UPDATES FROM FALLON HEALTH - April 2026

"The secret of getting ahead is getting started."

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.

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.

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.

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 [email protected].

Sincerely,

Deb Daviau

VP of Medicare and Executive Director of NaviCare

Things to do to prepare for AEP

• Explore what’s required for AHIP certification.
• Look at CMS testing and training requirements for AEP.
• Review your client database to confirm who are current Medicare Advantage members, age-ins, and dual eligible.
• Identify those clients who may be affected by potential changes to Medicare Advantage or prescription drug plans.
• Set up a preliminary timetable for when to:
  • Review the CMS Final Rule for the upcoming plan year
  • Order approved marketing materials
  • Prepare your outreach material
• Schedule appointments with clients for Oct. 1 or later to review plans and coverage.

Medicare enrollment periods

Jan. 1 through March 31

Medicare Advantage Open Enrollment Period (OEP)

Medicare Advantage enrollees may do the following:

• Enroll in a different Medicare Advantage plan
• Enroll in a Medicare Supplement plan
• Return to Original Medicare

April 1 through Oct. 14

Lock-in period

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*.

*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.

Oct. 15 through Dec. 7

Medicare’s Annual Enrollment Period (AEP)

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. 

For brokers: Pre-AEP marketing and beneficiary education can begin on Oct. 1.

Important reminders about our NaviCare^® plan

Save Now card
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.

In 2026…

• NaviCare members get $375 loaded onto the Save Now card each calendar quarter. That’s $1,500 per year.
• 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.

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.

• 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. 

*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.

When can your clients enroll in NaviCare?

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.

Stay connected with Fallon Health

Contact us

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.

1-844-848-4931

You can also reach us by email: [email protected]

Check out our website

Especially our broker webpages. They're full of helpful information.

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