Fallon Health to Offer New Medicare Advantage Benefits to Keep Older Adults Healthy

New Features Promote Healthy Aging, Address Social Determinants of Health

Worcester, Mass., October 1, 2022— Advancing its focus on government health insurance markets, Fallon Health today announced that its 2023 Medicare Advantage offerings will include the introduction of new features created to promote better health.

Fallon’s Medicare Advantage plans include Fallon Medicare Plus (FMP) HMO, and a Special Needs Plan/Senior Care Options Program, called NaviCare HMO SNP or SCO. Each is designed with innovative and flexible benefits to support the specific needs of members.

Most Medicare beneficiaries today are women between the ages of 64 and 85 with three out of four reporting they enjoy good health, according to the Kaiser Family Foundation. For Fallon Medicare Plus HMO members, 2023 offerings are designed to provide more coverage for preventive care and to empower beneficiaries to take more control of their own health.

“The needs of our aging population are changing, and our health care system has to change as well,” said Richard Burke, President and CEO of Fallon Health. “Our whole-person approach to care and coverage gives us the flexibility to provide help that will have the most impact on our members’ lives.”

Among the notable improvements available through certain Fallon Medicare Plus plans are:

  • Enhanced dental benefits that cover routine preventive care such as cleanings, exams, and X-rays, with no out-of-pocket costs. Comprehensive dental care, like root canals, fillings, and crowns is also covered, with a copay.

Most Fallon Medicare Plus plans also offer an innovative Benefit Bank, which allows members to best determine how they take care of their personal needs. It can be used to pay for any copays or out-of-network services tied to certain services. The Benefit Bank is preloaded with money to pay for dental care, eyewear, fitness memberships, and hearing aids. Allowances range from $250-$1,000.

NaviCare members typically have more complex needs. Fallon’s 2023 offerings are designed to purposefully address social determinants of health (SDOH), which are non-medical barriers to achieving quality health outcomes. Research shows that SDOH factors can drive as much as 80 percent of health outcomes.

The new benefits available to members through Fallon’s NaviCare® program include:

  • A Self-Care card, which provides members up to $200 per year to buy personal care items and food products. It compliments Fallon’s Save Now card for health and hygiene products, and the Healthy Food Program where money is awarded when members complete certain activities like getting a flu shot or annual physical exam.  In all, members can have up to $900 a year to spend on items they need.
  • Expanded in-home support through Papa, a curated platform of companionship and support for older adults and families. Members will gain access to 60 hours per year with a Papa Pal, a vetted companion who can also assist them with running errands, grocery shopping, medication pick-up, doctor's appointments, and light house tasks. Results from Fallon’s 2022 pilot with Papa showed a 15 percent reduction in reported unhealthy days, and reductions in members reporting being lonely or severely lonely. Fallon was the first health plan in Massachusetts to offer Papa as a benefit to its members.

These new features build on existing benefits already offered by Fallon. For example, NaviCare members receive unlimited free rides to and from medical appointments as well as up to 140 non-medical rides per year to visit friends, run errands or attend religious services.           

“SDOH needs left unmet can create complications down the road,” said Deb Daviau, Vice President of Medicare and Executive Director of NaviCare for Fallon Health. “The new features were purposefully chosen to make a real difference in the lives of our members.”      

The new benefits are consistent with Fallon’s strategy, announced last year, to focus on providing care and coverage to individuals enrolled in government-sponsored health insurance. Today, members in those programs make up 87 percent of Fallon’s membership, the highest level in the organization’s 45-year history.

Fallon’s new Medicare Advantage and HMO SNP and SCO benefits will be available January 1. To learn more about all of Fallon’s 2023 Medicare Advantage offerings during the open enrollment season underway October 15 through December 7, please visit fallonhealth.org.




Fallon Health contact:
Melissa Randall
Director, Corporate Communications
Fallon Health

About Fallon Health
Fallon Health is a mission-driven not-for-profit health care services organization based in Worcester, Massachusetts. For 45 years we have been improving health and inspiring hope in the communities we serve. Committed to caring for those who need us most, we pride ourselves on providing equitable access to coordinated, integrated care for our members with a special focus on those who qualify for Medicare and Medicaid. We also serve as a provider of care through our Program of All-Inclusive Care for the Elderly (PACE). Dedicated to delivering high quality health care, we are continually rated among the nation’s top health plans for member experience and service and clinical quality.