Skip to content
Home ยป Fallon Health Plans

Fallon Health Plans

Introduction to Fallon Health Plans

When it comes to choosing a health insurance provider, it’s important to select a company that offers comprehensive healthcare coverage, easy accessibility to doctors and hospitals, and reliable customer service. Fallon Health Plans, a leading health insurance company in Central and Eastern Massachusetts, offers all of this and more.

Founded in 1977, Fallon Health Plans has been providing high-quality, affordable healthcare coverage for over 40 years. With more than 270,000 members, the company has become one of the most trusted health insurance providers in the region.

What sets Fallon Health Plans apart?

One of the things that sets Fallon Health Plans apart from other health insurance providers is its dedication to providing innovative healthcare solutions that meet the ever-evolving needs of its members. The company offers a variety of health plans with different levels of coverage, as well as a range of add-on benefits and services, such as dental and vision coverage, wellness programs, and telemedicine options.

Awards and Recognition

Over the years, Fallon Health Plans has received numerous awards and accolades for its commitment to excellence. The company has been recognized for its outstanding customer service, innovative healthcare solutions, and overall quality of care. In fact, Fallon Health Plans has consistently received high ratings from independent rating agencies such as the National Committee for Quality Assurance (NCQA) and the Centers for Medicare & Medicaid Services (CMS).

Mission and Values

Fallon Health Plans is not just a health insurance company, it’s also a mission-driven organization with a commitment to improving the health and well-being of its members and the communities it serves. The company’s core values, which include compassion, integrity, innovation, collaboration, and accountability, guide everything it does.

Service Area

Fallon Health Plans primarily serves Central and Eastern Massachusetts, with plans available in Worcester, Middlesex, Essex, Suffolk, and Norfolk counties. The company also offers plans in some parts of New Hampshire.

Fallon Health Plans is a reputable health insurance provider with a long-standing history of providing quality healthcare coverage to its members. Its commitment to innovation, customer service, and community make it a top choice for anyone looking for a health insurance provider.

Benefits and Coverage Options of Fallon Health Plans

Fallon Health Plans is a well-known health insurance provider that offers a wide range of healthcare options to individuals and families. The company has a variety of plans that meet the needs and budget of different customers. Here are some of the benefits and coverage options available through Fallon Health Plans:

Primary Care Physicians

One of the main benefits of Fallon Health Plans is that it offers access to an extensive network of primary care physicians. These healthcare providers are an essential part of any healthcare plan, and Fallon Health Plans has a network of more than 3,500 primary care doctors. Customers can choose their preferred physician and schedule appointments with them.

Specialist Care

Fallon Health Plans also provides access to an extensive network of specialists across different fields of medicine such as cardiology, obstetrics, and oncology. This is crucial for those who need specialized care for specific health conditions.

Prescriptions and Medications

Another essential aspect of healthcare is prescription medication. Fallon Health Plans provides coverage for prescription drugs. Customers can choose from more than 68,000 pharmacies across the country to fill their prescriptions.

Behavioral Health Services

Fallon Health Plans also offers a comprehensive range of behavioral health services, including therapy, counseling, and other treatment options. The company has a network of licensed behavioral health providers, including psychiatrists, psychologists, and social workers.

Wellness and Preventive Care

Fallon Health Plans prioritizes preventive care for its customers, encouraging them to stay healthy through routine checkups, immunizations, and other preventive care services. The company also offers wellness programs that promote healthy living and provide resources and tools to help customers maintain a healthy lifestyle.

Health Savings Accounts

Fallon Health Plans also has health savings accounts (HSAs) that enable customers to set aside pre-tax dollars for qualified medical expenses. This is a great option for those who want to save money on healthcare expenses.

Medicare Plans

For those who qualify for Medicare, Fallon Health Plans has a range of options that provide comprehensive coverage, including medical, prescription drug, and other healthcare services.

Other Benefits

In addition to the above benefits, Fallon Health Plans also has a range of other services and benefits, such as virtual care and telemedicine, travel assistance, and emergency medical services.

Fallon Health Plans is known for its comprehensive coverage options, impressive network of healthcare providers, and commitment to customer satisfaction. Customers can choose from a range of plans that meet their specific needs, and the company provides ongoing support and customer service to ensure they have the best healthcare experience possible.

Providers and Networks available through Fallon Health Plans

When choosing a health insurance provider, accessing high-quality healthcare services is paramount. That is why a major consideration when selecting Fallon Health Plans is the providers and networks available through the plan. Fallon Health Plans operates through various networks of providers in the regions where it is available.

HMO Network

Fallon Health Plans offers a Health Maintenance Organization (HMO) network for its members. With the HMO network, enrollees need to select a primary care physician (PCP) who acts as the gatekeeper for healthcare services. The PCP maintains medical records and approves referrals to specialists as required. The HMO network is available across Massachusetts and Maine regions through which Fallon Health Plans operates.

HMO Direct Care Network

Fallon Health Plans offers a unique HMO Direct Care network in which members receive primary care services directly from the HMO. This network offers high-quality care and is only available in Worcester County in Massachusetts. Members who enroll in this network can have access to routine check-ups and emergency medical care at any of the five Fallon-owned clinics in the area.

POS Network

Fallon Health Plans also offers a Point of Service (POS) network, referred to as the Fallon Select Care network. The POS network operates across Massachusetts and provides networks of physicians and hospitals that members have access to. With this plan, members can access out-of-network healthcare services for extra costs.

PPO Network

Fallon Health Plans offers the Preferred Provider Organization (PPO) network known as Summit ElderCare. This plan is specifically for seniors aged 55 years and above who qualify for Medicare and Medicaid programs. Summit ElderCare offers coverage for medication, medical services, and related supplies. This is only available in Worcester County in Massachusetts.

Provider availability

The provider availability with Fallon Healths Plans’ network varies according to the plan type and geographical region. Members can access a list of providers and hospitals on the Fallon Health Plans website to check for availability. Members may also use the PlanFinder tool on the same website to match plan coverage and providers to their needs.

Provider networks compared to other insurers

Fallon Health Plans’ provider networks are some of the most comprehensive in the regions where they operate. The network has multiple clinics and hospitals that enforce quality standards, ensuring that members receive the best possible care. Compared to other health insurance providers in the market, Fallon Health Plans has a more robust network of providers and hospitals, ensuring high-quality care and patient satisfaction.

Fallon Health Plans offers multiple provider networks with varying coverage options and geographical availability. As an enrollee, members can select a plan that works best for them and can receive care from a wide range of providers and hospitals in the network. Fallon Health Plans is committed to making healthcare more accessible and affordable, and its provider networks are specifically designed to achieve this goal.

How to Enroll in Fallon Health Plans

Enrolling in a health insurance plan can be a daunting task, but with Fallon Health Plans, the process is simple and straightforward. Here’s what you need to know about enrolling in Fallon Health Plans:


Before you can enroll in a health insurance plan with Fallon Health Plans, you need to determine if you’re eligible. Fallon Health Plans offers coverage to individuals and families who live in Massachusetts and parts of New Hampshire. In order to be eligible, you’ll need to meet certain criteria such as income, age, and residency.

Enrollment Period

Fallon Health Plans has an open enrollment period each year, during which anyone can sign up for a health insurance plan. The open enrollment period typically runs from November 1st to December 15th of each year. However, if you have experienced certain life events such as losing your job, getting married, or having a child, you may qualify for a special enrollment period and be able to enroll outside of the open enrollment period.

Choosing a Plan

One of the most important steps in enrolling in a health insurance plan with Fallon Health Plans is choosing the right plan for your needs. Fallon offers a variety of plans, including HMOs and PPOs, each with its own set of benefits and coverage options. When choosing a plan, consider factors such as your budget, your health needs, and whether your preferred doctors and hospitals are in-network.

Application Process

Once you’ve determined your eligibility and selected a plan, the application process is simple. You can apply online through the Fallon Health Plans website, or by calling the customer service hotline and speaking with a representative. You’ll need to provide some personal and financial information, such as your name, address, income, and Social Security number. You may also be asked to provide information about your current health insurance plan if you have one.

Verification and Confirmation

After you’ve submitted your application, Fallon Health Plans will review your information and verify your eligibility. If everything checks out, you’ll receive a confirmation of your enrollment in a health insurance plan. It’s important to review this confirmation carefully to make sure that all of the information is accurate and that you’re enrolled in the correct plan.

Enrolling in a health insurance plan can seem overwhelming, but with Fallon Health Plans, the process is designed to be as simple and stress-free as possible. By understanding your eligibility, enrollment period, and the different plans available, you can make an informed decision and feel confident in your choice of health insurance coverage. Plus, with Fallon’s customer service and support, you can rest easy knowing that help is always just a phone call away.


In conclusion, Fallon Health Plans is a health insurance provider that offers a variety of benefits and coverage options to its members. With its extensive network of providers and access to top-quality healthcare services, Fallon has become a popular choice for many individuals and families in need of health insurance.

Fallon offers comprehensive coverage options for preventive care, primary care, specialist consultations, emergency services, hospital care, prescription drugs, and behavioral health services. Members can choose from a range of plans to best suit their needs and budget, including HMO, PPO, and Medicare Advantage plans.

Fallon also boasts a broad network of healthcare providers, including primary care physicians, specialists, hospitals, and clinics. Members can access care from these providers across Massachusetts and New Hampshire, ensuring they receive quality care close to home.

Enrolling in Fallon Health Plans is a straightforward process that can be done online or by phone. The customer service and support team at Fallon are available to guide members through the enrollment process and answer any questions they may have.

Fallon Health Plans takes customer service seriously and provides its members with a dedicated customer service line. Members can contact the Fallon team for assistance with claims, benefits, coverage, and any other concerns they may have. Customer satisfaction is a top priority at Fallon, and they are committed to providing members with the best-in-class service they deserve.

Comparing Fallon Health Plans to other health insurance providers, Fallon stands out for its comprehensive coverage options, broad network of providers, and exceptional customer service. Overall, Fallon is an excellent choice for anyone in need of health insurance in the Massachusetts and New Hampshire regions.