A non-government entity
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 2025, 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 2025.
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 $40.00. 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:
Sign up for Fallon Medicare Plus Saver No Rx (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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 a range of benefits, including inpatient and outpatient hospital services, with varying copays. You'll have no copay for days 6-90 of inpatient hospital stays, and a $275 copay for outpatient services. Emergency services, primary care, and preventive services are covered, along with hearing, vision, and dental services with copays. Additional benefits include ambulance services, home health services, and skilled nursing facility care, with specific copays or coinsurance depending on the service. The plan also provides coverage for home infusion, dialysis, and medical equipment with copays or coinsurance, and covers other services like OTC items, with some services requiring prior authorization and referral.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the Fallon Medicare Plus Saver No Rx (HMO) plan, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For days 1-5, there is a $315 copay, and for days 6-90, there is no copay. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $275 copay, Observation Services, Ambulatory Surgical Center (ASC) Services with a $275 copay, Outpatient Substance Abuse Services with a $40 copay for both individual and group sessions, and Outpatient Blood Services. Prior authorization and a doctor referral are required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for ground and air ambulance services, each with a $250 copay, and transportation services with a $35 copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Fallon Medicare Plus Saver No Rx (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $90 copay, Urgently Needed Services have a $15 copay, and Worldwide Emergency Transportation has a $250 copay; all have no coinsurance.
Primary Care See details
The Fallon Medicare Plus Saver No Rx (HMO) plan covers primary care physician services and occupational therapy services with a doctor referral and authorization. Chiropractic Services are partially covered, with routine care not covered. Other covered services include physician specialist services with a copay between $20 and $40, mental health specialty services, physical therapy, speech-language pathology services with a $20 copay, and additional telehealth benefits with a copay between $0 and $40.
Preventive Services See details
Preventive Services includes coverage for many services, such as glaucoma screenings and diabetes self-management training. Health Education has a copay of $25.00, and Wigs for Hair Loss Related to Chemotherapy have a 20% coinsurance with a maximum plan benefit coverage amount of $350.00.
Hearing Services See details
Hearing services include routine hearing exams with a $40 copay, with a limit of one exam per year, and prescription hearing aids with a copay between $695 and $2645, up to two per year; fitting/evaluation for hearing aids, inner ear prescription hearing aids, outer ear prescription hearing aids, over-the-ear prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
The Fallon Medicare Plus Saver No Rx (HMO) plan covers vision services, including eye exams with a $40 copay. Eyewear is covered, with a combined maximum benefit of $150 per year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services are covered, with a $40 copay for Medicare Dental Services. Other Diagnostic Dental Services have a $20-$40 copay, while Restorative Services have a $31-$856 copay, and Adjunctive General Services have a $39-$157 copay. Endodontics have a $107-$990 copay, Periodontics have a $80-$953 copay, Prosthodontics, removable have a $37-$865 copay, and Prosthodontics, fixed have a $76-$860 copay. Oral and Maxillofacial Surgery has a $77-$667 copay, and Oral Exams, Prophylaxis (Cleaning), and Fluoride Treatment are also covered. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a copay between $0 and $35. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Fallon Medicare Plus Saver No Rx (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered under the Fallon Medicare Plus Saver No Rx (HMO) plan, with Durable Medical Equipment (DME) requiring prior authorization and a 20% coinsurance, but Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance, and Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered under the Fallon Medicare Plus Saver No Rx (HMO) plan. Diagnostic Procedures/Tests, Lab Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered. Diagnostic Radiological Services have a copay of at most $250.
Home Health Services See details
Home Health Services are covered by the Fallon Medicare Plus Saver No Rx (HMO) plan with no copay or coinsurance, but additional hours of care and personal care services are not covered. Prior authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the sub-services are covered, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. A doctor's referral is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Fallon Medicare Plus Saver No Rx (HMO) plan, but require prior authorization and a doctor's referral. You will have no copay for days 1-20, and a $203 copay for days 21-100.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items, with a maximum benefit of $125.00 per year, as well as Nicotine Replacement Therapy (NRT) and Naloxone coverage; however, Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved