Fallon Health
https://fallonhealth.optin.com/newsletter/awlist6928505
2026-04-10T11:45:08-04:00
REMINDER: Fallon Health Broker Bulletin - April 2026
2026-04-10T11:45:08-04:00
2026-04-10T12:21:12-04:00
tag:fallonhealth.optin.com,2021:Post/29573131
The secret of getting ahead is getting started UPDATES FROM FALLON HEALTH - April 2026 "The secret of getting ahead is getting started." This quote,…
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<span class="aw-preheadertext" style="color: #ffffff; display: none; font-size: 0; line-height: 0; margin: 0; padding: 0; visibility: hidden;">The secret of getting ahead is getting started</span><div class="aw-preheaderspacer" style="display: none; max-height: 0; overflow:
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<div class="definition-parent"><div class="text-element"><p style="line-height: 1; text-align: center; font-size: 16px;"><span style="font-size:12px;"><span>UPDATES FROM FALLON HEALTH - April 2026</span></span></p></div></div>
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<div class="definition-parent"><div class="text-element"><p style="line-height: 1.15; font-size: 16px;"><span style="color:#D76127;font-size:24px;"><span><strong>"The secret of getting ahead is getting started."</strong></span></span></p><p style="line-height: 1; font-size: 16px;"> </p><p style="line-height: 1; font-size: 16px;"> </p></div></div>
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<div class="definition-parent"><div class="text-element"><p style="line-height: 1.15; font-size: 16px;">This quote, often credited to Mark Twain, usually crosses my mind this time of year, when we prepare to begin our work on next year’s plans and benefits.</p><p style="line-height: 1.15; font-size: 16px;"> </p><p style="line-height: 1.15; font-size: 16px;">It’s because I feel that a time like this provides a great opportunity: the chance to focus on what I can do to set myself
up for future success. I bet you feel the same.</p><p style="line-height: 1.15; font-size: 16px;"> </p><p style="line-height: 1.15; font-size: 16px;">So, in the spirit of helping you achieve your 2026 goals, we put together a list of things you can do now to prepare for this year’s AEP. That list is below, and it’s followed by a few other important reminders.</p><p style="line-height: 1.15; font-size: 16px;"> </p><p style="line-height: 1.15; font-size: 16px;">As always, if you have any
questions or need any assistance, you can call our Broker Relations team at 1-844-848-4931 (TRS 711) from 8:30 a.m. to 5:00 p.m., Monday through Friday. Or you can send an email to <a href="mailto:MedicareSalesBrokers@fallonhealth.org" style="color: rgb(75, 123, 236); text-decoration-color: currentcolor;">MedicareSalesBrokers@fallonhealth.org</a>.</p><p style="line-height: 1.15; font-size: 16px;"> </p></div></div>
<div class="definition-parent"><div class="text-element"><p style="font-size: 16px;">Sincerely,</p><p style="line-height: 1.15; font-size: 16px;"> </p></div></div>
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<div class="definition-parent"><div class="text-element"><p style="line-height: 1.15; font-size: 16px;"> </p></div></div>
<div class="definition-parent"><div class="text-element"><p style="line-height: 1.15; font-size: 16px;">Deb Daviau</p><p style="line-height: 1.15; font-size: 16px;">VP of Medicare and Executive Director of NaviCare</p><p style="line-height: 1.15; font-size: 16px;"> </p></div></div>
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<div class="definition-parent"><div class="text-element"><h1 style="line-height: 1.15; font-size: 28px;"><span style="font-size:24px;"><span>Things to do to prepare for AEP</span></span></h1></div></div>
<div class="definition-parent"><div class="text-element"><ul><li style="line-height:1.15;">Explore what’s required for AHIP certification.</li><li style="line-height:1.15;">Look at CMS testing and training requirements for AEP.</li><li style="line-height:1.15;">Review your client database to confirm who are current Medicare Advantage members, age-ins, and dual eligible.</li><li style="line-height:1.15;">Identify those clients who may be affected by potential changes to Medicare
Advantage or prescription drug plans.</li><li style="line-height:1.15;">Set up a preliminary timetable for when to:<ul><li style="line-height:1.15;">Review the CMS Final Rule for the upcoming plan year</li><li style="line-height:1.15;">Order approved marketing materials</li><li style="line-height:1.15;">Prepare your outreach material</li></ul></li><li style="line-height:1.15;">Schedule appointments with clients for Oct. 1 or later to review plans and coverage.</li></ul></div></div>
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<div class="definition-parent"><div class="text-element"><h1 style="line-height: 1.15; font-size: 28px;"><span>Medicare enrollment periods</span></h1></div></div>
<div class="definition-parent"><div class="text-element"><p style="line-height: 1.15; font-size: 16px;"><span style="font-size:20px;"><strong>Jan. 1 through March 31</strong></span></p><p style="line-height: 1.15; font-size: 16px;"><i>Medicare Advantage Open Enrollment Period (OEP)</i></p><p style="line-height: 1.15; font-size: 16px;"> </p><p style="line-height: 1.15; font-size: 16px;">Medicare Advantage enrollees may do the following:</p><ul><li style="line-height:1.15;">Enroll
in a different Medicare Advantage plan</li><li style="line-height:1.15;">Enroll in a Medicare Supplement plan</li><li style="line-height:1.15;">Return to Original Medicare</li></ul><p style="font-size: 16px;"> </p><p style="line-height: 1.15; font-size: 16px;"><span style="font-size:20px;"><strong>April 1 through Oct. 14</strong></span></p><p style="font-size: 16px;"><i>Lock-in period</i></p><p style="font-size: 16px;"> </p><p style="line-height: 1.15; font-size: 16px;">Individuals
cannot enroll in or change plans unless they’re turning 65, have a new qualifying medical condition, or qualify for the Special Enrollment Period*.</p><p style="line-height: 1.15; font-size: 16px;"> </p><p style="line-height: 1.15; font-size: 16px;">*<i>Special Enrollment Periods are during and up to 2 months following a special circumstance, including a change of residence, lost employer or union group health plan coverage, being enrolled in or losing Medicaid coverage, or qualifying for
Medicare’s Extra Help to pay for Part D coverage.</i></p><p style="font-size: 16px;"> </p><p style="line-height: 1.15; font-size: 16px;"><span style="font-size:20px;"><strong>Oct. 15 through Dec. 7</strong></span></p><p style="line-height: 1.15; font-size: 16px;"><i>Medicare’s Annual Enrollment Period (AEP)</i></p><p style="line-height: 1.15; font-size: 16px;"> </p><p style="line-height: 1.15; font-size: 16px;">Anyone eligible for Medicare can enroll in or change a Medicare Advantage
plan or a Medicare Supplement plan, or they can return to Original Medicare. </p><p style="line-height: 1.15; font-size: 16px;"> </p><p style="line-height: 1.15; font-size: 16px;"><strong><u>For brokers</u>:</strong> Pre-AEP marketing and beneficiary education can begin on Oct. 1.</p><p style="line-height: 1.15; font-size: 16px;"> </p></div></div>
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<div class="definition-parent"><div class="text-element"><h1 style="line-height: 1.15; font-size: 28px;">Important reminders about our NaviCare<span style="font-size:16px;"><sup>®</sup></span> plan</h1></div></div>
<div class="definition-parent"><div class="text-element"><p style="line-height: 1.15; font-size: 16px;"><span style="font-size:20px;"><span><strong>Save Now card</strong></span></span><br/>Every NaviCare HMO SNP member receives a Save Now card. The card is preloaded each calendar quarter (Jan. 1, April 1, July 1, and Oct. 1) with money to buy health and personal care items. NaviCare members can buy items in participating stores or place an order by phone or online, with free
shipping.</p><p style="line-height: 1.15; font-size: 16px;"> </p><p style="line-height: 1.15; font-size: 16px;"><strong>In 2026…</strong></p><ul><li style="line-height:1.15;">NaviCare members get $375 loaded onto the Save Now card each calendar quarter. That’s<strong> $1,500 per year.</strong></li><li style="line-height:1.15;">For members who have qualifying chronic conditions: Each calendar quarter, $200 of their Save Now dollars can be used to buy healthy food and $175 for health and
personal care items.</li></ul><p style="line-height: 1.15; margin-left: 40px; font-size: 16px;">The money to purchase healthy foods is part of the Special Supplemental Benefits for the Chronically Ill (SSBCI) program* and is only for members who have qualifying chronic conditions. Not all members qualify. Members who want to find out if they’re eligible for this benefit can call their Fallon Health Navigator.</p><ul><li style="line-height:1.15;">Balances don’t carry over from one quarter to
another. Amounts loaded on the Save Now card each quarter should be used in full each quarter. </li></ul><p style="line-height: 1.15; font-size: 16px;"> </p><p style="line-height: 1.15; font-size: 16px;"><i>*The $200 (per calendar quarter) food benefit is part of a special supplemental program for the chronically ill. To qualify, enrollees must have chronic-condition diagnoses documented with Fallon Health, such as cardiovascular disorders, chronic and disabling behavioral health
conditions, chronic lung disorders, diabetes, and neurologic disorders. This is not a complete list of eligible chronic conditions. Not all members with an eligible condition will qualify. Other eligibility and coverage criteria also apply.</i></p><p style="line-height: 1.15; font-size: 16px;"> </p><p style="line-height: 1.15; font-size: 16px;"><span style="font-size:20px;"><strong>When can your clients enroll in NaviCare?</strong></span></p><p style="line-height: 1.15; font-size:
16px;">Your clients can enroll in NaviCare HMO SNP at any time, all year long. Their coverage will begin on the first day of the month after they enroll.</p></div></div>
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<div class="definition-parent"><div class="text-element"><h1 style="line-height: 1.15; font-size: 28px;"><span>Stay connected with Fallon Health</span></h1><p style="line-height: 1.15; font-size: 16px;"> </p></div></div>
<div class="definition-parent"><div class="text-element"><p style="line-height: 1.15; font-size: 16px;"><span><strong>Contact us</strong></span></p><p style="line-height: 1.15; font-size: 16px;"><span>Our easy-to-reach Broker Relations team is available to you at every stage of the sales process. We can provide you with personalized support over the phone Monday through Friday, 8:30 a.m. to 5:00 p.m.</span></p><p style="line-height: 1.15; font-size: 16px;"> </p></div></div>
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Fallon Health Broker Bulletin - April 2026
2026-04-07T10:20:02-04:00
2026-04-07T11:20:59-04:00
tag:fallonhealth.optin.com,2021:Post/29548826
The secret of getting ahead is getting started UPDATES FROM FALLON HEALTH - April 2026 "The secret of getting ahead is getting started." This quote,…
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<span class="aw-preheadertext" style="color: #ffffff; display: none; font-size: 0; line-height: 0; margin: 0; padding: 0; visibility: hidden;">The secret of getting ahead is getting started</span><div class="aw-preheaderspacer" style="display: none; max-height: 0; overflow:
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<div class="definition-parent"><div class="text-element"><p style="line-height: 1; text-align: center; font-size: 16px;"><span style="font-size:12px;"><span>UPDATES FROM FALLON HEALTH - April 2026</span></span></p></div></div>
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<div class="definition-parent"><div class="text-element"><p style="line-height: 1.15; font-size: 16px;"><span style="color:#D76127;font-size:24px;"><span><strong>"The secret of getting ahead is getting started."</strong></span></span></p><p style="line-height: 1; font-size: 16px;"> </p><p style="line-height: 1; font-size: 16px;"> </p></div></div>
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<div class="definition-parent"><div class="text-element"><p style="line-height: 1.15; font-size: 16px;">This quote, often credited to Mark Twain, usually crosses my mind this time of year, when we prepare to begin our work on next year’s plans and benefits.</p><p style="line-height: 1.15; font-size: 16px;"> </p><p style="line-height: 1.15; font-size: 16px;">It’s because I feel that a time like this provides a great opportunity: the chance to focus on what I can do to set myself
up for future success. I bet you feel the same.</p><p style="line-height: 1.15; font-size: 16px;"> </p><p style="line-height: 1.15; font-size: 16px;">So, in the spirit of helping you achieve your 2026 goals, we put together a list of things you can do now to prepare for this year’s AEP. That list is below, and it’s followed by a few other important reminders.</p><p style="line-height: 1.15; font-size: 16px;"> </p><p style="line-height: 1.15; font-size: 16px;">As always, if you have any
questions or need any assistance, you can call our Broker Relations team at 1-844-848-4931 (TRS 711) from 8:30 a.m. to 5:00 p.m., Monday through Friday. Or you can send an email to <a href="mailto:MedicareSalesBrokers@fallonhealth.org" style="color: rgb(75, 123, 236); text-decoration-color: currentcolor;">MedicareSalesBrokers@fallonhealth.org</a>.</p><p style="line-height: 1.15; font-size: 16px;"> </p></div></div>
<div class="definition-parent"><div class="text-element"><p style="font-size: 16px;">Sincerely,</p><p style="line-height: 1.15; font-size: 16px;"> </p></div></div>
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<div class="definition-parent"><div class="text-element"><p style="line-height: 1.15; font-size: 16px;"> </p></div></div>
<div class="definition-parent"><div class="text-element"><p style="line-height: 1.15; font-size: 16px;">Deb Daviau</p><p style="line-height: 1.15; font-size: 16px;">VP of Medicare and Executive Director of NaviCare</p><p style="line-height: 1.15; font-size: 16px;"> </p></div></div>
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<div class="definition-parent"><div class="text-element"><h1 style="line-height: 1.15; font-size: 28px;"><span style="font-size:24px;"><span>Things to do to prepare for AEP</span></span></h1></div></div>
<div class="definition-parent"><div class="text-element"><ul><li style="line-height:1.15;">Explore what’s required for AHIP certification.</li><li style="line-height:1.15;">Look at CMS testing and training requirements for AEP.</li><li style="line-height:1.15;">Review your client database to confirm who are current Medicare Advantage members, age-ins, and dual eligible.</li><li style="line-height:1.15;">Identify those clients who may be affected by potential changes to Medicare
Advantage or prescription drug plans.</li><li style="line-height:1.15;">Set up a preliminary timetable for when to:<ul><li style="line-height:1.15;">Review the CMS Final Rule for the upcoming plan year</li><li style="line-height:1.15;">Order approved marketing materials</li><li style="line-height:1.15;">Prepare your outreach material</li></ul></li><li style="line-height:1.15;">Schedule appointments with clients for Oct. 1 or later to review plans and coverage.</li></ul></div></div>
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<div class="definition-parent"><div class="text-element"><h1 style="line-height: 1.15; font-size: 28px;"><span>Medicare enrollment periods</span></h1></div></div>
<div class="definition-parent"><div class="text-element"><p style="line-height: 1.15; font-size: 16px;"><span style="font-size:20px;"><strong>Jan. 1 through March 31</strong></span></p><p style="line-height: 1.15; font-size: 16px;"><i>Medicare Advantage Open Enrollment Period (OEP)</i></p><p style="line-height: 1.15; font-size: 16px;"> </p><p style="line-height: 1.15; font-size: 16px;">Medicare Advantage enrollees may do the following:</p><ul><li style="line-height:1.15;">Enroll
in a different Medicare Advantage plan</li><li style="line-height:1.15;">Enroll in a Medicare Supplement plan</li><li style="line-height:1.15;">Return to Original Medicare</li></ul><p style="font-size: 16px;"> </p><p style="line-height: 1.15; font-size: 16px;"><span style="font-size:20px;"><strong>April 1 through Oct. 14</strong></span></p><p style="font-size: 16px;"><i>Lock-in period</i></p><p style="font-size: 16px;"> </p><p style="line-height: 1.15; font-size: 16px;">Individuals
cannot enroll in or change plans unless they’re turning 65, have a new qualifying medical condition, or qualify for the Special Enrollment Period*.</p><p style="line-height: 1.15; font-size: 16px;"> </p><p style="line-height: 1.15; font-size: 16px;">*<i>Special Enrollment Periods are during and up to 2 months following a special circumstance, including a change of residence, lost employer or union group health plan coverage, being enrolled in or losing Medicaid coverage, or qualifying for
Medicare’s Extra Help to pay for Part D coverage.</i></p><p style="font-size: 16px;"> </p><p style="line-height: 1.15; font-size: 16px;"><span style="font-size:20px;"><strong>Oct. 15 through Dec. 7</strong></span></p><p style="line-height: 1.15; font-size: 16px;"><i>Medicare’s Annual Enrollment Period (AEP)</i></p><p style="line-height: 1.15; font-size: 16px;"> </p><p style="line-height: 1.15; font-size: 16px;">Anyone eligible for Medicare can enroll in or change a Medicare Advantage
plan or a Medicare Supplement plan, or they can return to Original Medicare. </p><p style="line-height: 1.15; font-size: 16px;"> </p><p style="line-height: 1.15; font-size: 16px;"><strong><u>For brokers</u>:</strong> Pre-AEP marketing and beneficiary education can begin on Oct. 1.</p><p style="line-height: 1.15; font-size: 16px;"> </p></div></div>
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<div class="definition-parent"><div class="text-element"><h1 style="line-height: 1.15; font-size: 28px;">Important reminders about our NaviCare<span style="font-size:16px;"><sup>®</sup></span> plan</h1></div></div>
<div class="definition-parent"><div class="text-element"><p style="line-height: 1.15; font-size: 16px;"><span style="font-size:20px;"><span><strong>Save Now card</strong></span></span><br/>Every NaviCare HMO SNP member receives a Save Now card. The card is preloaded each calendar quarter (Jan. 1, April 1, July 1, and Oct. 1) with money to buy health and personal care items. NaviCare members can buy items in participating stores or place an order by phone or online, with free
shipping.</p><p style="line-height: 1.15; font-size: 16px;"> </p><p style="line-height: 1.15; font-size: 16px;"><strong>In 2026…</strong></p><ul><li style="line-height:1.15;">NaviCare members get $375 loaded onto the Save Now card each calendar quarter. That’s<strong> $1,500 per year.</strong></li><li style="line-height:1.15;">For members who have qualifying chronic conditions: Each calendar quarter, $200 of their Save Now dollars can be used to buy healthy food and $175 for health and
personal care items.</li></ul><p style="line-height: 1.15; margin-left: 40px; font-size: 16px;">The money to purchase healthy foods is part of the Special Supplemental Benefits for the Chronically Ill (SSBCI) program* and is only for members who have qualifying chronic conditions. Not all members qualify. Members who want to find out if they’re eligible for this benefit can call their Fallon Health Navigator.</p><ul><li style="line-height:1.15;">Balances don’t carry over from one quarter to
another. Amounts loaded on the Save Now card each quarter should be used in full each quarter. </li></ul><p style="line-height: 1.15; font-size: 16px;"> </p><p style="line-height: 1.15; font-size: 16px;"><i>*The $200 (per calendar quarter) food benefit is part of a special supplemental program for the chronically ill. To qualify, enrollees must have chronic-condition diagnoses documented with Fallon Health, such as cardiovascular disorders, chronic and disabling behavioral health
conditions, chronic lung disorders, diabetes, and neurologic disorders. This is not a complete list of eligible chronic conditions. Not all members with an eligible condition will qualify. Other eligibility and coverage criteria also apply.</i></p><p style="line-height: 1.15; font-size: 16px;"> </p><p style="line-height: 1.15; font-size: 16px;"><span style="font-size:20px;"><strong>When can your clients enroll in NaviCare?</strong></span></p><p style="line-height: 1.15; font-size:
16px;">Your clients can enroll in NaviCare HMO SNP at any time, all year long. Their coverage will begin on the first day of the month after they enroll.</p></div></div>
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<div class="definition-parent"><div class="text-element"><h1 style="line-height: 1.15; font-size: 28px;"><span>Stay connected with Fallon Health</span></h1><p style="line-height: 1.15; font-size: 16px;"> </p></div></div>
<div class="definition-parent"><div class="text-element"><p style="line-height: 1.15; font-size: 16px;"><span><strong>Contact us</strong></span></p><p style="line-height: 1.15; font-size: 16px;"><span>Our easy-to-reach Broker Relations team is available to you at every stage of the sales process. We can provide you with personalized support over the phone Monday through Friday, 8:30 a.m. to 5:00 p.m.</span></p><p style="line-height: 1.15; font-size: 16px;"> </p></div></div>
<div class="definition-parent"><div class="text-element"><h1 style="line-height: 1.15; text-align: center; font-size: 28px;"><span>1-844-848-4931</span></h1><p style="line-height: 1.15; text-align: center; font-size: 16px;"> </p><p style="line-height: 1.15; text-align: left; font-size: 16px;"><span>You can also reach us by email: </span><a href="mailto:MedicareSalesBrokers@fallonhealth.org" style="color: rgb(75, 123, 236); text-decoration-color:
currentcolor;"><span><u>MedicareSalesBrokers@fallonhealth.org</u></span></a></p></div></div>
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<div class="definition-parent"><div class="text-element"><p style="line-height: 1.15; font-size: 16px;"><span><strong>Check out our website</strong></span></p><p style="line-height: 1.15; font-size: 16px;"><span>Especially our </span><a href="https://fallonhealth.org/en/brokers.aspx" rel="noopener noreferrer" style="color: rgb(75, 123, 236); text-decoration-color: currentcolor;" target="_blank"><span><u>broker webpages</u></span></a><span>. They're full of helpful
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<div class="definition-parent"><div class="text-element"><p style="line-height: 1.15; font-size: 16px;"><span><strong>Streamline your Fallon Health enrollments</strong></span></p><p style="line-height: 1.15; font-size: 16px;"><span>Use </span><a href="https://fallon.sunfirematrix.com/app/agent/fchp" rel="noopener noreferrer" style="color: rgb(75, 123, 236); text-decoration-color: currentcolor;" target="_blank"><span><u>SunFire</u></span></a><span>. It makes the process
easier.</span></p></div></div>
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