Retiree solutions and Medicare group plans

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. You choose a plan based on the network doctors you want to see, what you want to pay and the benefit allowance you need. 

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

Fallon Medicare Plus Central Premier is available to Worcester County residents only. It is a limited provider network, which means that members can only receive care from these select provider groups:

  • Reliant Medical Group
  • Heywood Hospital and providers
  • St. Vincent Hospital
  • Select Steward Health Care providers
  • And other contracted providers

Fallon Medicare Plus Premier

Fallon Medicare Premier is our statewide network, available to members across our entire service area*, including those who live in Worcester County.

The Fallon Medicare Plus Premier network includes thousands of providers—from the Berkshires to Boston, from the South Shore to the North Shore.

Both plans include rich benefits like:

  • Benefit Bank
    The Benefit Bank card is preloaded with money that can be used for dental care, eyewear, fitness memberships and hearing aids. Use the card to pay a portion, or the full cost, of an item. Allowances range from $250 to $500.
  • Hearing aids
  • Copayments varying from $695 to $995 through Amplifon. You can use your Benefit Bank toward these copayments or on hearing aids purchased from other providers, if you choose.
  • Eyewear
    $150 toward eyewear, every year. Also, the Benefit Bank can be used toward additional eyewear costs.
  • Dental
    Coverage for preventive care like cleanings, routine exams and X-rays as well as comprehensive services like root canals. Also, the Benefit Bank can be used to pay for dental services.
  • SilverSneakers®
  • Includes a free gym membership and on-demand library of classes, workouts and instructional videos. Plus, the Benefit Bank can be used to pay for fitness memberships.
  • WW® membership
    Free 13-consecutive-week WW membership (formerly Weight Watchers).
  • Care Connect
    24/7 access to registered nurses by phone, at a $0 copay. Nurses provide guidance on where
    to go for care and/or they can connect you with your doctor.)

 

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.

2022 plan documents

2021 plan documents

Online tools

 

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.