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Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Tufts Medicare Preferred HMO Prime Rx Plus (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Tufts Medicare Preferred HMO Prime Rx Plus (HMO) in 2026, please refer to our full plan details page.
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) is a HMO plan offered by Point32Health, Inc. available for enrollment in 2025 to people living in Most of Massachusetts. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Tufts Medicare Preferred HMO Prime Rx Plus (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Tufts Medicare Preferred HMO Prime Rx Plus (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Tufts Medicare Preferred HMO Prime Rx Plus (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $255.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3850.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan offers excellent prescription drug coverage with a $0 drug deductible, allowing your benefits to start immediately. For Tier 1 preferred generics, standard pharmacy copays start at just $2 for a one-month supply, while Tier 2 generics cost $4. Furthermore, Tier 6 vaccines are highly accessible with no copay at standard pharmacies. For brand-name and specialty medications, costs are based on coinsurance, requiring 20% for Tier 3 preferred brands and 40% for Tier 4 non-preferred drugs. Tier 5 specialty drugs carry a 33% coinsurance for a one-month supply at standard pharmacies and mail order. To maximize savings, standard mail order options are available, capping three-month generic copays at just $4 for Tier 1 and $8 for Tier 2.
Additional Benefits
The Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan offers affordable access to everyday medical care, including primary care visits for a $10 copay and specialist visits for a $15 copay with no coinsurance. Inpatient hospital stays require a $200 copay per admission, while outpatient services range from no copay up to a $75 copay. Emergency care is covered with a $110 copay, which is waived upon hospital admission, and urgent care requires a $30 copay. This plan also includes valuable supplemental coverage, featuring routine eye and hearing exams for a $15 copay, a $150 annual eyewear allowance, and prescription hearing aid coverage. Members can access unlimited transportation to approved health locations and home health services with no copay or coinsurance. Additionally, most preventive services, lab tests, and X-rays are covered with no copay, helping you manage your healthcare costs.
Inpatient Hospital See details
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) covers inpatient acute and psychiatric hospital stays with a $200 copay per admission and no coinsurance. This benefit is partially covered, as upgrades and non-Medicare-covered stays for acute care, as well as additional days and non-Medicare-covered stays for psychiatric care, are not covered.
Outpatient Services See details
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) covers outpatient services with no coinsurance, featuring a $0 to $75 copay for outpatient hospital services and a $75 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse services carry a $10 copay per session with no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by Tufts Medicare Preferred HMO Prime Rx Plus (HMO) with no copay and no coinsurance.
Ambulance and Transportation Services See details
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) covers ground and air ambulance services with a $150 copay and no coinsurance. Transportation services are partially covered, offering unlimited one-way rides to plan-approved health-related locations with no copay and no coinsurance, while trips to any health-related location are not covered.
Emergency Services See details
Emergency Services under the Tufts Medicare Preferred HMO Prime Rx Plus (HMO) are covered with a $110 copay and no coinsurance, with the copay waived if you are admitted to the hospital within one day. Urgently needed care requires a $30 copay and no coinsurance, while worldwide emergency services are covered with no coinsurance and copays of $110 for emergency care, $30 for urgent care, and $150 for emergency transportation.
Primary Care See details
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) covers primary care visits for a $10 copay and specialist visits for a $15 copay, both with no coinsurance. Other professional services like physical therapy, mental health, and telehealth are covered with no coinsurance and copays ranging from no copay up to $75, though routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered under the Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan, with most services like annual physical exams and health screenings costing no copay and no coinsurance. While home and bathroom safety devices require a 10% coinsurance, several services are not covered, including personal emergency response systems, post-discharge medication reconciliation, adult day health, home-based palliative care, in-home support, and caregiver support.
Hearing Services See details
Hearing services under the Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan are partially covered, featuring routine hearing exams and evaluations for a $15 copay and no coinsurance. Up to two prescription hearing aids are covered per year with a copay between $250 and $1,150 and no coinsurance, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) partially covers vision services, offering one routine eye exam per year for a $15 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $150 combined maximum limit per year for contacts, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered under the Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan, which covers Medicare-covered dental care with a $15 copay and no coinsurance, requiring prior authorization and referrals. Routine and comprehensive dental services, including oral exams, cleanings, x-rays, and restorative procedures, are not covered.
Home Infusion bundled Services See details
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) partially covers home infusion bundled services with no copay and no coinsurance, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs are covered with no copay and no coinsurance, while Medicare Part B chemotherapy, radiation, and other Part B drugs are not covered.
Dialysis Services See details
Dialysis Services are covered under the Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) covers medical equipment with no copays, though prior authorization is required. Durable medical equipment and prosthetic devices require a 10% coinsurance, medical supplies carry a coinsurance ranging from no coinsurance to 10%, and diabetic equipment has no coinsurance. Note that diabetic supplies and therapeutic shoes or inserts are not covered under this plan.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered under Tufts Medicare Preferred HMO Prime Rx Plus (HMO), as therapeutic radiological services are not covered. Covered diagnostic tests require a $0 to $30 copay with no coinsurance, lab and outpatient X-ray services feature no copay and no coinsurance, and diagnostic radiological services require a copay and a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Tufts Medicare Preferred HMO Prime Rx Plus (HMO) with no copay and no coinsurance. Both prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no copay and no coinsurance under the Tufts Medicare Preferred HMO Prime Rx Plus (HMO), but only some services are covered as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring a $20 daily copay for days 1 through 20 and no copay for days 21 through 100. Prior authorization is required, but a three-day prior hospital stay is not, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other services are partially covered by Tufts Medicare Preferred HMO Prime Rx Plus (HMO), which features unlimited acupuncture treatments with no copay and no coinsurance. Over-the-counter (OTC) items, meal benefits, and other supplemental services are not covered under this plan.
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