Benefits and services
NaviCare HMO SNP is a Medicare Advantage Special Needs Plan that combines Medicare benefits and MassHealth Standard benefits, including Medicare Part D. For people with MassHealth Standard alone, NaviCare SCO offers the same benefits as NaviCare HMO SNP.
Premiums and cost-sharing
As a NaviCare member, you'll have no plan premiums and no copayments or coinsurance.
Low income subsidy
This table shows you what your monthly plan premium will be since you get extra help from Medicare to help pay for your Medicare prescription drug plan costs.
What's covered
NaviCare provides your covered medical items and services and certain prescription drugs, as well as needed community-based home and personal care services.
NaviCare covers Medicare and MassHealth Standard benefits and services like:
- Doctor visits
- Covered prescription drugs and certain over-the-counter drugs with a prescription
- Hospital stays
- Rehabilitation services
- Durable medical equipment (such as canes and wheelchairs)
- Personal emergency response systems
- SilverSneakers® Fitness Program or SilverSneakers Steps®
- A 13-consecutive-week membership in Weight Watchers®
- Quit to Win, our stop smoking program
- Eyeglasses and vision services
- Dental care
- Transportation to and from medical and rehabilitation visits with prior authorization
- Care management services including:
- Coordination of your care between your doctors
- Coordination of your in-home services
Support designed just for you
Getting the right care at the right time is important for your good health. With NaviCare, you will have a Primary Care Team assigned to you. This team works with you, your family and your health care providers to ensure you receive the best possible care when you need it.
You’ll choose a primary care physician from our network of doctors that are among the region’s most respected. Your current physician may already be part of our network.
Your primary care physician works with a team, called the Primary Care Team, to develop your care plan. You will have a Geriatric Support Services Coordinator (GSSC) who will help arrange for community services. The Primary Care Team will have access to a centralized electronic record of your up-to-date health, medical and drug information which will make it easier for your Primary Care Team to manage and coordinate your health care. You will also have a Nurse Case Manager and Navigator who will help manage your health care needs.
Your Navigator will help you with:
- Scheduling doctor visits
- Coordinating pre-approved rides for medical and rehabilitation appointments
- Making arrangements for services approved by the Primary Care Team
For more details on benefits, services and coverage, you can download the documents below:
Summary of Benefits
A Summary of Benefits is a booklet that provides details on plan benefits.
Evidence of Coverage
An Evidence of Coverage (EOC) is a booklet that we provide once you become a member. It’s part of your contract with us and it describes your complete benefits as well as how to use the plan. You can also find information about grievance, coverage determination and appeals processes starting in chapter 9, and the exceptions processes in chapter 5 respectively, in your plan's Evidence of Coverage.
- NaviCare HMO SNP Evidence of Coverage (coming soon)
This EOC is for members who are enrolled in both Medicare and MassHealth Standard.
To view the PDF files above, you may need to download a free copy of Adobe® Acrobat Reader software on your computer.
Adobe is a registered trademark of Adobe Systems Incorporated.
A Coordinated Care Plan with a Medicare Advantage contract and a contract with the Massachusetts Medicaid program. Medicare Advantage contracts between the federal government and managed care organizations are valid for one calendar year. The benefits, premiums, copayments and service areas offered by FCHP are subject to change on an annual basis (on January 1 each year).
All Medicare Advantage Plans agree to stay in the program for a full year at a time. Each year, the plans decide whether to continue for another year. Even if a Medicare Advantage Plan leaves the program, you will not lose Medicare coverage. If a plan decides not to continue, it must send you a letter at least 60 days before your coverage will end. The letter will explain your options for Medicare coverage in your area.
The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. Your benefits may change on January 1 each year. Limitations and restrictions may apply. 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, MassHealth or NaviCare® will be responsible for the costs. Except in emergent and urgent care situations, you must use network pharmacies to access the prescription drug benefit. Quantity limits and restrictions may apply.
SilverSneakers® is a registered trademark of Healthways.
Weight Watchers® is a registered trademark of Weight Watchers International, Inc.
H9001_N_2012_15 CMS Approved 11072011
The information on this page was last updated on 10/1/2011.