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Tufts Medicare Preferred HMO Prime Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Tufts Medicare Preferred HMO Prime Rx (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 (HMO) in 2025, please refer to our full plan details page.
Tufts Medicare Preferred HMO Prime Rx (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 (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 (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 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $213.00. 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 (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying costs depending on the drug tier and pharmacy. For example, you'll pay an $8.00 copay for preferred generic drugs at standard and mail order pharmacies. For standard generic drugs, you'll pay 23% coinsurance at standard and mail order pharmacies. Specialty tier drugs have no copay at standard pharmacies. After your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Tufts Medicare Preferred HMO Prime Rx (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $300 copay per stay, while outpatient services can have copays ranging from $0 to $100. Emergency services have a $110 copay. The plan includes coverage for primary care with a $10 copay, vision and hearing services, and dental services, all with associated copays. Preventive services are also covered, including annual exams and weight management programs.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, each with a $300 copay per stay, and a service-specific out-of-pocket maximum of $900.00. Additional Days for Inpatient Hospital-Acute is covered, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $100, Observation Services have a $100 copay, and ASC Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $10.00, and Outpatient Blood Services include the waiver of the three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Tufts Medicare Preferred HMO Prime Rx (HMO) plan. There is no copay or coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $125 copay for both ground and air ambulance services; there is no coinsurance. Transportation Services to a plan-approved health-related location are covered, and 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 by Tufts Medicare Preferred HMO Prime Rx (HMO). Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services has a $30 copay, and Worldwide Emergency Transportation has a $125 copay.
Primary Care See details
Primary Care Physician services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits and Opioid Treatment Program Services are covered. Primary Care Physician services have a $10 copay, Chiropractic Services have a $15 copay, Occupational Therapy Services have a $15 copay, Physician Specialist Services have a $15 copay, Individual and Group Sessions for Mental Health Specialty Services have a $0-$10 copay, Other Health Care Professional services have a $10-$20 copay, Individual and Group Sessions for Psychiatric Services have a $0-$10 copay, Physical Therapy and Speech-Language Pathology Services have a $15 copay, Additional Telehealth Benefits have a $0-$100 copay, and Opioid Treatment Program Services have a $15 copay. Podiatry Services are not covered.
Preventive Services See details
The Tufts Medicare Preferred HMO Prime Rx (HMO) plan covers a variety of preventive services, including annual physical exams, health education, in-home safety assessments, wigs for hair loss due to chemotherapy (up to $500 per year), weight management programs (up to $150 per year), alternative therapies, therapeutic massage, nutritional/dietary benefits, fitness benefits, kidney disease education, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit. Home and bathroom safety devices and modifications are covered with 10% coinsurance. However, personal emergency response systems, post-discharge in-home medication reconciliation, re-admission prevention, home-based palliative care, in-home support services, support for caregivers, additional smoking cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, and counseling services are not covered.
Hearing Services See details
Hearing Services for the Tufts Medicare Preferred HMO Prime Rx (HMO) plan include hearing exams with a $15 copay, and prescription hearing aids. Prescription Hearing Aids (all types) have a copay between $250 and $1150, while Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear and OTC Hearing Aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a $15 copay, as well as eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum plan benefit coverage of $150 per year.
Dental Services See details
Dental services are partially covered under the Tufts Medicare Preferred HMO Prime Rx (HMO) plan. Medicare Dental Services require prior authorization and a doctor's referral, with a $15 copay, while orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, prosthodontics, fixed, 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 (HMO) plan, including Medicare Part B Insulin Drugs, but Medicare Part B Chemotherapy/Radiation Drugs are not covered. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the Tufts Medicare Preferred HMO Prime Rx (HMO) plan. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Tufts Medicare Preferred HMO Prime Rx (HMO) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no copay, but has a 10% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have no copay and a coinsurance for Medicare-covered devices and supplies. Diabetic Equipment has a coinsurance between 0% and 10%, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Tufts Medicare Preferred HMO Prime Rx (HMO) plan. 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.
Home Health Services See details
Home Health Services are covered by the Tufts Medicare Preferred HMO Prime Rx (HMO) plan with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. You will pay a copay of $20 for days 1-20, $80 for days 21-44, and no copay for days 45-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes acupuncture, meal benefits, and other services. Acupuncture is covered with no copay or coinsurance. The meal benefit is available for chronic illnesses. Other 1 includes medical stockings and sleeves and requires prior authorization with a 10% coinsurance. The following services are not covered: 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.
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