2019 Fallon Senior Plan Saver (HMO) H9001-29-7 in MA from Fallon Community Health Plan | HealthPocket

Fallon Senior Plan Saver (HMO)

$59/mo

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Zip Code02128
Applicant4/22/1984 Male
Coverage Start4/23/2019
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Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C)
Insurance ProviderFallon Community Health Plan
Plan IDH9001-29-7
Plan Year2019
CMS Rating
Plan TypeHMO
Annual Deductible$0.00

What To Know About This Plan
  • This is a health coverage only plan with no drug coverage

Costs and Other Important Information

Plan Year2019
Monthly Health Plan Premium$59.00
Monthly Drug Plan PremiumNot Applicable
Health Plan Deductible$0
Other health plan deductibles?No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$6,700 In-network
Optional Supplemental BenefitsNo

Benefits

SERVICECOST
Inpatient hospital coverage$300 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient hospital coverage$275 per visit
Doctor visitsPrimary:$25 per visit
Specialist:$40 per visit
Preventive care$0 copay
Emergency care/Urgent careEmergency:$90 per visit (always covered)
Urgent care:$25 per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:$0 copay
Lab services:$0 copay
Diagnostic radiology services (e.g., MRI):$250
Outpatient x-rays:$0 copay
Mental health servicesInpatient hospital - psychiatric:$300 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient group therapy visit with a psychiatrist:$40
Outpatient individual therapy visit with a psychiatrist:$40
Outpatient group therapy visit:$40
Outpatient individual therapy visit:$40
Skilled Nursing Facility$0 per day for days 1 through 20
$150 per day for days 21 through 44
$0 per day for days 45 through 100
Rehabilitation servicesOccupational therapy visit:$20
Physical therapy and speech and language therapy visit:$20
Ground ambulance$200
Transportation$35
Foot care (podiatry services)Foot exams and treatment:$40
Routine foot care:Not covered
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):20% per item
Prosthetics (e.g., braces, artificial limbs):20% per item
Diabetes supplies:$0 copay
Wellness programs (e.g., fitness, nursing hotline)Covered
Medicare Part B drugsChemotherapy:20%
Other Part B drugs:20%

Benefits Services

Hearing
Hearing exam$40
Fitting/evaluationNot covered
Hearing aids$695-995There may be limits on how much the plan will provide.
Preventive Dental
Office visit$25.00
Oral examCovered under office visit. There may be limits on how much the plan will provide.
CleaningCovered under office visit. There may be limits on how much the plan will provide.
Fluoride treatmentCovered under office visit. There may be limits on how much the plan will provide.
Dental x-ray(s)Covered under office visit. There may be limits on how much the plan will provide.
Comprehensive Dental
Non-routine servicesNot covered
Diagnostic services$6-40There may be limits on how much the plan will provide.
Restorative services$31-830There may be limits on how much the plan will provide.
Endodontics$34-990
Periodontics$80-953
Extractions$42-506
Prosthodontics, other oral/maxillofacial surgery, other services$0-865There may be limits on how much the plan will provide.
Vision
Routine eye exam$40There may be limits on how much the plan will provide.
OtherNot covered
Contact lenses$0 copay. There may be limits on how much the plan will provide.
Eyeglasses (frames and lenses)$0 copay. There may be limits on how much the plan will provide.
Eyeglass framesNot covered
Eyeglass lensesNot covered
UpgradesNot covered

Coverage Area for Fallon Senior Saver (HMO)

StateMassachusetts
CountySuffolk

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 screening
Osteoporosis management in women who had a fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Controlling blood pressure
Rheumatoid arthritis management
Reducing the risk of falling
Plan all-cause readmissions

Member Experience with Health Plan

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

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Members choosing to leave the health plan
Beneficiary access and performance problems
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/TDD availability - Drugs
Appeals auto-forward
Appeals upheld

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Members choosing to leave the drug plan
Beneficiary access and performance problems
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
High risk medication
Part D medication adherence for diabetes
Part D medication adherence for hypertension
Part D medication adherence for cholesterol
Medication Therapy Management program completion rate

Physicians that accept Fallon Senior Saver (HMO) for Massachusetts

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Hazarika, Rajneesh
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Balsamo, Angelo
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Reisman, Jerald
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Bravo, Kevin
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Eisenberg, David
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Mulroy, William
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Firer, Leonard
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Smikle, Yvonne
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Vaid, Kuldip
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Chua, Janet
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Gugino, Laverne
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Sotrel, Ginter
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Goudie, James
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Zeller, Julie
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Gaonkar, Sameer
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Chen, Phyllis
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Bajic, Sibinka
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Sprague, Kellie
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Heist, Rebecca
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Specht, Michelle
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Brewster, Anne
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Patel, Dinesh
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Laby, Daniel
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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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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual 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 a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)

Medicare Plans Found

 

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual 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 a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)