4

4 out of 5 stars* for plan year 2024

Plan ID: H9001-032

What You Need to Know:

  • Fallon Medicare Plus Super Saver HMO (HMO) is a Medicare Advantage Health Maintenance Organization Local HMO plan.
  • It must provide all of the same hospital and medical benefits as Medicare Part A and Part B, however, costs may be different.
  • It has additional benefits not included in Medicare Part A and Part B, including prescription drug coverage.
  • The plan's monthly premium is $60, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is $445 (Tier Yes excluded from the Deductible.).
  • The plan includes an out-of-pocket maximum of $7,550 per year (in-network).
  • Fallon Medicare Plus Super Saver HMO (HMO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is $445 (Tier Yes excluded from the Deductible.).
  • This plan's Part D Initial Coverage Limit is $38.

* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.

$60

Monthly Premium

Medicare Plan Features
Monthly Premium: $60.00
Part C Premium: $22.30
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$60.00 $22.30 $37.70 $0 $37.70 $445.0 1.0
Gap Coverage: No
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local HMO
Similar Plan: H9001-034
Special Needs Type: NULL
Chronic Condition: NULL
Additional Gap Coverage: No additional gap coverage, only the Donut Hole Discount
Maximum Out-of-Pocket Limit for Parts A & B (Moop): $7,550
Annual Deductible: $445 (Tier Yes excluded from the Deductible.)
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Barnstable, Massachusetts: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
82 members577 members 4.5 out of 5 Stars. 4 out of 5 Stars. 4 out of 5 Stars.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 3,480 drugs
Number of Members Enrolled in this Plan in Barnstable, Massachusetts: 577 members
Number of Drugs Per Tier: NULL
Preferred Pharmacy Cost Sharing During Initial Coverage Phase: NULL
Special Needs Plan SNP Eligibility Requirement: NULL
Monthly Premium Split as Follows:
Part C Premium Part D Base Premium Part D Supplemental Premium Total Premium
$22.30 $37.70 $0.00 $60.00
Monthly Premium with Extra Help Low Income Subsidy:
LIS100 Subsidy Total Monthly Premium with LIS Parts CD LIS25 Subsidy Monthly PartD Premium with LIS LIS25 Subsidy Total Monthly Premium with LIS Parts CD LIS50 Monthly PartD Premium with LIS LIS50 Subsidy Total Monthly Premium with LIS Parts CD LIS75 Monthly PartD Premium with LIS LIS75 Subsidy Total Monthly Premium with LIS Parts CD
$24.80 $28.90 $51.20 $20.10 $42.40 $11.30 $33.60
Formulary Drug Details:
Tier 1 # of Drugs per Tier Tier 1 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 2 # of Drugs per Tier Tier 2 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 3 # of Drugs per Tier Tier 3 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 4 # of Drugs per Tier Tier 4 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 5 # of Drugs per Tier Tier 6 Preferred Pharmacy Cost Sharing (initial coverage phase)
410 $0.00 1748 $9.00 273 $42.00 355 $95.00 633 25%

Other Medicare Advantage Plans in Barnstable, Massachusetts

Plan Name Type Premium MOOP Rx Deduct. Rating
Tufts Medicare Preferred HMO Value Rx (HMO) (2023)Local HMO$3,450$200
4
Tufts Medicare Preferred HMO Basic Rx (HMO) (2023)Local HMO$3,450$225
4
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
Tufts Medicare Preferred HMO Saver Rx (HMO) (2023)Local HMO$7,550$250
4
Fallon Medicare Plus Green HMO (HMO) (2023)Local HMO$6,700$300
4
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
Fallon Medicare Plus Blue HMO (HMO) (2023)Local HMO$3,400$0
4
Tufts Medicare Preferred HMO Prime No Rx (HMO) (2023)Local HMO *$3,450$-
4
Tufts Medicare Preferred HMO Value No Rx (HMO) (2023)Local HMO *$3,450$-
4
Fallon Medicare Plus Orange HMO (HMO) (2023)Local HMO$7,550$300
4
Fallon Medicare Plus Saver No Rx HMO (HMO) (2023)Local HMO *$7,550$-
4
Medicare PPO Blue PlusRx (PPO) (2023)Local PPO$3,400$200
4
Medicare PPO Blue SaverRx (PPO) (2023)Local PPO$7,550$405
4
Medicare PPO Blue ValueRx (PPO) (2023)Local PPO$4,900$320
4
Medicare HMO Blue PlusRx (HMO) (2023)Local HMO$3,400$200
4
Medicare HMO Blue ValueRx (HMO) (2023)Local HMO$4,900$320
4
Medicare HMO Blue FlexRx (HMO-POS) (2023)Local HMO$3,900$260
4
Medicare HMO Blue SaverRx (HMO) (2023)Local HMO$7,550$320
4
AARP Medicare Advantage Choice (Regional PPO) (2023)Regional PPO$6,700$295
5
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) (2023)Local HMO$3,450$0
4
Harvard Pilgrim Stride Basic Rx (HMO) (2023)Local HMO$4,500$445
3
Harvard Pilgrim Stride Value Rx Plus (HMO) (2023)Local HMO$3,400$0
3
Tufts Medicare Preferred HMO Prime Rx (HMO) (2023)Local HMO$3,450$0
4
Harvard Pilgrim Stride Value Rx (HMO) (2023)Local HMO$3,400$350
3
Medicare Advantage Plans by Fallon Health
Fallon Medicare Plus Green HMO (HMO) (2023)Local HMO$6,700$300
4
Fallon Medicare Plus Blue HMO (HMO) (2023)Local HMO$3,400$0
4
Fallon Medicare Plus Orange HMO (HMO) (2023)Local HMO$7,550$300
4
Fallon Medicare Plus Saver No Rx HMO (HMO) (2023)Local HMO *$7,550$-
4

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