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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 $132.00. 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 a $0 drug deductible, meaning you have no deductible to meet before your prescription coverage begins. For Tier 1 preferred generics, you will pay a low $2 copay for a one-month supply at standard pharmacies, while Tier 2 generics require a $4 copay. Furthermore, Tier 6 vaccines are highly accessible with no copay for up to a three-month supply at standard pharmacies. For brand-name and specialty medications, the plan utilizes coinsurance rather than set copays. Tier 3 preferred brands require a 20% coinsurance, while Tier 4 non-preferred drugs carry a 40% coinsurance for both standard pharmacy and standard mail-order options. Tier 5 specialty drugs are covered with a 33% coinsurance for a one-month supply.
Additional Benefits
The Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan offers affordable coverage for core medical needs with low, predictable out-of-pocket costs. Members pay a $10 copay for primary care visits, a $15 copay for specialists, and no copay for most preventive services. Inpatient hospital stays require a $200 copay per admission, while emergency room visits carry a $110 copay that is waived if admitted. This plan also features valuable additional benefits, including routine eye and hearing exams for a $15 copay and up to $150 annually for eyewear. Additionally, members can access unlimited acupuncture treatments and plan-approved transportation with no copay, though routine dental care and over-the-counter benefits are not covered. Necessary durable medical equipment and dialysis services are also covered, subject to coinsurance and no copays.
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, non-Medicare-covered stays, and additional days for psychiatric stays 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. Members pay no copay and no coinsurance for ambulatory surgical center and blood services, while outpatient substance abuse sessions carry a $10 copay with no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered under the Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan with no copay and no coinsurance.
Ambulance and Transportation Services See details
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) covers ambulance services with a $150 copay and no coinsurance for both ground and air transport. Transportation services are partially covered, offering unlimited one-way rides to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) covers emergency services with a $110 copay, which is waived if admitted within one day, and urgently needed services with a $30 copay, both with no coinsurance. Worldwide emergency care, urgent care, and emergency transportation are also covered with no coinsurance and copays of $110, $30, and $150 respectively.
Primary Care See details
Primary care benefits under the Tufts Medicare Preferred HMO Prime Rx Plus (HMO) feature a $10 copay for primary care visits and a $15 copay for specialist visits, both with no coinsurance. While physical therapy, occupational therapy, and mental health services are covered with no coinsurance and low copays, podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered under the Tufts Medicare Preferred HMO Prime Rx Plus (HMO), featuring no copay and no coinsurance for most services, including annual physical exams, while home and bathroom safety devices require a 10% coinsurance. Sub-services that are not covered include personal emergency response systems, post-discharge medication reconciliation, re-admission prevention, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, and counseling services.
Hearing Services See details
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) partially covers hearing services, offering one routine hearing exam and fitting evaluation per year for a $15 copay and no coinsurance. Up to two prescription hearing aids are covered annually with a copay ranging from $250 to $1,150 and no coinsurance, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Tufts Medicare Preferred HMO Prime Rx Plus (HMO), which excludes other eye exam services but covers one annual routine eye exam with a $15 copay and no coinsurance. Eyewear is covered with no copay and no coinsurance up to a $150 maximum plan benefit limit per year.
Dental Services See details
Dental services are partially covered under the Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan, which only covers Medicare-covered dental services with a $15 copay and no coinsurance. Other dental benefits, including routine cleanings, oral exams, x-rays, and comprehensive procedures like orthodontics and restorative services, 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. While Medicare Part B insulin drugs are covered with no copay or coinsurance, 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
Medical equipment is covered under the Tufts Medicare Preferred HMO Prime Rx Plus (HMO) with no copays, subject to prior authorization. Durable medical equipment and prosthetics carry a 10% coinsurance, medical supplies require no coinsurance to 10% coinsurance, and diabetic equipment is partially covered with no coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) provides partial coverage for diagnostic and radiological services, as therapeutic radiological services are not covered. Under this plan, lab services and outpatient X-rays have no copay and no coinsurance, diagnostic procedures and tests have a $0 to $30 copay with no coinsurance, and diagnostic radiological services require a copay and a minimum 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. To access these covered services, both a referral and prior authorization are required.
Cardiac Rehabilitation Services See details
While Cardiac Rehabilitation Services are technically listed with no copay and no coinsurance, they are not covered in practice under the Tufts Medicare Preferred HMO Prime Rx Plus (HMO) plan. All related sub-services, including standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Tufts Medicare Preferred HMO Prime Rx Plus (HMO) 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, and while a prior three-day inpatient hospital stay is not required for admission, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Tufts Medicare Preferred HMO Prime Rx Plus (HMO) offers partial coverage for other services, featuring 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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