Benefits, items and services

NaviCare HMO SNP is a Medicare Advantage HMO Special Needs Plan that combines MassHealth Standard benefits and Medicare benefits, including Medicare Part D prescription drug coverage. For people who qualify only for MassHealth Standard, NaviCare SCO offers the same benefits as NaviCare HMO SNP.

Premiums and cost-sharing

As a NaviCare member, you'll have no monthly plan premium, no copayments, no coinsurance and no deductibles.

Low-income subsidy
The low-income subsidy table shows you what your monthly plan premium will be, if you get extra help from Medicare to help pay for your Medicare prescription drug plan costs. You will also find information on how to find out if you qualify for extra help.

What's covered

NaviCare covers MassHealth Standard and Medicare benefits, items and services such as:

You also get extra benefits and services such as:

  • Up to $300 for the 2019 plan year toward the purchase of eyewear, every year
  • Enhanced dental services, including crowns, dentures and implants
  • Rides to the pharmacy, gym or fitness activities, or establishments that provide medical services, such as counseling providers or health fairs at senior centers (up to 90 round-trip rides per year, limit of one round-trip ride per day)
  • Save Now card that is preloaded with money to help pay for certain health-related, over-the-counter items
  • Telehealth service that provides 24 hour/7 day-a-week access to a doctor by phone, mobile app or online at no extra cost to you
  • Gym membership through SilverSneakers® and up to $200 reimbursement for another qualified fitness facility or fitness classes (H9001_N_2018_17 Accepted 09192017, pdf)
  • A 13-consecutive-week membership in Weight Watchers®
  • Quit to Win, our program to help you stop using tobacco
  • A Navigator to help you manage your care, coordinate medical appointments and advocate for your needs 

More information about benefits, items, services and coverage

For more details on benefits, items, 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 part of your contract with us. It describes your complete benefits as well as how to use the plan. You can also find information about our grievance, coverage determination and appeal (and exceptions for Part D) processes in chapter 8, and the exception process for prescription drugs in chapter 5, respectively, in your Evidence of Coverage.


Annual Notice of Changes (ANOC)

An ANOC is a document which explains any changes in your coverage, costs, or service area that will be effective on January 1.


Dental Addendum

This shows dental services that are covered when you receive them from a dentist in the NaviCare network.


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.)

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. This information is not a complete description of benefits. Call 1-877-790-4971 (TRS 711) for more information. SilverSneakers® is a registered trademark of Tivity Health, Inc. Weight Watchers® is a registered trademark of Weight Watchers International, Inc. Adobe is a registered trademark of Adobe Systems Incorporated.

The information on this page was last updated on 8/15/2018.

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