New beginnings

Hello and welcome to 2022! I hope you had a wonderful holiday, and a happy and healthy start to the New Year. 

For many, January is a time of new beginnings and looking forward. For Fallon Health in particular, 2022 promises to be an exciting year. Our focused commitment on government programs, like Medicare and Medicaid, will create even more opportunities for us to address the diverse, changing and unique needs of populations we serve—older adults, people with complex health conditions and lower-income individuals. 

Also in this new year—and for the first time in decades—we are excited to launch a new mission statement that truly encompasses our path ahead: Improving health and inspiring hope. As a health care services organization that is both a health plan and a provider, Fallon has the unique ability to focus on the needs of our members as individuals. For example, during this time where COVID-19 is rearing its ugly head yet again, Fallon Medicare Plus members can opt for telehealth visits with their PCPs, or for primary care services with a Teladoc physician, at $0 cost. 

Remember that the Fallon Medicare broker team is always available to help you with whatever you or your clients need. Please feel free to reach out to us any time with issues or questions.


Deb Daviau

VP of Medicare and Executive Director of NaviCare

Costs for at-home COVID-19 tests to be covered

Fallon Health will cover the costs of over-the-counter COVID-19 antigen tests for all Fallon members whose plans include a pharmacy benefit—including our Medicare Advantage members. This decision exceeds federal government mandates, which only require coverage for members of commercial plans.

With Fallon, every member matters and no member is left behind. Older adults have been disproportionately affected by the pandemic. We believe that it is important to arm our Medicare members with everything possible to keep them and their loved ones safe and well. Teams at Fallon are working out the details of this policy now, and more information will be made available in the coming days. Please note that Fallon also covers medically necessary PCR and antigen tests.

Benefit Bank updates for 2022

As you know, our Benefit Bank program offers your clients the flexibility to spend their Benefit Bank dollars as they choose: on everything from dental care and eyewear to hearing aids, fitness memberships (now including approved online fitness programs) and online WW® memberships (also new in 2022). It’s also easier to navigate the various plan offerings, because the amounts have been streamlined for our Fallon Medicare Plus and Fallon Medicare Plus Central plans. The Benefit Bank page of our website has all the details.

NaviCare enrollment dates

Fallon Health’s NaviCare® plan provides members with benefits, items and services that are covered by Medicare and MassHealth Standard—plus more. Members of our NaviCare® SCO and NaviCare® HMO SNP plans receive all the care and services they need at no cost to them. There may be certain times of the year that you can enroll your clients in NaviCare®, depending on which plan they want to join:

NaviCare® SCO – Your eligible clients can enroll at any time; coverage begins the first day of the following month.

NaviCare® HMO SNP – Your eligible clients can enroll once per calendar quarter during the first three quarters of the year (January­­–March, April–June or July–September); coverage begins the first day of the following month. Your eligible clients can also enroll during Medicare’s Annual Enrollment Period, October 15–December 7; coverage begins on January 1.

'Improving Your Health' radio segment launches this month

A monthly radio segment called ‘Improving Your Health with Fallon’s Richard Burke’ will begin airing on WCRN 830 AM at the end of January. Fallon Health’s President and CEO, Richard Burke, will provide an experienced voice and local perspective on some of the biggest health care topics shaping the region today. The segment will air live during ‘Talk of the Commonwealth’ and ‘Worcester Radio Network’ at 8:35 a.m. on the last Wednesday of each month.

The DOs and DON’Ts of Medicare Advantage Open Enrollment Period (OEP)

Between January 1 and March 31, Medicare Advantage enrollees who aren’t happy with their current plan have an opportunity to change their coverage and/or switch plans. However, Medicare limits sales activities during OEP. Here’s a list of what can and can’t be done:

  • DO send marketing/enrollment materials, schedule and have one-on-one meetings, and/or provide information about OEP over the phone if your clients request them.
  • DO market to age-ins (who have not yet made an enrollment decision), dual-eligible and LIS beneficiaries.
  • DON’T send unsolicited materials advertising the opportunity to make an enrollment change or referencing the OEP.
  • DON’T knowingly target beneficiaries who are in the OEP because they made a choice during AEP.
  • DON’T engage in or promote activities that intend to target the OEP as an opportunity to make further sales.
  • DON’T call/contact former enrollees who selected a new plan during AEP.

Should any of your clients tell you they’re reconsidering their Medicare options, we’ll be able to process any new enrollments or plan changes you submit to us by the end of the business day on March 31. Enrollments can be submitted to us online at https://fallon.sunfirematrix.com/app/agent/fchp, emailed to us at MedicareSalesBrokers@fallonhealth.org or faxed to us at 1-508-757-0572.

Join our broker team

If you haven’t already, please check out the new broker pages on our website. You can find information there about becoming a broker with Fallon and tools you can use if you are already a broker with us. 

If you aren’t ready to become a Medicare broker with us, we also have a broker referral program that you can take advantage of. Fallon offers competitive compensation to agents and brokers who provide us with member referrals for several of our plans within our Government Programs products portfolio. For more information, please call our Medicare support team Monday–Friday, 8:30 a.m.–5 p.m., at 1-844-848-4931 (TRS 711), or email us at MedicareSalesBrokers@fallonhealth.org.

Contact us

Our easy-to-reach Broker Relations team is available to you at every stage of the sales process. We provide you with personalized support over the phone.

Call us today:


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