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Medicare Advantage · HMO
Fallon Health
Plan year 2027

NaviCare (HMO D-SNP) H8928-002

Monthly premium
$22.70
+ your Part B premium
Max out-of-pocket
$9,850
in-network annual cap
Primary care
$0
per visit copay
Specialist
$0
per visit
Eligibility required for this D-SNP
You must be entitled to Medicare Part A, enrolled in Part B, and have a Medicaid category this plan accepts. The plan must verify your Medicaid status. Eligibility alone does not create a year-round right to enroll.
Common dual-eligibility labels

These definitions are educational. They do not confirm which Medicaid categories this specific plan accepts.

FBDE
Full Medicaid benefits in addition to Medicare.
QMB+
QMB help with Medicare costs plus full Medicaid benefits.
SLMB+
SLMB help with the Part B premium plus full Medicaid benefits.
QMB
Help with Medicare premiums and Medicare-covered cost sharing.
Check the Summary of Benefits or Evidence of Coverage for the exact Medicaid levels this plan accepts.
Could a Medicare Savings Program help?

Medicare Savings Programs are run by each state. The 2026 federal baseline monthly income limits are:

  • QMB: $1,350 for one person or $1,824 for a married couple
  • SLMB: $1,616 for one person or $2,184 for a married couple
  • QI: $1,816 for one person or $2,455 for a married couple
Alaska, Hawaii, and some states use different limits or resource rules. Qualifying for an MSP does not by itself confirm eligibility for this D-SNP. Apply through your state Medicaid office.
Extra benefits for members who qualify
  • Food and produce benefit
  • Non-medical transportation benefit
These benefits are not available to every member. Even if you have a listed chronic condition, the plan must confirm that you meet its coverage criteria. See the Evidence of Coverage for complete rules.

Your costs at a glanceIn-network, for the 2027 plan year

Rx deductible
$700
Outpatient surgery
$0
Emergency room
$0
Urgent care
$0

This plan is for people with Medicaid. What you pay depends on your Medicaid level: with QMB, your share of Medicare-covered services is covered; with full Medicaid benefits, your state may also cover Medicaid-covered services. Your state Medicaid office can confirm your level — or call us at 1-866-764-3312 (TTY 711) and a Licensed Medicare Advisor will help confirm it and discuss this plan's details with you. If you lose Medicaid eligibility, you may be billed the plan's cost sharing.

What's included, and what it's actually worth4 benefits included. Tap any card for the detail

OTC allowance

$375/quarter OTC allowance
Prepaid card$375/quarter OTC allowance

Vision

$403/yr eyewear allowance
Eyewear allowance$403/yr eyewear allowance
This is a supplemental benefit with plan-specific limits. See plan documents for details.
See more details about this plan
Doctor Visits: PCP$0 copay
In-network$0 copay per visit
Doctor Visits: Specialist$0 copay
In-network$0 copay per visit
Outpatient Surgery$0 copay
In-network$0 copay per procedure
Fitness$0 fitness benefit
Transportation48 one-way trips/year
Trips per year48 one-way trips/year

Your coverageCheck your coverageFrom the doctors and prescriptions you added

Our take

Where this plan shines

See your primary doctor for $0.
The specialist copay ($0) is among the more affordable options.

Things to know before you enroll

This plan’s out-of-pocket maximum is above the national median.
Network restriction — you’ll need to use in-network providers except in emergencies.
Limited coverage while traveling outside the plan’s service area.
Questions? Talk to a licensed agent at1-866-764-3312 (TTY: 711)

Plan documents

Check Your Doctors
See if your doctors accept this plan
Documentos en español
Llame a The Pocket Protector al 1-866-764-3312 (TTY: 711) para recibir ayuda con documentos en español

Plan questions

Common questions about NaviCare (HMO D-SNP)

What does NaviCare (HMO D-SNP) cover?

NaviCare (HMO D-SNP) is a Dual Eligible Special Needs Plan, a Medicare Advantage plan for people who have Medicare and a Medicaid category the plan accepts. The plan record also identifies Part D prescription drug coverage. Published supplemental benefits include vision ($403/yr eyewear allowance), over-the-counter (OTC) ($375/quarter OTC allowance), fitness ($0 fitness benefit), and transportation (48 one-way trips/year). Review the plan documents for covered services, limits, and rules. Coverage can change each plan year.

Learn about Medicare Advantage

How much does NaviCare (HMO D-SNP) cost in 2027?

The published 2027 monthly plan premium for NaviCare (HMO D-SNP) is $22.70. Any Medicare premiums you owe are separate from the listed plan premium. The listed Part D deductible is $700. The in-network medical out-of-pocket maximum is $9,850; it does not include Part D drug spending. Published visit costs include primary care $0 and specialist visits $0. Member costs can depend on the Medicaid category the plan accepts and verifies. These figures are plan data, not a personal yearly-cost estimate.

Understand Medicare drug-cost limits

Can I use my current doctors with NaviCare (HMO D-SNP)?

CMS lists NaviCare (HMO D-SNP) as a HMO plan. A network label alone does not confirm that a specific doctor participates. Use the doctor lookup tool, then confirm with the doctor's office and the plan before receiving care. Provider networks and member costs can change. Emergency care and travel coverage can follow different network rules.

Check your doctors

Do I qualify for NaviCare (HMO D-SNP)?

NaviCare (HMO D-SNP) is listed in the current plan record as a D-SNP. You must be entitled to Medicare Part A, enrolled in Part B, and have a Medicaid category this plan accepts. The plan must verify your Medicaid status. Eligibility alone does not create a year-round right to enroll.

Learn about Medicare Savings Programs

What extra benefits does NaviCare (HMO D-SNP) offer for dual-eligible members?

The current plan record for NaviCare (HMO D-SNP) lists vision ($403/yr eyewear allowance), over-the-counter (OTC) ($375/quarter OTC allowance), fitness ($0 fitness benefit), and transportation (48 one-way trips/year). Member costs can depend on the Medicaid category the plan accepts and verifies. The record identifies Part D prescription drug coverage. Review the plan documents for benefit limits, eligibility rules, and how Medicare and Medicaid coverage work together.

When can I enroll in NaviCare (HMO D-SNP)?

NaviCare (HMO D-SNP) is a 2027 Medicare Advantage plan. The Annual Enrollment Period runs from October 15 through December 7, with changes taking effect January 1. The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 for people already enrolled in Medicare Advantage. Because this is a D-SNP, the plan must also verify its eligibility requirements. A qualifying circumstance may create a Special Enrollment Period, but eligibility alone does not guarantee a year-round right to enroll. Confirm the enrollment window and effective date that apply to you before changing coverage.

Review Medicare enrollment periods

More plan options

Explore related plans

Browse the full 2027 Dual Eligible Special Needs Plan directory. This plan is offered in Massachusetts. Plan availability can vary by county.

More Dual Eligible Special Needs Plan options

These plans are offered in at least one of the same states. Check your ZIP or county before choosing a plan.

Helpful next steps

The Pocket Protector · NPN 21126942 · 1-866-764-3312 (TTY: 711) · thepocketprotector.com

Plan benefits, premiums, and copays may vary by county and plan. You must continue to pay your Medicare Part B premium. Benefits and costs may vary by service area. Contact the plan or CMS for complete details.

We unbiasedly compare all plans regardless of appointment or sales commissions. Agents are not bonused off commissionable sales. Agents are paid flat amounts and share in company financials across all businesses and products. Federal Regulation requires us to disclose currently we represent a number of organizations which offer a variety of products in your area across Medicare Supplement, Medicare Advantage, and Part D Drug Plans. You can always contact Medicare.gov or 1-800-MEDICARE for help with plan choices.

Members may receive a monthly or quarterly allowance in the form of a benefits prepaid card to pay for a wide range of plan-approved items. Unused amounts will expire at the end of the month or quarter.

Out-of-network/non-contracted providers are under no obligation to treat plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you to contact the plan.

Dental, hearing, vision, and other supplemental benefits may have limitations and restrictions. These benefits vary by plan. Please refer to the plan's Evidence of Coverage for details.

The plan formulary, pharmacy network, provider network, and/or copays may change at any time.

This spending allowance is a special supplemental program for members with specific health conditions. Qualifying conditions include diabetes mellitus, cardiovascular disorders, chronic and disabling mental health conditions, chronic lung disorders, or chronic heart failure, among others. Some plans may require at least two conditions and other requirements apply. See the plan's Evidence of Coverage for details.

Even if you have a listed chronic condition, you may not receive the benefit. Coverage also depends on the plan's specific coverage criteria for the SSBCI.

If you use this program for rent or utilities, Housing and Urban Development (HUD) requires it to be reported as income if you seek assistance. Contact your local HUD office if you have questions.

To join a Dual Eligible Special Needs Plan (D-SNP), you must be entitled to Medicare Part A, enrolled in Medicare Part B, and receive full Medicaid benefits or assistance from your state. Eligibility requirements vary by state and may require further verification. Enrollment in the plan depends on contract renewal.

Membership in this plan depends on your continued Medicaid eligibility. If you lose your Medicaid eligibility, you may be disenrolled from this plan. Contact your state Medicaid office or 1-800-MEDICARE (TTY: 1-877-486-2048) for more information.

Benefits shown are based on CMS public plan data. Actual benefits vary by county. Not all plans available in all areas. Speak with a licensed agent before enrolling.

  1. The Pocket Protector represents Medicare Advantage HMO, PPO, and PFFS organizations and stand-alone PDP prescription drug plans that have a Medicare contract. Enrollment depends on the plan's contract renewal.
  2. The Pocket Protector is not connected with or endorsed by the United States government or the federal Medicare program.

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