UPDATES FROM FALLON HEALTH - October 2025

SPECIAL EDITION

Over the past few months, you’ve done a lot to prepare for AEP—everything from getting your necessary certifications and product trainings to refreshing your sales strategies and making sure your client database is up to date.

Because of your hard work and focus, you’re more than ready to help your Medicare Advantage clients on Oct. 15.

As Manny Lopes, our president and CEO, said in the January edition of this newsletter: You’re a valuable resource. You have a deep understanding of the market and are knowledgeable about Medicare Advantage plans like ours. This enables you to focus on your clients’ needs, so you can connect them with the insurance plans and providers that’ll serve them best.

So that we can help you provide exceptional service to your clients, we’ve filled this edition with AEP-related resources and plan information.

We hope this AEP is your most successful one yet!

Sincerely,

Sandra Villalba

Director of Medicare Sales

Fallon Health product training sessions

Join us at 1 or more of the following Fallon Health product certification training sessions. They’ll be held online through Oct. 9.

Oct. 1 and 8, 3:00–4:30 p.m.

• Microsoft Teams Meeting ID: 269 983 572 757 7, Passcode: L2wb6Va7
• 774-243-2133 Phone conference ID: 307 283 285#

Oct. 2 and 9, 9:00–10:30 a.m.

• Microsoft Teams Meeting ID: 243 716 372 062 2, Passcode: CE3Jc762
• 774-243-2133 Phone conference ID: 116 405 877#

Resources for selling

High-quality, printed copies of various Fallon Health materials are available for you to share with your clients. They include:

• Enrollment materials
• Benefits brochures
• Sales kits
• And more!

Have questions or need materials?

Our Broker Relations team is standing by and ready to help with extended hours during AEP. Here's how—and when—you can reach us:

Call us at 1-844-848-4931 (TRS 711) 

• Monday to Friday during our regular hours of 8:30 a.m. to 5:00 p.m.
• Saturdays from 8:30 a.m. to 3:00 p.m. from Oct. 15 to Dec. 7

Send us an email at MedicareSalesBrokers@fallonhealth.org 

Streamline your Fallon Health enrollments

Use SunFire. It makes the process easier.

Fallon Medicare Plus™ Medicare Advantage 

Fallon Medicare Plus members may have a Benefit Bank card that's preloaded with money that can be used for dental care, prescription eyewear, gym/fitness memberships, and prescription hearing aids (allowances vary depending on the plan).

Reminder for 2025: If members have a balance on the Benefit Bank card at the end of 2025, it won’t carry over. Balances can be used until Dec. 31, 2025.

Update for 2026: In 2026, the Benefit Bank card* is available with Fallon Medicare Plus Green, Blue, and Saver No Rx plans. Allowances range from $250 to $500, depending on the plan you choose. Plus, if someone joins our Green or Saver No Rx plans, they’ll get an additional $175 to shop for health care items, like pain relievers and cold/allergy medicine, at select retail locations or with our online partner.

*Not available in 2026 for the Fallon Medicare Plus Orange plan

NaviCare^® HMO SNP

Save Now card

NaviCare members have a Save Now card that's preloaded each calendar quarter (Jan. 1, April 1, July 1, and Oct. 1) with money to buy health and personal care items. If a member has a balance on the Save Now card, it can be used only until Dec. 31, 2025.

Update for 2026: For members who have qualifying chronic conditions—each calendar quarter, $200 of their Save Now dollars will be set aside for healthy food and $175 for them to buy health and personal care items. Not all members qualify.

Transportation benefit for 2026

NaviCare members in 2026 will get free:

• Unlimited rides to and from medical appointments and places where they receive health care
• 48 one-way rides to the pharmacy
• 100 one-way rides* to run errands, visit friends, attend religious services, and more

If friends and family provide rides, they can receive reimbursement for mileage of pre-approved rides. 

*The 100 one-way rides are part of the Special Supplemental Benefits for the Chronically Ill (SSBCI) program and only for members who have qualifying chronic conditions. Not all members qualify. Members can find out if they qualify for this benefit by contacting their Fallon Health Navigator or calling NaviCare Enrollee Services at 1-877-700-6996 (TRS 711), 8 a.m. to 8 p.m., Monday through Friday (7 days a week, Oct. 1 to March 31).

For 2026, individuals who want to be a member of a Senior Care Options plan like NaviCare HMO SNP will need to be enrolled in: 

• Medicare Parts A and B
• MassHealth Standard

More information about these eligibility changes is available online at mass.gov/info-details/2026-sco-eligibility-changes.

Contact us

Our easy-to-reach Broker Relations team is available to you at every stage of the sales process. We can provide you with personalized support over the phone Monday through Friday, 8:30 a.m. to 5:00 p.m.

You can also reach us by email: MedicareSalesBrokers@fallonhealth.org

Check out our website

Especially our broker webpages. They're full of helpful information.