UPDATES FROM FALLON HEALTH - January 2023

There’s something about beginning a new year, isn’t there? It’s familiar, yet fresh and full of possibilities—like starting a new book or journal.

It’s the same for the work we do at Fallon Health. Plan enrollment periods are predetermined—Medicare OEP gets things going in January and AEP wraps up the year in December—and we know what’s needed to prepare for both. At the same time, we look forward to working with new members and new partners alike. 

With that in mind, we’re kicking off 2023 with some helpful reminders for your new year. If you have any questions, please contact us. You can call our Broker Relations team at 1-844-848-4931 (TRS 711), Monday–Friday, 8:30 a.m.–5:00 p.m., or send them an email at

MedicareSalesBrokers@fallonhealth.org. Or, you may contact Nicolette Allsopp, Medicare Broker Relationship Manager, at 1-508-368-9262 or Nicolette.Allsopp@fallonhealth.org. 

Sincerely,

Deb Daviau

Vice President of Medicare and Executive Director of NaviCare

Between Jan. 1 and March 31, Medicare Advantage enrollees have an opportunity to change their coverage and/or switch plans. However, Medicare limits sales activities during OEP. 

Here's what you can DO

• DO market to:

1. Beneficiaries who have aged-in to plan eligibility, and who have not yet selected coverage
2. Dual-eligibles (people who are eligible for both Medicare and Medicaid coverage)
3. Low-Income Subsidy (LIS) beneficiaries

• DO provide materials to clients who request them.
• DO meet with clients who request a meeting to discuss OEP options.

And here are the DON'Ts

• DON'T call/contact former enrollees who selected a new plan during AEP.
• DON'T engage in or promote activities that intend to target the OEP as an opportunity to make further sales.
• DON'T knowingly target beneficiaries who are in the OEP because they made a choice during AEP.
• DON'T send unsolicited materials advertising the opportunity to make an enrollment change or referencing the OEP.

Should any of your clients tell you they're reconsidering their Medicare options, we'll be able to process any eligible new enrollments or plan changes you submit to us by the end of the business day on March 31. 

Here’s how you can submit OEP enrollments to Fallon Health:

• Through SunFire, our online enrollment tool
• Via email at MedicareSalesBrokers@fallonhealth.org
• By fax at 1-508-757-0572

Fallon Health has been covering, and will continue to cover over-the-counter COVID-19 tests. We will cover the cost of the following: 

• NaviCare^® members—up to eight over-the-counter FDA emergency use authorized tests per member per month without prior authorization. 
• Fallon Medicare Plus™ members—up to four over-the-counter FDA-emergency use authorized tests per member per month without prior authorization.

In addition to over-the-counter tests, Fallon Health is covering diagnostic tests known as polymerase chain reaction (PCR) and antigen tests. These tests identify whether a person has active COVID-19 infection, and will be covered at no cost-sharing for members as long as their health care provider identifies that you are symptomatic with COVID-19 related symptoms. Learn more.

Fallon Health's NaviCare plans provide members aged 65 or older residing in our service area with benefits, items, and services that are covered by Medicare and MassHealth Standard—plus more. This is how they work: 

• If your clients have only MassHealth Standard, they can join NaviCare SCO. 
• If your clients also have Medicare Parts A and B, they can enroll in NaviCare HMO SNP. Both plans offer the same coverage and benefits. 

This is when your clients can enroll:

• NaviCare SCO—Any time; coverage begins the first day of the following month. 
• NaviCare HMO SNP—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) and during Medicare's Annual Enrollment Period (Oct. 15–Dec. 7; coverage begins on Jan. 1).

Fallon Health’s Program of All-Inclusive Care for the Elderly (PACE), Summit ElderCare, is the largest PACE provider in New England, offering program access to 10 counties across Massachusetts. It offers and delivers complete, coordinated, individualized care for older adults who want to live at home instead of a nursing home.

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 from Monday–Friday, 8:30 a.m.–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.

Streamline your Fallon Health enrollments

Use SunFire. It makes the process easier.