Fallon Community Health Plan Insurance Review & Complaints: Health & Medicare Supplement Insurance (2023)

Fallon Community Health Plan is a Massachusetts-based health system that includes its own health plan. With more than 40 years in business, they were the first federally qualified HMO in the state and now offer coverage in New York and New Hampshire. Fallon Community Care is one of the company’s affordable healthcare options. FCHP also offers a variety of Medicare health plans similar to those offered by the best insurance companies with bigger names.

Comparing Fallon Health Plan Medicare Supplement quotes to others before you buy is the best way to get a great deal. Enter your ZIP code above now to use our FREE tool to compare rates.

About Fallon Health Plan

Fallon Community Health Plan (FCHP), was founded in 1977, and by the following year became federally qualified to offer HMO health insurance plans. The company became one of the first HMOs in the state to be given a special Medicare contract in 1980, making them one of the top choices for senior health care.

Their success and first continued; in 1994 they were the first HMO to be accredited by the National Committee for Quality Assurance. In 1999 they earned the rank of Newsweek’s best HMO in the country.

Fallon expanded into New Hampshire in 2009, offering coverage in some parts of the state. A 2014 partnership with the Weinberg Campus created Fallon Weinberg and expanded the company further, into Western New York. Fallon officially dropped the Community from its name, but still uses the FCHP acronym.

Fallon today remains a leader in senior health care and offers Medicare Advantage, Medicare Supplement, and several other plans and programs for comprehensive care.

Fallon Medicare Plans: Advantage and Supplement

Fallon goes beyond the usual plans to offer extra benefits and options for seniors. Plan choices vary by location, so for the purpose of this review, we used the ZIP code for the company’s corporate headquarters in Worcester, MA to obtain plan information.

Medicare Advantage

In our sample area, Fallon offers five plans that include Part D coverage and one plan without.

The Fallon Medicare Plus Central Orange HMO is the only $0 premium (above and beyond your regular Medicare premium) offered by Fallon. It is an HMO plan and has copays of $10 for primary care visits and $20-40 for specialist visits. This plan has a $300 prescription deductible on Tiers 3 and up,  and excluding Tier 6.

The Fallon Medicare Plus Central Green HMO plan is also an HMO plan, and it has copays of $25 for primary care and $20-$40 for specialist visits. Prescription deductibles are the same as the Orange Plan.

The Fallon Medicare Plus Central Blue HMO plan is an HMO-POS plan with copays of $10 for primary care visits, $15-20 for specialists, and $300 a day for the first five days of inpatient hospital stays. There is no deductible for prescriptions.

All of the plans are also available with a wider network of care for a higher premium, although the Orange plan remains a $0 plan regardless of network choice.

All of these plans include Part D.

Fallon Community Health Plan Medicare Supplement

We checked the available plans for the same ZIP code for Medicare Supplement. Fallon’s two available plans follow the state of Massachusetts’ standards, which differ from most of the country.

The Core plan covers the first three pints of blood each year, along with most coinsurance amounts and emergency travel medical. The step-up from this plan is the 1 plan, which covers nearly all out of pocket costs not covered by Medicare.

Other Products

Fallon offers some other products and assistance for seniors. But is Fallon Health a part of MassHealth? Yes it is.

NaviCare is Fallon’s combined program for those that qualify for both Medicare and MassHealth standard (Medicaid). It includes a number of extra benefits on top of what is covered by those two services.

Summit ElderCare is a program designed to assist those who want to live at home but require assistance with things like medication and at-home care for daily tasks.

Fallon Health Plan Medicare Rates

As mentioned, there is one $0 premium plan that is available from Fallon. This is the most affordable Fallon Health Plan Medicare insurance option. This means you do not pay anything more than your usual Medicare premiums. From there, rates climb, Green plan at $29 a month and the Blue plan at $129 a month.

Supplement plans come in at $126 for Core and $215 for 1.

We are unable to compare to other plans on a national level, particularly since Massachusetts’ Supplement plans differ from most other places, but from what we have seen overall and particularly in this state, Fallon is expensive. There are a few lower-priced plans, but the copays are on the high side. The highest cost plans are well above what we have seen elsewhere and still have higher copays.

Supplement plans as well appear to be priced on the high side.

How Fallon Community Health Plan Manages Claims

Ease of Filing a Claim

Fallon Community Health Plan aims to provide a streamlined claims process for its members. Fallon typically handles billing directly with healthcare providers. This process can vary depending on the type of plan and the provider’s network. Members are encouraged to refer to their policy documents or contact Fallon directly for guidance on filing claims.

Average Claim Processing Time

Fallon Community Health Plan does not specify the average claim processing time. Claim processing times can vary based on factors such as the type of claim, completeness of documentation, and provider cooperation. To obtain information about claim processing times, members should consider reaching out to Fallon’s customer service or reviewing their policy materials.

Customer Feedback on Claim Resolutions and Payouts

Fallon Community Health Plan does not provide specific customer feedback on claim resolutions and payouts. Customer feedback is valuable in assessing an insurance provider’s track record in handling claims. Individuals interested in Fallon’s services may want to seek out customer reviews and ratings from reputable sources or contact Fallon directly for insights into claim resolutions.

Digital and Technological Features of Fallon Community Health Plan

Mobile App Features and Functionality

Mobile apps can enhance the insurance experience by providing features such as policy access, claims submission, and account management. Interested individuals are encouraged to visit Fallon’s official website or app store platforms for information on their mobile app capabilities.

Online Account Management Capabilities

Online account management typically includes features like policy viewing, bill payment, and claims tracking. Those interested in exploring Fallon’s online account management options should visit the company’s official website or contact them directly for details.

Digital Tools and Resources

Such tools could include educational resources, calculators, or online customer support. To learn more about the availability of digital tools and resources, individuals should visit Fallon’s official website or contact the company directly.

Fallon Health Plan Medicare Ratings and Consumer Reviews

Fallon Community Health Plan has an A- rating with the Better Business Bureau (BBB), with the rating brought down a notch by one complaint to which they failed to respond. Only three complaints were closed in the past three years, and two of those were in the past 12 months.

Fallon has a solid 4.5 out of 5 rating with the National Committee for Quality Assurance. That is a pretty good score, but there is some room for improvement in the Consumer Satisfaction area of the survey as well as a few other categories.

Medicare gave Fallon’s Medicare Advantage plans an overall 4 out of 5 rating, which is excellent.

There are 11 reviews on Yelp, and the overall rating is two stars. A couple of five-star ratings help bring that up a bit, but most of the reviews are negative. The overall volume of complaints, however, is low.

Fallon Health Plan Medicare: What’s the Bottom Line?

Fallon has a pretty good selection of plans and they have a good reputation across the board, but they are on the pricey side. For an HMO, their rates are high, and the copays tend to be on the high side too for the cost of the monthly premiums. If you are willing to pay more for an insurance company with a good reputation, put Fallon on the list.

Before you buy Fallon Health Plan Medicare insurance, it’s a good idea to see what other options are out there.