medicare Advantage plans and benefits

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We have a number of plan options to fit your different needs. No matter what plan option you choose, Fallon Senior Plan (FSP) HMO provides comprehensive medical coverage, and multiple options include Medicare Part D prescription drug coverage too. With Fallon Senior Plan options you get:

SilverSneakers^® Fitness Program or SilverSneakers Steps^®
A free routine physical, plus additional health screenings at no cost
Weight Watchers^®
Preventive dental care (available for some plans)
Vision care, including a $150 yearly benefit coverage for eyewear
Worldwide emergency coverage
Nurse Connect, which gives you free telephone and online access to registered nurses 24 hours a day, seven days a week, 365 days a year.

	FSP Saver HMO	FSP Standard HMO	FSP Super Saver Rx HMO	FSP Saver Rx HMO	FSP Saver Enhanced Rx HMO	FSP Standard Enhanced RX HMO	FSP Plus Enhanced Rx HMO
	Plans without Part D presciption drug coverage		Plans with Part D prescription drug coverage
Overview
	Lower-premium plan	Moderate-premium plan	Zero-premium plan	Lower-premium plan	Lower-premium plan	Moderate-premium plan	Highest premium plan
	No Part D coverage	No Part D coverage	Part D coverage (with deductible)	Part D coverage (with deductible)	Part D coverage (no deductible)	Part D coverage (no deductible)	Part D coverage (no deductible)
	Mid-range medical cost-sharing	Mid-range medical cost-sharing	Higher medical cost-sharing	Mid-range medical cost-sharing	Mid-range medical cost-sharing	Mid-range medical cost-sharing	Lowest medical cost-sharing
Monthly plan premiums Learn about getting help paying your prescription drug costs
Hampden County	$0	$27	$0	$6	$17	$69	$92
All other areas*	$28	$96	$0	$54	$65	$138	$198
Benefits and copayments
Routine annual physical	$0	$0	$0	$0	$0	$0	$0
Immunizations (pneumonia, hepatitis B and flu)	$0	$0	$0	$0	$0	$0	$0
Preventive services (Medicare-covered)	$0	$0	$0	$0	$0	$0	$0
Primary care office visits	$25	$15	$25	$25	$25	$15	$10
Specialist office visits	$30	$25	$40	$30	$30	$25	$15
Inpatient hospital care	$500 for each stay Separate $1,500 out-of-pocket limits per year for acute, rehabilitation, and mental health hospital stays $0 for substance abuse care Inpatient rehabilitation is covered up to 90 days	$400 for each stay Separate $1,200 out-of-pocket limits per year for acute, rehabilitation and mental health hospital stays $0 for substance abuse care Inpatient rehabilitation is covered up to 90 days	$300 per day for days 1-5. $0 for additional days. $0 for substance abuse care Inpatient rehabilitation is covered up to 90 days	$500 for each stay 1,500 out-of-pocket limits per year for acute, rehabilitation, and mental health hospital stays $0 for substance abuse care Inpatient rehabilitation is covered up to 90 days	$500 for each stay Separate $1,500 out-of-pocket limits per year for acute, rehabilitation, and mental health hospital stays $0 for substance abuse care Inpatient rehabilitation is covered up to 90 days	$400 for each stay Separate $1,200 out-of-pocket limits per year for acute, rehabilitation, and mental health hospital stays $0 for substance abuse care Inpatient rehabilitation is covered up to 90 days	$150 for each stay Separate $300 out-of-pocket limits per year for acute, rehabilitation, and mental health hospital stays $0 for substance abuse care Inpatient rehabilitation is covered up to 90 days
Dental	$30 for Medicare-covered dental benefits In general, preventive dental benefits (such as cleanings) not covered	$25 for Medicare-covered dental benefits $25 per routine checkup, including up to 2 oral exams, 2 cleanings, 2 fluoride treatments and 2 dental X-rays every year Includes additional comprehensive dental benefits	$40 for Medicare-covered dental benefits In general, preventive dental benefits (such as cleanings) not covered	$30 for Medicare-covered dental benefits In general, preventive dental benefits (such as cleanings) not covered	$30 for Medicare-covered dental benefits In general, preventive dental benefits (such as cleanings) not covered	$25 for Medicare-covered dental benefits $25 per routine checkup, including up to 2 oral exams, 2 cleanings, 2 fluoride treatments and 2 dental X-rays every year Includes additional comprehensive dental benefits	$15 for Medicare-covered dental benefits $25 per routine checkup, including up to 2 oral exams, 2 cleanings, 2 fluoride treatments and 2 dental X-rays every year Includes additional comprehensive dental benefits
Emergency care	$65 (waived if you are admitted within 72 hours) Worldwide coverage	$65 (waived if you are admitted within 72 hours) Worldwide coverage	$65 (waived if you are admitted within 72 hours) Worldwide coverage	$65 (waived if you are admitted within 72 hours) Worldwide coverage	$65 (waived if you are admitted within 72 hours) Worldwide coverage	$65 (waived if you are admitted within 72 hours) Worldwide coverage	$65 (waived if you are admitted within 72 hours) Worldwide coverage
Outpatient surgery	$150	$125	$175	$150	$150	$125	$50
Diagnostic tests, X-rays, lab services and therapeutic radiology	$0	$0	$0	$0	$0	$0	$0
Diagnostic radiology (CAT, PET, MRI, nuclear studies)	$125 for each CAT, PET, MRI scan and nuclear study $500 out-of-pocket maximum	$100 for each CAT, PET, MRI scan and nuclear study $400 out-of-pocket maximum	$150 for each CAT, PET, MRI scan and nuclear study	$125 for each CAT, PET, MRI scan and nuclear study $500 out-of-pocket maximum	$125 for each CAT, PET, MRI scan and nuclear study $500 out-of-pocket maximum	$100 for each CAT, PET, MRI scan and nuclear study $400 out-of-pocket maximum	$75 for each CAT, PET, MRI scan and nuclear study $300 out-of-pocket maximum
Vision services	$0 for Medicare-covered glaucoma tests $30 for one supplemental routine eye exam every year $150 plan coverage limit for eyewear every year	$0 for Medicare-covered glaucoma tests $25 for one supplemental routine eye exam every year $150 plan coverage limit for eyewear every year	$0 for Medicare-covered glaucoma tests $40 for one supplemental routine eye exam every year $150 plan coverage limit for eyewear every year	$0 for Medicare-covered glaucoma tests $30 for one supplemental routine eye exam every year $150 plan coverage limit for eyewear every year	$0 for Medicare-covered glaucoma tests $30 for one supplemental routine eye exam every year $150 plan coverage limit for eyewear every year	$0 for Medicare-covered glaucoma tests $25 for one supplemental routine eye exam every year $150 plan coverage limit for eyewear every year	$0 for Medicare-covered glaucoma tests $15 for one supplemental routine eye exam every year $150 plan coverage limit for eyewear every year
SilverSneakers^® Fitness Program—Includes a free basic membership at participating fitness facilities throughout the U.S., or SilverSneakers Steps	$0	$0	$0	$0	$0	$0	$0
Weight Watchers^® membership	$0	$0	$0	$0	$0	$0	$0
Nurse Connect—Free telephone and online access to registered nurses 24 hours a day, seven days a week, 365 days a year.	$0	$0	$0	$0	$0	$0	$0
Part D prescription drug coverage
Deductible	This plan does not have Part D prescription drug coverage.	This plan does not have Part D prescription drug coverage.	$320	$320	No deductible	No deductible	No deductible
Initial coverage period stage Until the yearly drug costs (paid by both you and your plan) reach $2930	This plan does not have Part D prescription drug coverage.	This plan does not have Part D prescription drug coverage.	After the deductible, you pay the following in a retail or mail-order pharmacy for up to a 30-day supply. Tier 1: $4 Tier 2: $20 Tier 3: $55 Tier 4: 25% coinsurance	After the deductible, you pay the following in a retail or mail-order pharmacy for up to a 30-day supply. Tier 1: $4 Tier 2: $20 Tier 3: $55 Tier 4: 25% coinsurance	You pay the following in a retail or mail-order pharmacy for up to a 30-day supply. Tier 1: $4 Tier 2: $20 Tier 3: $55	You pay the following in a retail or mail-order pharmacy for up to a 30-day supply. Tier 1: $4 Tier 2: $20 Tier 3: $55	You pay the following in a retail or mail-order pharmacy for up to a 30-day supply. Tier 1: $4 Tier 2: $20 Tier 3: $55
Coverage gap stage After the total yearly drugs costs (paid by both you and your plan) reach $2,930	This plan does not have Part D prescription drug coverage.	This plan does not have Part D prescription drug coverage.	You pay 86% for all generic drugs and 50% of the negotiated rate for brand drugs from manufacturers that agreed to pay the discount until your yearly out-of-pocket drug costs reach $4,700.	You pay 86% for all generic drugs and 50% of the negotiated rate for brand drugs from manufacturers that agreed to pay the discount until your yearly out-of-pocket drug costs reach $4,700.	You pay 86% for all generic drugs and 50% of the negotiated rate for brand drugs from manufacturers that agreed to pay the discount until your yearly out-of-pocket drug costs reach $4,700.	You pay 86% for all generic drugs and 50% of the negotiated rate for brand drugs from manufacturers that agreed to pay the discount until your yearly out-of-pocket drug costs reach $4,700.	You pay 86% for all generic drugs and 50% of the negotiated rate for brand drugs from manufacturers that agreed to pay the discount until your yearly out-of-pocket drug costs reach $4,700.
Catastrophic coverage stage After your yearly out-of-pocket drug costs reach $4,700	This plan does not have Part D prescription drug coverage.	This plan does not have Part D prescription drug coverage.	You pay the greater of 5% coinsurance, or $2.60 for generic (including brand drugs treated as generic) and $6.50 for all other drugs.	You pay the greater of 5% coinsurance, or $2.60 for generic (including brand drugs treated as generic) and $6.50 for all other drugs.	You pay the greater of 5% coinsurance, or $2.60 for generic (including brand drugs treated as generic) and $6.50 for all other drugs.	You pay the greater of 5% coinsurance, or $2.60 for generic (including brand drugs treated as generic) and $6.50 for all other drugs.	You pay the greater of 5% coinsurance, or $2.60 for generic (including brand drugs treated as generic) and $6.50 for all other drugs.
Healthy extras** FCHP Family Fun—get discounted admissions and other savings at area attractions and activities,including museums, sports facilities and zoos. Online and in-store discounts at CVS/pharmacy—get a 20% discount on more than 1,500 CVS/pharmacy-brand health-related products—good at any CVS/pharmacy store or online at cvs.com. Naturally Well—get discounts on vitamins and health care services such as acupuncture and massage therapy. Pet care discount—get discounts on pet care at participating VCA hospitals! You'll get one free initial physical exam for new clients ($60 value) and a 10% discount on general services such as consultations, lab tests, x-rays and more.

* Worcester County and portions of Hampshire, Franklin, Middlesex and Norfolk counties.

** The products and services described above are neither offered nor guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the FCHP grievance process.

Fallon Senior Plan Super Saver Rx HMO does not have separate out-of-pocket limits for inpatient acute hospital care, inpatient mental health care, inpatient rehabilitation care, or for imaging (CAT, PET, MRI and nuclear studies). However, all of our Fallon Senior Plan HMO plans include a $3,400 out-of-pocket limit for Medicare-covered services.

A Health plan with a Medicare contract.

You must use plan providers except in emergency or urgent care situations or for out-of-area renal dialysis. If you obtain routine care from out-of-network providers, neither Medicare nor Fallon Senior Plan HMO will be responsible for the costs.

The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information, contact the plan.

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227), TTY users should call 1-877-486-2048, 24 hours a day/7 days a week; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday, TTY users should call 1-800-325-0778; or the Massachusetts Medicaid Office at 1-800-841-2900 (TTY: 1-888-665-9997).

This information is available for free in other languages. Please contact our customer service number at 1-800-325-5669 for additional information.

Esta información está disponible de forma gratuita en otros idiomas. Póngase en contacto con nuestro servicio de atención al cliente llamando al 1-800-325-5669 para obtener información adicional.

Members may enroll in the plan only during specific times of the year. Contact Fallon Community Health Plan for more information. Limitations, copayments and restrictions may apply.

You must have Medicare Part A and Part B to enroll in this plan. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.

Except in emergent and urgent care situations, you must use network pharmacies to access the prescription drug benefit. Quantity limits and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, 2013.

SilverSneakers^® is a registered trademark of Healthways. Weight Watchers^® is a registered trademark of Weight Watchers International, Inc.

H9001_2012_720_18 CMS Approved 10172011

The information on this page was last updated on 10/1/2011.

Call us toll-free at 1-888-340-5504 (TTY users, please call TRS Relay 711.), Monday through Friday,
8 a.m. to 8 p.m. (From October 15 through February 14, we're available seven days a week.)

Call us toll-free at 1-888-340-5504 (TTY users, please call TRS Relay 711), Monday through Friday, 8 a.m. to 8 p.m.
(October 15 through February 14, we're available seven days a week.) | joinseniorplan@fchp.org

Compare our Medicare Advantage plans and benefits

Plans without Part D presciption drug coverage

Plans with Part D prescription drug coverage

Overview

Monthly plan premiums

Benefits and copayments

Part D prescription drug coverage