A non-government entity
Fallon Medicare Plus Green (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Fallon Medicare Plus Green (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Fallon Medicare Plus Green (HMO) in 2026, please refer to our full plan details page.
Fallon Medicare Plus Green (HMO) is a HMO 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 Fallon Medicare Plus Green (HMO) 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 Fallon Medicare Plus Green (HMO).
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.
For Fallon Medicare Plus Green (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $100.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $300.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5200.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Fallon Medicare Plus Green (HMO) plan features an annual drug deductible of $300. Members enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs through standard pharmacies and mail order. Tier 2 generic medications are also highly affordable, starting at a $7 copay for a one-month supply. For brand-name and specialized medications, Tier 3 preferred brand drugs require a $47 copay for a one-month supply. Tier 4 non-preferred drugs carry a 34% coinsurance, and Tier 5 specialty drugs require a 29% coinsurance for a one-month supply. Standard mail order options for Tier 2 and Tier 3 drugs offer additional savings on three-month supplies.
Additional Benefits
The Fallon Medicare Plus Green (HMO) plan offers comprehensive coverage for core medical needs with predictable out-of-pocket costs and no coinsurance for many services. Patients pay a $10 copay for primary care visits, $20 to $40 for specialists, and a $300 daily copay for the first five days of inpatient hospital stays, which drops to no copay for days six through ninety. Emergency room visits require a $110 copay, while routine preventive services and annual physicals are fully covered with no copay. For additional wellness needs, the plan provides routine dental cleanings, home health services, and cardiac rehabilitation with no copay. Routine eye and hearing exams require a $40 copay, supported by a $150 annual eyewear allowance and coverage for up to two hearing aids per year. Additionally, members benefit from a $175 annual allowance for over-the-counter items, while durable medical equipment and dialysis require a 20% coinsurance with no copay.
Inpatient Hospital See details
Inpatient hospital care under Fallon Medicare Plus Green (HMO) is partially covered with no coinsurance, requiring a $300 daily copay for days 1 through 5 and no copay for days 6 through 90. While unlimited additional acute care days are covered with no copay, additional psychiatric days, acute upgrades, and non-Medicare-covered acute stays are not covered.
Outpatient Services See details
Fallon Medicare Plus Green (HMO) covers outpatient hospital services with a $325 copay and ambulatory surgical center services with a $300 copay, both featuring no coinsurance. Outpatient substance abuse sessions have a $40 copay and no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under Fallon Medicare Plus Green (HMO) with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under Fallon Medicare Plus Green (HMO), with Medicare-covered ground and air ambulance services requiring a $225 copay and no coinsurance. Transportation benefits are partially covered, offering unlimited one-way trips from a hospital to a skilled nursing facility for a $35 copay and no coinsurance, though transportation to other health-related locations is not covered.
Emergency Services See details
Fallon Medicare Plus Green (HMO) covers emergency services with a $110 copay, which is waived if you are admitted to the hospital within 72 hours, and urgently needed services with a $25 copay, both featuring no coinsurance. Worldwide emergency and urgent care are also covered with a $110 copay, while worldwide emergency transportation is available with a $225 copay and no coinsurance.
Primary Care See details
Fallon Medicare Plus Green (HMO) covers primary care visits with a $10 copay and specialist services for a $20 to $40 copay, with no coinsurance for either. Therapy services require a $20 copay, mental health and psychiatric sessions have a $40 copay, and opioid treatment has no copay, all with no coinsurance, though chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services offered by Fallon Medicare Plus Green (HMO) are partially covered, featuring no copay and no coinsurance for annual physicals, kidney disease education, and standard screenings. Additional benefits include health education with a $25 copay and no coinsurance, and chemotherapy wigs with a 20% coinsurance and no copay, while services like in-home safety assessments, alternative therapies, and caregiver support are not covered.
Hearing Services See details
Fallon Medicare Plus Green (HMO) covers routine hearing exams with a $40 copay, no coinsurance, and a referral requirement, limited to one exam per year. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $695 to $2,645 for up to two aids per year, while fitting evaluations, OTC hearing aids, and inner, outer, or over-the-ear models are not covered.
Vision Services See details
Vision services are partially covered by Fallon Medicare Plus Green (HMO), which offers one routine eye exam annually with a $40 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $150 combined annual maximum for contacts, upgrades, or one pair of lenses and frames.
Dental Services See details
Dental services are partially covered by Fallon Medicare Plus Green (HMO), offering routine preventive care like cleanings and exams with no copay and no coinsurance. Medicare-covered, diagnostic, and comprehensive restorative services require copays ranging from $20 to $990 with no coinsurance, while implants, orthodontics, maxillofacial prosthetics, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Fallon Medicare Plus Green (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Part B insulin is covered with a copay of $0 to $35 and no coinsurance, while chemotherapy, radiation, and other Part B drugs require a coinsurance of 0% to 20% and no copay.
Dialysis Services See details
Dialysis services are covered under Fallon Medicare Plus Green (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Fallon Medicare Plus Green (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, requiring prior authorization. Diabetic equipment is partially covered with no copay and no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Fallon Medicare Plus Green (HMO) partially covers Diagnostic and Radiological Services with no coinsurance, though prior authorization and referrals are required. Covered diagnostic services have no copay, but diagnostic procedures, tests, and lab services are not covered; diagnostic radiological services require a minimum $250 copay, while therapeutic radiological and outpatient X-ray services are not covered.
Home Health Services See details
Home health services are covered under Fallon Medicare Plus Green (HMO) with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are offered under the Fallon Medicare Plus Green (HMO) plan with no copay, no coinsurance, and a required referral. While some services are covered, specific options such as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered.
Skilled Nursing Facility (SNF) See details
Fallon Medicare Plus Green (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization and a referral are required. This partially covered benefit features no copay for days 1 to 20 and 45 to 100, a $150 copay for days 21 to 44, and does not cover additional days beyond the standard 100 days.
Other Services See details
Fallon Medicare Plus Green (HMO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a maximum annual benefit of $175. Acupuncture, meal benefits, and other additional services are not covered under this plan.
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