A non-government entity
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 2025, 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 2025.
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 $245.00. 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 $3650.00 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:
Sign up for Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, standard generic drugs have a 23% coinsurance, while preferred generic drugs have a $4 copay at a standard pharmacy. After your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan offers comprehensive coverage with varying costs. Inpatient hospital stays have a $200 copay per admission, and outpatient services range from no copay to a $75 copay. Emergency services have a $110 copay, and primary care visits cost $10. Preventive services are covered with no copay, and there are $15 copays for eye exams and hearing exams. Dental services have a $15 copay for Medicare-covered services, and vision services include eyewear benefits. The plan also includes coverage for home health services and skilled nursing facilities, and some other services like acupuncture with no copay.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both with a $200 copay per admission or stay, and a service-specific out-of-pocket maximum of $400. Additional Days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, as are Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services for the Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan includes coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0-$75, Observation Services have a $75 copay, Ambulatory Surgical Center Services have no copay, and both Individual and Group Sessions for Outpatient Substance Abuse have a $10 copay.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan. There is no copay or coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and air ambulance services have a $90 copay, and there is no coinsurance. Transportation Services to a plan-approved health-related location are covered, while transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $110 copay, and Urgently Needed Services have a $30 copay, while Worldwide Emergency Services have a $110 copay for Worldwide Emergency Coverage, a $30 copay for Worldwide Urgent Coverage, and a $90 copay for Worldwide Emergency Transportation.
Primary Care See details
The Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan covers Primary Care Physician Services with a $10 copay. Chiropractic Services are partially covered, with a $15 copay for Medicare-covered services and other chiropractic services, but routine care is not covered. The plan also covers Occupational Therapy Services, Physician Specialist Services, Physical Therapy, and Speech-Language Pathology Services, with a $15 copay. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services are covered with a copay ranging from $0 to $10 and a $15 copay, respectively. Additionally, the plan covers Additional Telehealth Benefits with a copay ranging from $0 to $75.
Preventive Services See details
Preventive Services are covered, including Medicare-covered zero dollar services, annual physical exams, and additional preventive services. Additional services like wigs for hair loss, weight management programs, and home and bathroom safety devices and modifications are covered, and some services like Personal Emergency Response System (PERS) and counseling are not covered.
Hearing Services See details
Hearing exams are covered with a $15 copay. Prescription hearing aids are covered, with a copay between $250 and $1150. Fitting/evaluation for hearing aids and routine hearing exams are covered.
Vision Services See details
Vision services include eye exams with a $15 copay and eyewear benefits, including contact lenses, eyeglasses, eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum benefit of $150 per year.
Dental Services See details
Dental services are partially covered under the Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan, with a $15 copay for Medicare Dental Services. Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan, including Medicare Part B Insulin Drugs. Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered under the Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 10% coinsurance with no copay, while Durable Medical Equipment for use outside the home and Diabetic Supplies and Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $30, and Lab Services with no copay. Diagnostic Radiological Services have a 20% coinsurance, while Therapeutic Radiological Services are not covered. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered. This benefit requires both authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific sub-services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan, with a $20 copay for days 1-20, and no copay for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture, a meal benefit, and medical stockings and sleeves. Acupuncture is covered with no copay or coinsurance, and the meal benefit is covered for a chronic illness. Medical stockings and sleeves have a 10% coinsurance, and other services such as over-the-counter items, EPSDT services, and private duty nursing services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved