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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 $227.00. 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 features no drug deductible, allowing your prescription coverage to begin immediately. For Tier 1 preferred generic drugs, you will pay a low $2 copay for a one-month supply at standard pharmacies and through standard mail order. Tier 2 generic medications cost a $4 copay for a one-month supply, while Tier 6 vaccines are available with no copay. For higher-tier medications, the plan utilizes coinsurance rather than flat copays. Tier 3 preferred brands require a 20% coinsurance, while Tier 4 non-preferred drugs carry a 40% coinsurance for standard pharmacy and mail order fills. Specialty drugs in Tier 5 require a 33% coinsurance for a one-month supply at standard locations.
Additional Benefits
The Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan offers affordable medical coverage with low out-of-pocket costs, including a $10 copay for primary care visits and a $15 copay for specialist visits. Inpatient hospital stays require a $200 copay per stay with no coinsurance, while outpatient hospital services range from no copay up to a $75 copay. Emergency room visits carry a $110 copay, which is waived if you are admitted, and urgent care services require a $30 copay. This plan also features no copay for home health services, partial hospitalization, and unlimited acupuncture, alongside unlimited plan-approved transportation with no copay. Routine vision and hearing exams are available for a $15 copay, with additional allowances for eyewear and coverage for prescription hearing aids. Diagnostic lab work and annual physicals are covered with no copay, helping you manage your preventive care and overall health efficiently.
Inpatient Hospital See details
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) covers inpatient acute and psychiatric hospital stays with a $200 copay per stay and no coinsurance. Unlimited additional days are covered for acute stays, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services carry a copay of $0 to $75 (including a $75 copay per stay for observation), while individual and group outpatient substance abuse sessions require a $10 copay.
Partial Hospitalization See details
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) covers partial hospitalization services with no copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Tufts Medicare Preferred HMO Prime Rx Plus (HMO), with Medicare-covered ground and air ambulance services requiring prior authorization and carrying a $150 copay and no coinsurance. Transportation services are partially covered, offering unlimited one-way rides to plan-approved locations with no copay or coinsurance, though trips to any other health-related locations are not covered.
Emergency Services See details
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) covers emergency services with a $110 copay and no coinsurance, with the copay waived if admitted to the hospital within one day. Urgently needed services are covered with a $30 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $30 to $150.
Primary Care See details
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) covers primary care visits for a $10 copay and specialist and therapy services for a $15 copay, all with no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, excluding routine chiropractic care, while podiatry services are not covered.
Preventive Services See details
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) covers preventive services, including annual physicals and kidney disease education, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay, though home safety modifications require a 10% coinsurance, and services such as personal emergency response systems, adult day health, and in-home support are not covered.
Hearing Services See details
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) covers annual routine hearing exams and fitting evaluations for a $15.00 copay and no coinsurance. Prescription hearing aids are partially covered for up to two devices per year with a copay ranging from $250.00 to $1150.00 and no coinsurance, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by Tufts Medicare Preferred HMO Prime Rx Plus (HMO), featuring a $15 copay and no coinsurance for an annual routine eye exam, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, offering up to a $150 combined annual benefit for contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) partially covers dental services, offering Medicare-covered dental care for a $15.00 copay and no coinsurance. Other dental services, including routine cleanings, exams, x-rays, and restorative procedures, are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services under Tufts Medicare Preferred HMO Prime Rx Plus (HMO) are partially covered with no copay and no coinsurance, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin and Part D home infusion drugs are covered, while Medicare Part B chemotherapy or radiation drugs and other Medicare Part B drugs are not covered.
Dialysis Services See details
Dialysis Services are covered by Tufts Medicare Preferred HMO Prime Rx Plus (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) covers medical equipment with no copay, requiring a 10% coinsurance for durable medical equipment and prosthetic devices, and 0% to 10% coinsurance for medical supplies. Diabetic equipment is partially covered with no copay or coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) partially covers diagnostic and radiological services, as therapeutic radiological services are not covered. Diagnostic services feature no coinsurance, with a $0 to $30 copay for diagnostic procedures and no copay for lab services, while outpatient X-rays require no copay and diagnostic radiological services require a 20% coinsurance.
Home Health Services See details
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) covers Home Health Services with no copay and no coinsurance. Prior authorization and a referral are required to access this covered benefit.
Cardiac Rehabilitation Services See details
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, though prior authorization and a referral are required. While some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered under Tufts Medicare Preferred HMO Prime Rx Plus (HMO) with no coinsurance, requiring prior authorization and a $20 daily copay for days 1 through 20, and no copay for days 21 through 100. A prior three-day hospital stay is not required, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) partially covers other services, offering unlimited acupuncture treatments with no copay and no coinsurance. Supplemental benefits such as over-the-counter (OTC) items and meal benefits are not covered under this plan.
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