Fallon Health NaviCare (HMO D-SNP) Medicare Special Need Plan H8928-002 • 2027
- Monthly Premium
- $22.70Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $9850.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Basic, $700.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 0 beneficiaries
Introduction
CMS Plan ID H8928-002 identifies Fallon Health NaviCare, a Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP) offered by Fallon Health. Its provider network is a Health Maintenance Organization (HMO), and Medicare Part D prescription drug coverage is included. For 2027, the plan has a $22.70 monthly premium, $0.00 medical deductible, and $9850.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $700.00.
Enrollment across the plan's service areas totals 0 beneficiaries, according to CMS. Enrollment is limited to beneficiaries who live within the plan's service area: See List.
Eligibility
Fallon Health NaviCare is a Medicare D-SNP plan for people who qualify for both Medicare and Medicaid.
- Special Needs Plan Type
- Dual-Eligible Special Needs Plan (D-SNP)
- Medicare Requirement
- Medicare Part A and Part B
- Special Needs Requirement
- Must qualify for Medicaid
- Service Area Requirement
- Must live in the plan's service area
- Prescription Drug Coverage
- Medicare Part D prescription drug coverage is included.
Plan Benefits
Fallon Health NaviCare has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H8928-002.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay | Coming soon |
| Specialist | In-network: $0 copay | Coming soon |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | Not covered | Coming soon |
| Telehealth benefit | In-network: $0 copay | Coming soon |
| Routine chiropractic | Not covered | Coming soon |
| Fitness benefits | Coming soon | Coming soon |
| Health education | In-network: $0 copay | Coming soon |
| Counseling services | Not covered | Coming soon |
| Over-the-counter drug benefits | In-network: $0 copay | Coming soon |
| Health transportation (non-emergency) | Coming soon | Coming soon |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $0 copay | Coming soon |
| Lab services | In-network: $0 copay | Coming soon |
| Outpatient x-rays | In-network: $0 copay | Coming soon |
| Diagnostic tests and procedures | In-network: $0 copay | Coming soon |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $0 copay | Coming soon |
| Worldwide emergency care | Coming soon | Coming soon |
| Urgent care | $0 copay | Coming soon |
| Inpatient hospital care | Tier 1 $0 per day for days 1-60 $0 per day for days 61-90 $0 per day for days 91-150 |
Coming soon |
| Skilled Nursing Facility | Tier 1 $0 per day for days 1-20 $0 per day for days 21-100 |
Coming soon |
| Ground ambulance | In-network: $0 copay | Coming soon |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $0 copay | Coming soon |
| Outpatient group therapy | In-network: $0 copay | Coming soon |
| Inpatient psychiatric hospital care | Tier 1 $0 per day for days 1-60 $0 per day for days 61-90 $0 per day for days 91-150 |
Coming soon |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $0 copay | Coming soon |
| Occupational therapy | In-network: $0 copay | Coming soon |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: $0 copay | Coming soon |
| Durable medical equipment | In-network: $0 copay | Coming soon |
| Prosthetics | In-network: $0 copay | Coming soon |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: $0 copay | Coming soon |
| Other Part B drugs (Medicare-covered) | In-network: $0 copay | Coming soon |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay | Coming soon |
| Dental x-rays | In-network: $0 copay | Coming soon |
| Cleaning | In-network: $0 copay | Coming soon |
| Periodontics | In-network: $0 copay | Coming soon |
| Endodontics | In-network: $0 copay | Coming soon |
| Restorative services | In-network: $0 copay | Coming soon |
| Implant services | In-network: $0 copay | Coming soon |
| Orthodontics | Not covered | Coming soon |
| Oral/Maxillofacial surgery | In-network: $0 copay | Coming soon |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | Not covered | Coming soon |
| Contact lenses | In-network: $0 copay | Coming soon |
| Eyeglass frames only | In-network: $0 copay | Coming soon |
| Eyeglass lenses only | In-network: $0 copay | Coming soon |
| Eyeglasses (frames & lenses) | In-network: $0 copay | Coming soon |
| Upgrades | In-network: $0 copay | Coming soon |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | Not covered | Coming soon |
| Fitting/evaluation | Not covered | Coming soon |
| Prescription hearing aids | Not covered | Coming soon |
| OTC hearing aids | Not covered | Coming soon |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Coming soon |
| Home-based palliative care | Not covered | Coming soon |
| Personal emergency response system | Coming soon | Coming soon |
| Weight management programs | Not covered | Coming soon |
| Wigs for chemotherapy-related hair loss | Coming soon | Coming soon |
| Alternative therapies | Not covered | Coming soon |
| Massage therapy | Not covered | Coming soon |
| Home/bathroom safety devices | Not covered | Coming soon |
Certain preventive services are covered 100% by Fallon Health NaviCare as a Part B benefit.
Prescription Drug Coverage
Fallon Health NaviCare includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $22.70 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $22.70 |
| Low-Income Premium Subsidy: | $33.82 |
| Low-Income Premium Subsidy Paid by CMS: | $22.70 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $700.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Fallon Health starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Fallon Health NaviCare may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Brand-name drugs | 25% coinsurance | Not available |
| Generic drugs | 25% coinsurance | Not available |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H8928)
Medicare assigns star ratings to plans based on quality and performance across multiple measures, including customer service, member experience, and health outcomes. Ratings are updated annually by the Centers for Medicare & Medicaid Services (CMS) and are shown on a 1 to 5 star scale, with 5 stars representing the highest quality.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for Fallon Health
- Website
- Fallon Health Plan Page
- Providers
- Fallon Health Providers Page
- Formulary
- Fallon Health Formulary Page
- Pharmacy
- Fallon Health Pharmacy Page
- New Member Health Plan Help
- (877)255-7108
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (877)255-7108
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Plan Availability
Fallon Health NaviCare (H8928-002-0) is available in the following locations (click to open):
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Fallon Health (official source) | http://fallonhealth.org/navicare | October 4, 2026 |
| CMS.gov | Dual Eligible Special Needs Plans (D-SNPs) | April 28, 2026 |
| Medicare.gov | Understanding Medicare Advantage Plans | April 28, 2026 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | April 28, 2026 |
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Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.