Ending your membership

Ending your membership in NaviCare may be voluntary (your own choice) or involuntary (not your own choice).

  • You might leave our plan because you have decided that you want to leave.
    • You can end your membership in the plan at any time.
    • The process for voluntarily ending your membership varies depending on what type of new coverage you are choosing.
  • There are also limited situations where you do not choose to leave, but we are required to end your membership in NaviCare HMO SNP or NaviCare SCO. We are not allowed to ask you to leave our plan for any reason related to your health.
    • If you are a member of NaviCare HMO SNP and feel that you are being asked to leave our plan because of a health-related reason, you should call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may call 24 hours a day, 7 days a week.
    • If you are a member of NaviCare SCO and feel that you are being asked to leave our plan because of a health-related reason, you should call MassHealth (Medicaid) at 1-800-841-2900. TTY users should call 1-800-497-4648.

If you leave NaviCare, it may take time before your membership ends and your new coverage goes into effect. During this time, you must continue to get your medical care, prescription drugs and OTC drugs through our plan.

If we end your membership in our plan, we must tell you our reasons in writing for ending your membership. We must also explain how you can make a complaint about our decision to end your membership.

You can find more information about ending your membership in your NaviCare HMO SNP or NaviCare SCO Evidence of Coverage in the chapter called, "Ending your membership in the plan."

We must end your membership in NaviCare HMO SNP if any of the following happen:

  • If you no longer have Medicare Part A and Part B.
  • If you are no longer eligible for MassHealth (Medicaid). If you move out of our service area.
  • If you are away from our service area for more than six months.
  • If you become incarcerated (go to prison).
  • If you are not a United States citizen or lawfully present in the United States.
  • If you lie about or withhold information about other insurance you have that provides prescription drug coverage.
  • If you intentionally give us incorrect information when you are enrolling in our plan and that information affects your eligibility for our plan. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)
  • If you continuously behave in a way that is disruptive and makes it difficult for us to provide medical care for you and other members of our plan. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)
  • If you let someone else use your membership card to get medical care. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)
  • If you are required to pay the extra Part D amount because of your income and you do not pay it, Medicare will disenroll you from our plan.

We must end your membership in NaviCare SCO if any of the following happen:

  • If you are no longer eligible for MassHealth (Medicaid).
  • If you move out of our service area.
  • If you are away from our service area for more than six months.
  • If you become incarcerated (go to prison).
  • If you are not a United States citizen or lawfully present in the United States.
  • If you lie about or withhold information about other insurance you have that provides prescription drug coverage.
  • If you intentionally give us incorrect information when you are enrolling in our plan and that information affects your eligibility for our plan.
  • If you continuously behave in a way that is disruptive and makes it difficult for us to provide medical care for you and other members of our plan.
  • If you let someone else use your membership card to get medical care or prescription drugs.

Fallon Health is an HMO plan with a Medicare contract and a contract with the Massachusetts Medicaid program. Enrollment in Fallon Health depends on contract renewal. NaviCare is a voluntary program in association with MassHealth/EOHHS and CMS. NaviCare SCO is available to anyone age 65 and older who has MassHealth Standard and lives in the service area. Individuals who also have Medicare Parts A and B may enroll in NaviCare HMO SNP. Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next. This information is not a complete description of benefits. Contact the plan for more information. Limitations and restrictions may apply. Benefits may change on January 1 of each year. You must continue to pay your Medicare Part B premium unless the Commonwealth of Massachusetts pays this premium for you. The Formulary and/or provider network may change at any time. You will receive notice when necessary. To view the PDF files above, you may need to download a free copy of Adobe® Acrobat Reader software on your computer. (This link takes you away from the NaviCare website.)  Adobe® is a registered trademark of Adobe Systems Incorporated.

H9001_N_2018_10 Approved 10192017
The information on this page was last updated on 10/1/2017.