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Fallon Medicare Plus Saver No Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Fallon Medicare Plus Saver No Rx (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 Saver No Rx (HMO) in 2026, please refer to our full plan details page.
Fallon Medicare Plus Saver No Rx (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 Saver No Rx (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Fallon Medicare Plus Saver No Rx (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 Saver No Rx (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $75.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6700.00 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
Prescription drugs are not covered by Fallon Medicare Plus Saver No Rx (HMO).
Additional Benefits
The Fallon Medicare Plus Saver No Rx (HMO) plan offers affordable access to core healthcare services, including primary care, home health, and cardiac rehabilitation with no copay. For specialist visits and physical therapy, members will pay low copayments ranging from $20 to $40. Inpatient hospital stays require a $315 daily copay for the first five days followed by no copay for days six through 90, while emergency room visits incur a $90 copay that is waived upon admission. Routine preventive care, annual physical exams, and preventive dental services are fully covered with no copay. Members also benefit from no copay on eyewear up to a $150 annual limit and a $175 annual allowance for over-the-counter items. Skilled nursing facility care features no copay for the first 20 days, while durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Fallon Medicare Plus Saver No Rx (HMO) with no coinsurance, featuring a $315 daily copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional acute days are covered with no copay, but upgrades, non-Medicare-covered acute stays, and additional psychiatric days are not covered.
Outpatient Services See details
Fallon Medicare Plus Saver No Rx (HMO) covers outpatient hospital and ambulatory surgical center services with a $275 copay and no coinsurance, subject to referral and prior authorization requirements. Outpatient substance abuse services are covered with a $40 copay per session and no coinsurance, while outpatient blood services are covered with no copay, deductible, or coinsurance.
Partial Hospitalization See details
Fallon Medicare Plus Saver No Rx (HMO) covers partial hospitalization services with no copay and no coinsurance, although prior authorization and a referral are required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Fallon Medicare Plus Saver No Rx (HMO), though transportation is only partially covered. Ground and air ambulance services require a $250 copay and no coinsurance, while plan-approved one-way chairvan trips from a hospital to a skilled nursing facility incur a $35 copay and no coinsurance. Transportation to any other health-related locations is not covered.
Emergency Services See details
Fallon Medicare Plus Saver No Rx (HMO) covers emergency services with a $90 copay and no coinsurance, which is waived if you are admitted to the hospital within 72 hours. Urgently needed services have a $15 copay with no coinsurance, while worldwide emergency and urgent care require a $90 copay and worldwide emergency transportation has a $250 copay, both with no coinsurance.
Primary Care See details
Fallon Medicare Plus Saver No Rx (HMO) offers primary care and opioid treatment services with no copay and no coinsurance, while specialist visits require a $20 to $40 copay with no coinsurance. Physical, occupational, and speech therapy services have a $20 copay, mental health sessions have a $40 copay, and telehealth ranges from a $0 to $40 copay, all with no coinsurance. Podiatry is not covered, and although some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Fallon Medicare Plus Saver No Rx (HMO) offers partially covered preventive services, featuring no copay and no coinsurance for annual physical exams, kidney disease education, and routine screenings. While supplemental benefits like health education require a $25 copay and chemotherapy wigs have a 20% coinsurance (up to $350 annually), services such as in-home safety assessments, personal emergency response systems, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home safety devices, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by Fallon Medicare Plus Saver No Rx (HMO), offering one annual routine hearing exam for a $40 copay and no coinsurance, and up to two prescription hearing aids per year with no coinsurance and copays ranging from $695 to $2,645. Fitting and evaluation exams, OTC hearing aids, and inner-ear, outer-ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Fallon Medicare Plus Saver No Rx (HMO), offering routine eye exams for a $40 copay and no coinsurance limited to one visit per year, while other eye exam services are not covered. Eyewear, including contact lenses and one pair of eyeglasses per year, is covered with no copay and no coinsurance up to a $150 annual maximum.
Dental Services See details
Fallon Medicare Plus Saver No Rx (HMO) covers dental services with no copay and no coinsurance for preventive care like cleanings, exams, and x-rays, while comprehensive services require copays ranging from $31 to $990 and no coinsurance. Prior authorization is required for comprehensive care, and other preventive dental services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Fallon Medicare Plus Saver No Rx (HMO) covers home infusion bundled services with no copay, subject to prior authorization. Under this plan, Medicare Part B insulin is covered with a $0 to $35 copay and no coinsurance, while chemotherapy and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Fallon Medicare Plus Saver No Rx (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Fallon Medicare Plus Saver No Rx (HMO) covers durable medical equipment and prosthetics with no copay and a 20% coinsurance. Diabetic equipment is partially covered with no copay and no coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered under this plan.
Diagnostic and Radiological Services See details
Fallon Medicare Plus Saver No Rx (HMO) diagnostic services are not covered because diagnostic procedures, tests, and lab services are excluded. Radiological services are partially covered with no coinsurance, featuring diagnostic radiological services for a $250 copay, while therapeutic radiological services and outpatient X-ray services are not covered.
Home Health Services See details
Home health services are covered by Fallon Medicare Plus Saver No Rx (HMO) with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Fallon Medicare Plus Saver No Rx (HMO) with no copay and no coinsurance, though a referral is required. While some services are covered, standard cardiac rehabilitation, intensive rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Fallon Medicare Plus Saver No Rx (HMO) covers skilled nursing facility (SNF) care with no coinsurance, requiring prior authorization and a referral but no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a daily copay of $203 for days 21 through 100, with no coverage provided for additional days.
Other Services See details
Fallon Medicare Plus Saver No Rx (HMO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $175 per year. Acupuncture and meal benefits are not covered under this plan.
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