Plan year 2027 · Medicare AdvantageCMS files of Sept. 22 and Oct. 1, 2026

Fallon Medicare Plus Blue, 2027

H9001Contract031Plan

HMO · 12 counties in Massachusetts

Run by Fallon Community Health Plan (contract H9001), sold as Fallon Health, owned by Fallon Community Health Plan, Inc.

Renews for 2027

2026 star rating, contract H9001: 4 of 5

Fallon Medicare Plus Blue (H9001-031) costs $117 to $217 a month in 2027, up $6 from 2026, with an in-network out-of-pocket limit of $3,400.

What changes from 2026 to 2027?

The changed lines are marked and come first. In-network amounts; members keep paying the Part B premium unless the plan reduces it. Where the plan files different amounts for parts of its area, the premium and limit show their range (your county's are in the table below). The plan files its benefits in parts for different counties, so lines marked ◆ show the most generous part of its area and some counties get less: the plan's Evidence of Coverage gives your county's amounts.
What you pay or get	2026	2027	Change
Monthly premium	$111 to $207	$117 to $217	up $6
Emergency room (best in its area)	$120 copay	$140 copay	up $20
Hospital stay, in network (best in its area)	$200 a stay	$300 a stay	up $100for a 5-day stay
Ground ambulance, in network (best in its area)	$125 copay	$250 copay	up $125
18 lines do not change
In-network out-of-pocket limit	$3,400	$3,400	no change
Drug deductible	$0	$0	no change
Part B premium reduction, monthly (best in its area)	none	none	no change
Primary care visit (best in its area)	$10 copay	$10 copay	no change
Specialist visit (best in its area)	$15 copay	$15 copay	no change
Medical deductible, in network (best in its area)	none	none	no change
Skilled nursing facility, in network (best in its area)	$15 a day for days 1–20, then $75 a day for days 21–44, then $0 a day for days 45–100	$15 a day for days 1–20, then $75 a day for days 21–44, then $0 a day for days 45–100	no change
Comprehensive dental, yearly limit (best in its area)	not offered	not offered	no change
Eyewear, yearly limit (best in its area)	$150 a year	$150 a year	no change
Hearing aids, yearly limit for both ears (best in its area)	not offered	not offered	no change
Over-the-counter items, yearly (best in its area)	not offered	not offered	no change
Counties served	12	12	no change
Drug tier 1, preferred generic	$0	$0	no change
Drug tier 2, generic	$7	$7	no change
Drug tier 3, preferred brand	$47	$47	no change
Drug tier 4, non-preferred drug	35% of the cost	35% of the cost	no change
Drug tier 5, specialty tier	33% of the cost	33% of the cost	no change
Drug tier 6, select care drugs	$0	$0	no change

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS plan benefit package files, 2027 and 2026; CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026). Plan details can change during the year; confirm on Medicare Plan Finder.

What will prescriptions cost?

Your share for a 30-day supply at a retail pharmacy, as filed with CMS; tiers whose share changes are marked
Tier	What the tier holds	2026	2027
Tier 1	Preferred Generic	$0	$0
Tier 2	Generic	$7	$7
Tier 3	Preferred Brand	$47	$47
Tier 4	Non-Preferred Drug	35% of the cost	35% of the cost
Tier 5	Specialty Tier	33% of the cost	33% of the cost
Tier 6	Select Care Drugs	$0	$0

Source: CMS plan benefit package files, 2027 and 2026. Insulin is capped at $35 a month by law. A drug's tier is set by the plan's formulary.

How does it compare with plans sold where it is?

In the counties it serves, 58 plans open to everyone are sold for 2027, this one included. Against the others, 57 a higher one. On the premium, 42 plans have a lower premium, 15 a higher one.

Out-of-pocket limits of the 58 plans open to everyone

$0 to under $2,0000 plans

$2,000 to under $4,000 (this plan)8 plans

$4,000 to under $6,00017 plans

$6,000 to under $8,00027 plans

$8,000 to $10,0006 plans

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).

Where is it sold, and what does it cost there?

12 counties, grouped by what the plan costs there
Monthly premium	Out-of-pocket limit	Where
$117	$3,400	Franklin (MA), Hampden (MA), Hampshire (MA)
$185	$3,400	Bristol (MA), Essex (MA), Middlesex (MA), Norfolk (MA), Plymouth (MA), Suffolk (MA)
$192	$3,400	Barnstable (MA), Berkshire (MA)
$217	$3,400	Worcester (MA)

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).

Who runs this plan?

Plan ID: H9001-031
Legal name of the contract: Fallon Community Health Plan
Sold as: Fallon Health
Parent company: Fallon Community Health Plan, Inc.
Plan type: HMO
2026 star rating of the contract: 4 of 5 overall; health plan 4 of 5, drug plan 4 of 5
Members, September 2026: 1,439
Plan website, as filed with CMS: fallonhealth.org/medicare

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS 2026 Star Ratings (October 2025); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11). CMS publishes the 2027 Star Ratings in October 2026.

What else should you check?

Other 2027 plans in Worcester, MAWhere most of its members live; premiums and limits side by side
Every Fallon Health plan for 2027Its contracts, counties and plans that end
The other 3 plans of contract H9001Same company, same contract
Is your prescription covered?Coverage share and tier for 2,259 drugs

Data, not advice. These are the plan's filed amounts, not a quote for you; confirm on Medicare Plan Finder or call the plan before you enroll.