Yes—Fallon Health plans cover psychiatrist visits when medically necessary, including for members enrolled in Fallon Medicare Plus, Fallon Medicare Plus Central, Summit ElderCare, and Fallon Health Weinberg PACE.
Does Fallon cover acupuncture?
Fallon Medicare plans cover up to 12 acupuncture visits in a 90-day period for chronic low back pain, consistent with Medicare National Coverage Determination NCD 30.3.
Other services like chiropractic or physical therapy? Those have different limits. Always double-check your specific plan details with Fallon Member Services before starting any treatment.
How many members does Fallon Health Plan have?
As of 2026, Fallon Health serves approximately 400,000 members, based on sustained enrollment growth since the 271,369 reported in 2018
That growth comes from expanding across Massachusetts and New York through Medicare Advantage, Medicaid, and commercial plans. For the latest figures, visit the Fallon Health website.
Is Fallon Health an HMO?
Yes—Fallon Health offers HMO plans as part of its portfolio, along with POS, PPO, Medicaid, and Medicare Advantage options
HMO plans usually require a primary care physician and referrals for specialty care. Check your specific plan’s Summary of Benefits for network and referral rules.
Is Fallon Health a nonprofit?
Yes—Fallon Health is a nonprofit organization, operating under 501(c)(3) status
As a nonprofit, it reinvests surplus revenue into community health programs and lower-cost services. Its contracts include CMS, MassHealth, and the New York Department of Health.
Is Wellforce care plan part of MassHealth?
Yes—Wellforce Care Plan is a MassHealth Accountable Care Organization (ACO) Partnership Plan
It operates through a network of providers focused on coordinated, high-quality care for MassHealth members. For a list of participating providers, visit the MassHealth provider directory.
Who qualifies for MassHealth?
Eligibility typically includes Massachusetts residents who are under 65, U.S. citizens or qualified immigrants, and meet income limits
Children under 19, pregnant individuals, and people with disabilities often qualify automatically. Seniors 65+ have separate asset and income criteria. Use the MassHealth Eligibility Tool to screen your case.
Does Fallon Navicare require referrals?
Yes—Fallon Navicare typically requires a referral from your primary care physician (PCP) for in-network specialty care
Out-of-network visits? Those usually need prior authorization. Check your Evidence of Coverage or call Fallon Member Services at 1-800-868-5200 for plan-specific rules.
Does MassHealth cover Botox?
No—MassHealth generally excludes Botox and related drugs for cosmetic purposes
Coverage may apply for FDA-approved medical uses, such as chronic migraines or muscle spasms. Prior authorization is often required. Consult your doctor and MassHealth formulary for details.
Is MassHealth Medicare?
No—MassHealth is Massachusetts’ Medicaid program, not Medicare
MassHealth provides coverage for low-income individuals, families, seniors, and people with disabilities. Medicare is a federal program for people 65+, regardless of income. Some individuals qualify for both programs (dual eligibility).
What does MassHealth do?
MassHealth provides health coverage and financial help to qualifying Massachusetts residents, including children, families, seniors, and people with disabilities
It pays for doctor visits, hospital care, prescriptions, and long-term services. Benefits vary by program—some members pay premiums or copays based on income.
How do I know if my MassHealth is active?
Log into your MassHealth account online or call the Member Service Center
You can also check via the MassHealth Member Portal or ask your provider to verify eligibility through the Provider Online Service Center (POSC).
Does MassHealth look at your bank account?
MassHealth generally does not review bank accounts for most members
(Honestly, this is the best approach for privacy.) However, for certain long-term care programs, asset limits apply (e.g., $2,000 for most individuals). Seniors 65+ should consult MassHealth’s asset rules before applying. Review the MassHealth Standard guidelines.
What is maximum income for MassHealth?
As of 2026, the maximum annual income limit for MassHealth Standard is $18,075 for an individual and $36,908 for a family of four
| Household Size | Max Annual Income |
|---|
| 1 | $18,075 |
| 2 | $24,353 |
| 3 | $30,630 |
| 4 | $36,908 |
Higher limits apply for children’s programs and pregnant individuals. Use the MassHealth income calculator to confirm your eligibility.
What is the income limit for MassHealth 2020?
In 2020, MassHealth income limits were based on 150% of the federal poverty level (FPL)
| Family Size | Monthly Income (150% FPL) | Annual Income (150% FPL) |
|---|
| 1 | $1,699 | $20,388 |
| 2 | $2,289 | $27,468 |
| 3 | $2,879 | $34,548 |
Those thresholds have since increased. For current limits, visit the MassHealth website.
What does MassHealth do?
MassHealth provides health benefits and help paying for them to qualifying children, families, seniors, and people with disabilities living in Massachusetts. We may offer benefits directly or help pay for all or part of your health insurance premiums.
Edited and fact-checked by the FixAnswer editorial team.
