NaviCare (HMO D-SNP)

NaviCare (HMO D-SNP) is a HMO D-SNP plan offered by Fallon Community Health Plan, Inc. available for enrollment in 2025 to people living in Massachusetts except Dukes and Nantucket counties. This plan received an overall rating of 4 out of 5 stars in 2026.

It's important to know that NaviCare (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.

Key Plan Facts

Below are a few key facts and commonly-asked questions about NaviCare (HMO D-SNP).

Plan Costs:

The cost of a Medicare Advantage Plan is made up of four main parts.

• First, the monthly premium — the amount you pay every month.
• Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
• Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
• Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.

You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.

Common Services:

Drug Coverage

The NaviCare (HMO D-SNP) Medicare plan features an annual prescription drug deductible of $615. Beneficiaries must pay this deductible amount out-of-pocket before the plan begins covering the costs of prescription medications. Specific drug coverage tier details, including individual copayments and coinsurance amounts, are not available for this plan. To determine how your specific medications are covered and calculate your exact costs, you should consult the plan's comprehensive formulary.

Additional Benefits

The NaviCare (HMO D-SNP) plan offers comprehensive coverage with many essential services featuring no copay and no coinsurance, including inpatient hospital stays, home health care, and skilled nursing facility services. Additionally, members benefit from preventive care, hearing exams, and up to 48 one-way health-related transportation trips per year with no copay and no coinsurance. The plan also provides a generous over-the-counter allowance of up to $375 every three months and up to $403 annually for eyewear with no copays. For other medical services, such as outpatient care, emergency services, primary and specialist visits, dialysis, and durable medical equipment, members pay no copay and a 20% coinsurance. Dental care is also highly accessible, offering no copay and no coinsurance for most preventive services, alongside a 20% coinsurance for Medicare-covered dental treatments. While several benefits require prior authorization or referrals, the plan minimizes out-of-pocket expenses by eliminating copays for the vast majority of covered services.