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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 $122.00. 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. There is no deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, a standard generic drug has a 23% coinsurance, while a preferred brand drug has a 50% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays require a $200 copay per admission, while outpatient services have copays ranging from $0 to $75. Emergency services have a $110 copay, and primary care visits cost $10. The plan covers preventive, hearing, vision, and dental services, with specific copays for each. Medical equipment and home health services have varying coinsurance or no cost. Other services include acupuncture, meal benefits, and medical stockings/sleeves, with certain exclusions.
Inpatient Hospital See details
Inpatient Hospital benefits cover both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, each 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, but Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered by the Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan. Outpatient hospital services have a copay between $0 and $75, observation services have a $75 copay, ambulatory surgical center services have no copay, and both individual and group outpatient substance abuse sessions have a $10 copay. Outpatient blood services include a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered. There is no copay or coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $90 copay for both ground and air ambulance services, and no coinsurance. Transportation Services to a plan-approved health-related location are covered, but 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 and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services and Worldwide Urgent Coverage have a $30 copay, and Worldwide Emergency Transportation has a $90 copay; there is 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 with a $10 copay, chiropractic services with a $15 copay (routine care not covered), occupational therapy services with a $15 copay, physician specialist services with a $15 copay, and mental health specialty services with a $0-$10 copay for individual or group sessions. The plan also covers other health care professional services with a $10-$20 copay, psychiatric services with a $0-$10 copay for individual or group sessions, physical therapy and speech-language pathology services with a $15 copay, additional telehealth benefits with a $0-$75 copay, and opioid treatment program services with a $15 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams, additional preventive services, health education, in-home safety assessments, medical nutrition therapy, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, nutritional/dietary benefits, fitness benefits, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. Personal Emergency Response Systems (PERS), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, and Counseling Services are not covered.
Hearing Services See details
Hearing exams are covered with a $15 copay, including routine hearing exams and fitting/evaluation for hearing aids, each limited to one visit per year. Prescription hearing aids are covered with a copay between $250 and $1150 for all types, but prescription hearing aids - inner ear, outer ear, and over the ear, are not covered. OTC hearing aids are not covered.
Vision Services See details
The Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan covers vision services, including eye exams with a $15 copay. Eyewear is covered with a combined maximum benefit of $150 every year, while contact lenses, eyeglasses, 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 are covered with a $15 copay, but 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. The plan requires prior authorization, and Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered by the Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics, and Medical Supplies, is covered by this plan. For DME, there is a 10% coinsurance and no copay, and for Prosthetic Devices, there is a 10% coinsurance and no copay. Medical Supplies have a coinsurance of 0% - 10% and no copay. Diabetic Equipment, including Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts, are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with copays and coinsurance depending on the specific service. Diagnostic Procedures/Tests have a copay between $0 and $30, while Lab Services have no copay. Diagnostic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have no copay. Therapeutic Radiological Services are not covered.
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, but require prior authorization and a referral. 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, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are covered. Prior authorization and a doctor's referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services 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 and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan covers acupuncture with no copay, meal benefits for chronic illness, and other services with a 10% coinsurance for medical stockings and sleeves. Over-the-counter (OTC) items, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and other services are not covered.
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