Fallon Community Health Plan Insurance Review & Ratings (2022)

Fallon Community Health Plan (FCHP) offers traditional and Medicare insurance plans to residents in Massachusetts, New Hampshire, New York. FCHP receives high ratings from industry reviewers, with few customer complaints.

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Chris Tepedino is a feature writer that has written extensively about home, life, and car insurance for numerous websites. He has a college degree in communication from the University of Tennessee and has experience reporting, researching investigative pieces, and crafting detailed, data-driven features. His works have been featured on CB Blog Nation, Flow Words, Healing Law, WIBW Kansas, and C...

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Laura Walker graduated college with a BS in Criminal Justice with a minor in Political Science. She married her husband and began working in the family insurance business in 2005. She became a licensed agent and wrote P&C business focusing on personal lines insurance for 10 years. Laura serviced existing business and wrote new business. She now uses her insurance background to help educate...

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Reviewed by Laura Walker
Former Licensed Agent Laura Walker

UPDATED: Mar 31, 2022

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The Rundown

  • Fallon Community Health Plan is both an insurer and provider of healthcare with a focus on care for seniors
  • Fallon Health offers care for local individuals, families, and businesses, as well as Medicare Supplement, Medicare Advantage, and Medicaid programs
  • Fallon Community Health Plan receives high ratings from industry reviewers, with mixed customer reviews

Based in Massachusetts, Fallon Community Health Plan (FCHP) is a healthcare system with its own health insurance plan. In operation for over 40 years, this federally qualified Health Maintenance Organization (HMO) offers coverage in New York and New Hampshire. As a regional company, Fallon Community Health Plan is able to offer affordable local healthcare options like Fallon Community Care. FCHP also provides several Medicare health plans on par with the offerings of larger insurance companies nationwide.

Fallon Community Health Plan is both an insurer and provider of care, offering a variety of health plan options including Medicaid, Medicare Advantage, and Medicare Supplement Insurance. FCHP also features all-inclusive care for seniors.

Fallon Community Health Plan

Founded in Massachusetts in 1977, Fallon Community Health Plan quickly became qualified as one of the state’s first federal Health Maintenance Organizations (HMOs). In 1980, FCHP became one of the first HMO health insurance plans in the nation to receive a special Medicare contract from the U.S. Health Care Financing Administration (HCFA). This contract has helped position Fallon Community Health Plan as a top health care option for seniors.

FCHP has also been accredited by the National Committee for Quality Assurance (NCQA) and has been recognized as one of the country’s leading HMOs. Fallon provides Medicare Advantage, Medicare Supplement, and several comprehensive care programs with a focus on senior healthcare.

Since 2009, Fallon Community Health Plan has offered coverage in New Hampshire, and a 2014 partnership has led to expansion into New York state. While continuing to use the FCHP abbreviation known to its customers, Fallon Community Health Plan has embraced a larger clientele base by simply changing its official name to Fallon Health.

A visit to the FCHP website will yield the Fallon Community Health Plan provider phone number, physical address, and hours of operation. From there, you can explore all of the healthcare options that Fallon Health has to offer.

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Fallon Community Health Plan Is a Part of MassHealth

MassHealth is a program that combines the Medicaid and Children’s Health Insurance Program (CHIP). In Massachusetts, MassHealth members can acquire coverage for hospital stays, doctor visits, prescription drugs, and many other services.

With participation in MassHealth, enrollees are able to select a primary care provider (PCP) and a health plan for each family member. A health plan is the group of participating doctors, hospitals, and health care providers that work together to provide the healthcare you need. And Fallon Health is one such health plan.

NaviCare is the Fallon Community Health Plan program that services patients who qualify for both Medicare and MassHealth Standard. If you are 65 or older, live in the service area, and are eligible for Medicaid, you can qualify for MassHealth. This feature allows you to take advantage of numerous benefits beyond what you normally receive from either Medicare or Medicaid alone.

Fallon Health Medicare Plans

Fallon Health offers several options for expanding your Original Medicare coverage. With Medicare Advantage, you can replace your Medicare Part A and Part B coverage with a plan that includes prescription drug coverage.

Fallon Medicare Plus Central plans offer distinct coverage options under the labels Orange, Green, and Blue. Each has unique features and differing costs for premiums, co-pays, and deductibles. All of these plans include Medicare Part D prescription drug coverage.

Fallon Community Health Plan also features two standard Medicare Supplement plans. The Core Plan covers limited blood transfusions, most coinsurance amounts, and emergency travel for medical expenses. FCHP also offers the Fallon Medicare Plus Supplement 1A Plan which handles most out-of-pocket expenses not covered by Original Medicare.

Summit ElderCare is a Fallon Health program that caters to seniors who still live at home but require assistance with daily tasks, at-home care, and medication.

Fallon Community Care Plan

In addition to Medicare-related coverage for seniors, Fallon Community Health Plan insurance also offers coverage for individuals, families, and businesses. With the Fallon Health Community Care Plan, enrollees can receive low monthly premiums, co-payments, and cost sharing for prescription drugs.

In addition, the FCHP Community Care Plan offers extra benefits geared toward healthy lifestyles and community involvement. Activities like gym memberships, fitness classes, and subscriptions to health education and smoking cessation programs can help lower your healthcare expenses.

Telehealth services are also featured to provide options for those wishing to avoid unnecessary exposure. Participating doctors nationwide can diagnose and treat dozens of common illnesses via phone, mobile device, or online interaction.

A subset of the Fallon Community Care Plan provides coverage for small businesses. If your business employs less than 50 people, you can purchase a Community Care plan to cover your employees and their families. Depending on your business size, you can either enroll directly through FCHP or visit the Massachusetts Health Connector to sign up.

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Fallon Community Health Plan Direct Care Network

You can access the Fallon Health Direct Care network from the official government website of Massachusetts. FCHP features two types of networks with different levels of benefits for your health care needs.

Select Care is a large, tiered network of providers with over 60,000 participants throughout Massachusetts and New Hampshire. This network provides access to a larger group of medical professionals, but you will face higher premiums.

Fallon Community Direct Care network includes fewer providers and is limited to Massachusetts. This concentrated network of doctors and hospitals is focused on the needs of the local community. Fallon Health’s Direct Care network offers cost-efficient care with a lower premium than the Select Care network.

Fallon Community Health Plan Insurance Reviews

With few complaints filed and closed within the last three years, FCHP has achieved an A- rating with the Better Business Bureau (BBB). There are almost no complaints filed to which Fallon Health has not responded.

The National Committee for Quality Assurance (NCQA) gives Fallon Community Health Plan a rating of 4.5 out of 5. This comprehensive review places FCHP among the nation’s best. FCHP scores high in several treatment areas, but it does have room for improvement in regard to consumer satisfaction.

Fallon Community Health Plan’s Medicare Advantage plans also received an overall rating of 4.5 out of 5 from the Centers for Medicare and Medicaid Services (CMS).

For a regional company, Fallon Community Health Plan has a relatively low number of reviews on Yelp. Fallon Health’s overall rating is two stars, indicating several negative complaints, but the sample size is fairly small.

Relative to pricing, Fallon Community Health Plan is a regional provider that tends to be priced higher than nationwide corporations. While FCHP does offer Medicare plans with low premiums and decent benefits packages, the co-pays and deductibles can be expensive. These prices tend to be higher than the average supplemental insurance costs for Medicare.

Filing a Claim with Fallon Health

Fallon Community Health Plan is an HMO, so there is usually no need for you to interact with them to file a claim. FCHP bills the insurance provider directly, so most insurance claims should be handled internally. You should not have to worry about the claims process unless you used an out-of-network provider in an emergency. As would be expected, the Fallon Health website does not offer much relative to claims information.

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Fallon Community Health Plan: The Bottom Line

Fallon Health is known in the industry to have a good reputation for transparent business practices and quality service. With plans and programs that prioritize the needs of the local community, FCHP provides residents with care focused on their individual circumstances. FCHP does feature low premiums, but with higher prices for co-pays and deductibles.

If you don’t mind paying a bit more for a health plan from a local provider with a solid reputation, you may want to consider Fallon Community Health Plan.

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