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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 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 $217.00. 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:
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Drug Coverage
The Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan has an enhanced alternative drug benefit. The plan has no deductible. During the initial coverage phase, you will pay different amounts depending on the drug tier and the pharmacy you use. For example, you will pay a $4 copay for preferred generic drugs at a standard pharmacy. For specialty tier drugs, there is no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan offers comprehensive coverage with varying costs for different services. You'll pay a $200 copay for inpatient hospital stays, while outpatient services have copays ranging from $0 to $75. Emergency services have a $110 copay, and primary care visits cost $10. Preventive services, including hearing and vision exams, are covered with specific copays and annual maximums for eyewear. Dental services are partially covered with a $15 copay for Medicare-covered services. The plan also includes coverage for home health services with no copay, and skilled nursing facility stays with a $20 copay for the first 20 days.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Inpatient Hospital-Acute has a copay of $200 per stay, and the plan has a service-specific out-of-pocket maximum of $400. Inpatient Hospital Psychiatric has a copay of $200 per stay, and the plan has a service-specific out-of-pocket maximum of $400.
Outpatient Services See details
Outpatient Services for the Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan cover various services, including outpatient hospital services with a copay between $0 and $75, observation services with a $75 copay, and ambulatory surgical center services with no copay. The plan also covers outpatient substance abuse services with a $10 copay for individual and group sessions and outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization benefits are covered under the Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan. There is no information about the cost of this service in the provided snippet.
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 services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $110 copay and no coinsurance, while Urgently Needed Services have a $30 copay and no coinsurance. Worldwide Emergency Coverage has a $110 copay, Worldwide Urgent Coverage has a $30 copay, and Worldwide Emergency Transportation has a $90 copay, with no coinsurance for any of these services.
Primary Care See details
The Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan covers Primary Care Physician Services for a $10 copay. Chiropractic Services are covered with a $15 copay, while Routine Chiropractic Care is not covered. Occupational Therapy Services, Physician Specialist Services, and Physical Therapy and Speech-Language Pathology Services are covered with copays of $15. Mental Health Specialty Services and Psychiatric Services have a $0-$10 copay for individual and group sessions. Other Health Care Professional services have a $10-$20 copay, and Additional Telehealth Benefits are covered with a $0-$75 copay. Opioid Treatment Program Services are covered with a $15 copay.
Preventive Services See details
Preventive services include coverage for Medicare-covered services, annual physical exams, additional preventive services, and other services like health education, with some services like Personal Emergency Response System (PERS), post discharge in-home medication reconciliation, re-admission prevention, and others not covered. The plan also covers services like wigs for hair loss related to chemotherapy with a maximum benefit of $500.00 per year, and weight management programs with a maximum benefit of $150.00 per year.
Hearing Services See details
Hearing exams are covered with a $15 copay, and routine hearing exams and fitting/evaluation for hearing aids are covered once per year. Prescription hearing aids are partially covered, with copays ranging from $250 to $1150, but inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $15 copay. Eyewear has a combined maximum benefit of $150 per year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental services are partially covered under the Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan. Medicare Dental Services require prior authorization and a doctor referral, with a $15 copay, while other services like Orthodontic Services, Restorative Services, and more are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Insulin and 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 for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment with a 10% coinsurance and Prosthetic Devices with a 10% coinsurance, but Durable Medical Equipment for use outside the home is not covered. Medical Supplies have a coinsurance of 0% - 10%, and Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $30, and Lab Services have no copay. Diagnostic Radiological Services have a 20% coinsurance, while Therapeutic Radiological Services are not covered, and 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. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the sub-services are covered. Prior authorization and a doctor referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan, but require prior authorization. For days 1-20, there is a $20 copay, and for days 21-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for Skilled Nursing Facility (SNF) are not covered.
Other Services See details
The Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan covers acupuncture with no copay and no coinsurance, and also offers a meal benefit for a chronic illness. Other services include medical stockings and sleeves with 10% coinsurance. Over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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