UPDATES FROM FALLON HEALTH - March 2022

The days are getting longer and the temperatures are warming up. In many places, mask mandates are easing. These are all welcome sights for me, and I hope they are for you as well.

As winter comes to a close this month, so does the Open Enrollment Period. 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, by email or by fax at 1-508-757-0572.

In the February edition of the Broker Bulletin, I mentioned that brokers will soon be able to refer clients to Summit ElderCare^®, our Program of All-Inclusive Care for the Elderly (PACE). Details are still to come, but if you’re interested in seeing what a Fallon Health PACE Center looks like, you can take a virtual walk-through today via this video tour.

As always, please feel free to reach out to the Fallon Medicare Broker team any time with any questions you may have.

Sincerely,

Deb Daviau

VP of Medicare and Executive Director of NaviCare^®

As you know, Fallon Health is covering over-the-counter COVID-19 tests for all of our Fallon Medicare Plus^TM Medicare Advantage members. Here are some helpful things for members to know about how this works:

• Fallon will cover the cost of up to eight over-the-counter FDA-emergency use authorized tests per member per month without prior authorization.
• Members can get FDA-authorized COVID-19 antigen test kits at a network pharmacy at no cost to them.
• Members should make sure they go to the pharmacy counter, present their member ID card and ask to have the product submitted to OptumRx.
• If members paid out-of-pocket for a test kit on or after January 15, they can submit a request for reimbursement to OptumRx.

Please note that Fallon Health also covers medically necessary PCR and antigen tests at no cost.

You probably already know that Fallon Medicare Plus Supplement plans give members the freedom to see providers they want to see when they want to see them—without network restrictions and little to no out-of-pocket expenses (based upon plan design). Members can see any provider who accepts Medicare and them as patients. No PCP. No referrals. No copayments. 

But did you know our supplement plans also provide several healthy extras? These added benefits help our members be as healthy as they can be. What sets Fallon apart is that our plans offer multiple benefits—at no extra cost—where others may only offer a fitness benefit or none at all. 

One of those $0 benefits is a vision care program, which includes one routine eye exam every year at a plan provider and $150 toward the first pair of eyeglasses or contact lenses per calendar year. We’ll feature other healthy extras in future editions of the Broker Bulletin.

Your clients who are 65 and older with both Medicare Parts A and B, as well as MassHealth Standard, may be eligible for Fallon’s NaviCare HMO SNP plan. Those 65 and older who have, or are eligible for, MassHealth Standard only can enroll in our NaviCare SCO plan. Both plans offer the same benefits and have zero cost sharing for the member. 

Here is when your clients can enroll in NaviCare:

* For individuals aging into Medicare and those who just gained Medicare Part A or B, coverage can begin prior to January 1.

It’s been just over six months since we launched the Broker Bulletin. Have you been finding it to be a helpful resource? We’d love to hear your feedback! Please share your thoughts by taking this survey.

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. A one-time referral fee will be provided to agents who refer prospects to enroll in one of our plans. For more information, please contact our Medicare support team by email or by phone at 1-844-848-4931 (TRS 711), Monday–Friday, 8:30 a.m.–5 p.m.

If you haven’t already, please check out the 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. 

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.