Benefits, items and services
NaviCare HMO SNP is a Medicare Advantage Special Needs Plan that combines Medicare benefits and MassHealth Standard benefits, including Medicare Part D. For people with MassHealth Standard alone, NaviCare SCO offers the same benefits as NaviCare HMO SNP.
Premiums and cost-sharing
As a NaviCare member, you'll have no plan premiums and no copayments or coinsurance.
Low income subsidy
This table shows you what your monthly plan premium will be since you get extra help from Medicare to help pay for your Medicare prescription drug plan costs.
NaviCare provides your covered medical items and services and certain prescription drugs, as well as needed community-based home and personal care services.
NaviCare covers Medicare and MassHealth Standard benefits, items and services like:
- Doctor visits
- Covered prescription drugs and certain over-the-counter drugs with a prescription
- Hospital stays
- Rehabilitation services
- Durable medical equipment (such as canes and wheelchairs)
- Personal emergency response systems
- SilverSneakers® Fitness Program or SilverSneakers Steps®
- A 13-consecutive-week membership in Weight Watchers®
- Quit to Win, our stop smoking program
- Eyeglasses and vision services
- Dental care, including dentures
- Transportation to and from medical and rehabilitation visits with prior approval
- Care management services including:
- Coordination of your care between your doctors
- Coordination of your in-home services
For more details on benefits, items, services and coverage, you can download the documents below:
Summary of Benefits
A Summary of Benefits is a booklet that provides details on plan benefits.
Evidence of Coverage
An Evidence of Coverage (EOC) is a booklet that we provide once you become a member. It’s part of your contract with us and it describes your complete benefits as well as how to use the plan. You can also find information about our grievance, coverage determination and appeal (and exceptions for Part D) processes in chapter 8, and the exception process for Part D in chapter 5, respectively, in your Evidence of Coverage.
This shows dental services that are covered when you receive them from a plan dentist.
To view the PDF files above, you may need to download a free copy of Adobe® Acrobat Reader software on your computer. (This link takes you away from the NaviCare-specific website pages.)
NaviCare is a Coordinated Care Plan with a Medicare contract and a contract with the Massachusetts Medicaid program. NaviCare is a voluntary program in association with MassHealth/EOHHS and CMS.
NaviCare HMO SNP is available to individuals age 65 and older who have Medicare Parts A and B and MassHealth Standard and live in the service area. NaviCare SCO is available to individuals age 65 and older who have MassHealth Standard and live in the service area. (Individuals with MassHealth Standard do not have to be covered by Medicare Parts A and B to enroll in NaviCare SCO.) You must continue to pay your Medicare Part B premium unless the Commonwealth of Massachusetts pays this premium for you.
The benefit information provided is a brief summary, not a complete description of the benefits. For more information, contact the plan. Limitations and restrictions may apply. Benefits, formulary and pharmacy network may change on January 1 each year.
SilverSneakers® is a registered trademark of Healthways.
Weight Watchers® is a registered trademark of Weight Watchers International, Inc.
Adobe is a registered trademark of Adobe Systems Incorporated.
H9001_N_2013_15 Approved 10292012
The information on this page was last updated on 10/1/2012.