Plan year 2026 · coverage ends Dec. 31, 2026CMS crosswalk of Oct. 1, 2026
Fallon Medicare Plus Orange is not offered under this ID in 2027
H9001Contract038Plan
HMO · served 12 counties in Massachusetts in 2026
Run by Fallon Community Health Plan (contract H9001), sold as Fallon Health, owned by Fallon Community Health Plan, Inc.
CMS crosswalk: renews as H9001-041 in 10 of its 12 counties; in the others the plan ends
Fallon Medicare Plus Orange (H9001-038) is not offered under this ID in 2027. The CMS plan crosswalk of October 1, 2026 moves its members into Fallon Medicare Plus Orange (H9001-041) (the plan renews under a new ID), in the 10 counties where that plan is sold (5,619 members in September 2026). In its other 2 counties (1,612 members) there is no plan to move into: coverage ends December 31, 2026, and members there need to choose a new plan.
What changes for its members in Fallon Medicare Plus Orange?
| What you pay or get | 2026 | 2027 | Change |
|---|---|---|---|
| In-network out-of-pocket limit | $7,550 | $9,850 | ▲up $2,300 |
| Drug deductible | $400 | $595 | ▲up $195 |
| Primary care visit (best in its area) | $10 copay | $20 copay | ▲up $10 |
| Skilled nursing facility, in network (best in its area) | $0 a day for days 1–20, then $188 a day for days 21–100 | $0 a day for days 1–20, then $184 a day for days 21–100 | ▼down $40for a 30-day stay |
| Ground ambulance, in network (best in its area) | $325 copay | $305 copay | ▼down $20 |
| Counties served | 12 | 10 | ▼down 2 |
| Drug tier 4, non-preferred drug | 35% of the cost | 25% of the cost | ▼down 10 points |
| Drug tier 5, specialty tier | 28% of the cost | 27% of the cost | ▼down 1 point |
| 14 lines do not change | |||
| Monthly premium | $0 | $0 | no change |
| Part B premium reduction, monthly (best in its area) | none | none | no change |
| Specialist visit (best in its area) | $20 copay | $20 copay | no change |
| Emergency room (best in its area) | $115 copay | $115 copay | no change |
| Medical deductible, in network (best in its area) | none | none | no change |
| Hospital stay, in network (best in its area) | $385 a day for days 1–7, then $0 a day for days 8–90 | $385 a day for days 1–7, then $0 a day for days 8–90 | 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 |
| 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 6, select care drugs | $0 | $0 | no change |
Source: CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026); 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. Your plan's Annual Notice of Change is the letter that confirms your 2027 plan; confirm on Medicare Plan Finder.
What can members do, and by when?
If you live in Bristol (MA), Essex (MA), Franklin (MA), Hampden (MA), Hampshire (MA), Middlesex (MA), Norfolk (MA), Plymouth (MA), Suffolk (MA), Worcester (MA)
- If you do nothing
- You are moved into Fallon Medicare Plus Orange on January 1, 2027.
- October 15 to December 7, 2026
- Open enrollment: choose another Medicare Advantage plan, or Original Medicare with a drug plan, instead.
If you live in Barnstable (MA), Berkshire (MA)
- Your coverage
- Ends December 31, 2026: Fallon Medicare Plus Orange is not sold where you live.
- October 15 to December 7, 2026
- Open enrollment: join another Medicare Advantage plan, or Original Medicare with a drug plan. Coverage starts January 1, 2027.
- December 8, 2026 to the end of February 2027
- A special enrollment period because the plan is leaving: you can still join a plan, but coverage starts the first day of the month after you join, so choose by December 31 to have no gap.
- If you do nothing
- You are enrolled in Original Medicare when the plan ends, without a drug plan unless you join one (with Extra Help or full Medicaid, Medicare enrolls you in one).
- Without a drug plan
- Going 63 days or more in a row without drug coverage can mean a late enrollment penalty if you join a drug plan later; joining by the end of February keeps a January and February gap under 63 days, waiting longer does not.
Source: Medicare.gov, “Special enrollment periods” and “Joining a plan” (read Oct. 7, 2026).
Where did its members live?
Where its members lived in September 2026; each county and state page lists the 2027 plans sold there.
| County | Members, Sept. 2026 | For 2027 |
|---|---|---|
| Worcester, MA | 3,354 | moves into H9001-041 |
| Berkshire, MA | 1,161 | plan ends here |
| Middlesex, MA | 566 | moves into H9001-041 |
| Barnstable, MA | 451 | plan ends here |
| Bristol, MA | 368 | moves into H9001-041 |
| Plymouth, MA | 303 | moves into H9001-041 |
| Hampden, MA | 250 | moves into H9001-041 |
| Norfolk, MA | 222 | moves into H9001-041 |
| Essex, MA | 195 | moves into H9001-041 |
| Franklin, MA | 183 | moves into H9001-041 |
| Suffolk, MA | 137 | moves into H9001-041 |
| Hampshire, MA | 41 | moves into H9001-041 |
Source: CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11).
What else should you check?
- 2027 plans in Worcester, MAThe plans you can join instead
- Fallon Health plans for 2027Plans the same company still offers
- Every plan not offered in 2027764 Medicare Advantage and drug plans