2020 Fallon Medicare Plus Central Orange HMO (HMO) H9001-37-0 in MA from Fallon Community Health Plan | HealthPocket

Fallon Medicare Plus Central Orange HMO (HMO)

$0/mo

Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderFallon Community Health Plan
Plan IDH9001-37-0
Plan Year2020
CMS Rating
Plan TypeHMO
Annual Deductible$300.00
Out-of-Pocket Maximum6700

What To Know About This Plan
  • This plan has health and drug coverage

Why We Like This Plan
  • has both Health and Drug Coverage
  • has no additional premium costs outside of your Medicare Part B premium
  • has a copay of $1 for Tier 1 preferred generic drugs (30 day supply, preferred retail pharmacies)

Overview

Premium
Total monthly premium$0.00
Health plan premium$0.00
Drug plan premium$0.00
Standard Part B premium$135.50
Part B premium reductionNo
Deductible
Health plan deductible$0
Drug plan deductible$300.00
Estimated yearly costs
Estimated total yearly costs for care$4,506.00
Out-of-pocket max
Out-of-pocket max$6,700 In-network

Benefits & costs

Doctor services
Primary doctor visit$10 per visit
Specialist visit$40 per visit
Tests, labs, & imaging
Diagnostic tests & procedures$0 copay
Lab services$0 copay
Diagnostic radiology services (like MRI)$300
Outpatient x-rays$0 copay
Emergency care$90 per visit (always covered)
Urgent care$10 per visit (always covered)
Hospital services
Inpatient hospital coverage$370 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient hospital coverage$350 per visit
Skilled nursing facility
Skilled nursing facility$0 per day for days 1 through 20
$160 per day for days 21 through 44
$0 per day for days 45 through 100
Preventive services
Preventive services$0 copay
Ambulance
Ground ambulance$260
Therapy services
Occupational therapy visit$20
Physical therapy & speech & language therapy visit$20
Mental health services
Outpatient group therapy with a psychiatrist$40
Outpatient individual therapy with a psychiatrist$40
Outpatient group therapy visit$40
Outpatient individual therapy visit$40
Opioid treatment services
Opioid treatment servicesCovered
Other services
Durable medical equipment (like wheelchairs & oxygen)20% per item
Prosthetics (like braces, artificial limbs)20% per item
Diabetes supplies$0 copay

Extra benefits & costs

Hearing
Hearing exam$40
Fitting/evaluationNot covered
Hearing aids - All types$695-995
Preventive dental
Oral examNot covered
CleaningNot covered
Fluoride treatmentNot covered
Dental x-raysNot covered
Comprehensive dental
Non-routine servicesNot covered
Diagnostic servicesNot covered
Restorative servicesNot covered
EndodonticsNot covered
PeriodonticsNot covered
ExtractionsNot covered
Prosthodontics, other oral/maxillofacial surgery, other servicesNot covered
Vision
Routine eye exam$40
Contact lenses$0 copay
Eyeglasses (frames & lenses)$0 copay
Eyeglass frames (only)Not covered
Eyeglass lenses (only)Not covered
UpgradesNot covered
More benefits
Transportation services for non-emergency care: Any health-related locationsNot covered
Transportation services for non-emergency care: Plan-approved locationsLimited coverage
Over the counter drug benefitsNot covered
Meals for short durationNot covered
Annual physical examsLimited coverage
TelehealthLimited coverage

Drug coverage & costs

Part B drugs
Chemotherapy drugs20%
Other Part B drugs20%

Coverage Area for Fallon Medicare Plus Central Orange HMO (HMO)

StateMassachusetts
CountySuffolk

All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit


30 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred Generic$1 copay$6 copay$1 copay$6 copay
Tier 2: Non-Preferred Generic$7 copay$12 copay$7 copay$12 copay
Tier 3: Preferred Brand Name$37 copay$42 copay$37 copay$42 copay
Tier 4: Non-Preferred Brand Name$86 copay$91 copay$86 copay$91 copay
Tier 5: Specialty Tier27% coinsurance27% coinsurance27% coinsurance27% coinsurance
Tier 6: Select Care Drugs$0 copay$0 copay$0 copay$0 copay

60 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred Generic$2 copay$12 copay$2 copay$12 copay
Tier 2: Non-Preferred Generic$14 copay$24 copay$14 copay$24 copay
Tier 3: Preferred Brand Name$74 copay$84 copay$74 copay$84 copay
Tier 4: Non-Preferred Brand Name$172 copay$182 copay$172 copay$182 copay
Tier 5: Specialty Tier
Tier 6: Select Care Drugs
90 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred Generic$3 copay$18 copay$2 copay$12 copay
Tier 2: Non-Preferred Generic$21 copay$36 copay$14 copay$24 copay
Tier 3: Preferred Brand Name$111 copay$126 copay$74 copay$84 copay
Tier 4: Non-Preferred Brand Name$258 copay$273 copay$172 copay$182 copay
Tier 5: Specialty Tier
Tier 6: Select Care Drugs

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Colorectal cancer screening
Annual flu vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Adult BMI assessment

Managing Chronic Conditions

Special needs plan care management
Care for older adults – medication review
Care for older adults – functional status assessment
Care for older adults – Pain assessment
Osteoporosis management in women who had a fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Rheumatoid arthritis management
Reducing the risk of falling
Improving bladder control
Medication reconciliation post-discharge
Plan all-cause readmissions
Statin Therapy for Patients with Cardiovascular Disease

Member Experience with Health Plan

Getting needed care
Getting appointments and care quickly
Customer service
Rating of health care quality
Rating of health plan
Care Coordination

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Members choosing to leave the health plan
Health plan quality improvement

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability - Medical

Drug Plan Customer Service

Call center – foreign language interpreter and TTY availability
Appeals auto-forward
Appeals upheldNot Rated

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Members choosing to leave the drug plan
Drug plan quality improvement

Member Experience with Drug Plan

Rating of drug plan
Getting needed prescription drugs

Drug Pricing and Patient Safety

MPF Price Accuracy
Medication adherence for diabetes medications
Medication adherence for hypertension - RAS antagonists
Medication adherence for cholesterol - Statins
MTM program completion rate for CMR
Statin use in persons with diabetes - SUPD

Physicians that accept Fallon Medicare Plus Central Orange HMO (HMO) for Massachusetts

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Rajneesh, Hazarika
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Angelo, Balsamo
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Jerald, Reisman
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William, Mulroy
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David, Eisenberg
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Kevin, Bravo
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Leonard, Firer
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Yvonne, Smikle
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Kuldip, Vaid
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Janet, Chua
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Laverne, Gugino
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Ginter, Sotrel
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Phyllis, Chen
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David, Harrison
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Julie, Zeller
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Sameer, Gaonkar
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James, Goudie
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Kellie, Sprague
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Sibinka, Bajic
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Rebecca, Heist
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Daniel, Laby
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Henry, Epino
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Ahmed, Elaini
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Rajneesh Hazarika, M.D.
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  • Phone Number
    (617) 569-5800
  • Office Locations
    10 Gove St
    East Boston, MA 02128
10 Gove St East Boston MA, 02128

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Medicare Plans Found

 

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).