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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 2026, 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 2026.
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 $223.00. 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 (HMO) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. Under this plan, Tier 1 preferred generic drugs require a $4 copay for a one-month supply at standard pharmacies and standard mail order. Tier 2 generic drugs carry an $8 copay for a one-month supply, while Tier 6 vaccines are covered with no copay. For higher-tier medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 20% coinsurance, Tier 4 non-preferred drugs require a 40% coinsurance, and Tier 5 specialty drugs require a 33% coinsurance for a one-month supply. Standard mail order offers cost-saving opportunities, such as a three-month supply of Tier 1 drugs for an $8 copay.
Additional Benefits
The Tufts Medicare Preferred HMO Prime Rx (HMO) plan offers robust coverage for core medical services with predictable out-of-pocket costs, featuring no coinsurance for most doctor visits and hospital stays. Primary care visits require a low $10 copay, specialist visits have a $15 copay, and inpatient hospital stays carry a $300 copay per stay. Emergency care is covered with a $110 copay, while many outpatient, preventive, and home health services are available with no copay. For specialized care, the plan provides routine vision and hearing exams for a $15 copay, alongside allowances for eyewear and coverage for prescription hearing aids. While routine dental and cardiac rehabilitation are not covered, members benefit from acupuncture and home health services with no copay. Additionally, durable medical equipment is covered with a 10% coinsurance, and dialysis services require a 20% coinsurance.
Inpatient Hospital See details
Tufts Medicare Preferred HMO Prime Rx (HMO) covers inpatient acute and psychiatric hospital stays with a $300 copay per stay and no coinsurance. While unlimited additional days are covered for acute care, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Tufts Medicare Preferred HMO Prime Rx (HMO) with no coinsurance, featuring a $0 to $100 copay for outpatient hospital services, a $100 copay per stay for observation services, and a $10 copay for outpatient substance abuse sessions. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Tufts Medicare Preferred HMO Prime Rx (HMO) with no copay and no coinsurance.
Ambulance and Transportation Services See details
Tufts Medicare Preferred HMO Prime Rx (HMO) covers ground and air ambulance services with a $175 copay and no coinsurance, requiring prior authorization. Transportation services are partially covered with no copay and no coinsurance for unlimited one-way trips to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Tufts Medicare Preferred HMO Prime Rx (HMO) covers emergency services with a $110 copay and no coinsurance, which is waived if you are admitted to the hospital within one day. Urgently needed services require a $30 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $30 to $175.
Primary Care See details
Tufts Medicare Preferred HMO Prime Rx (HMO) partially covers primary care and professional services with no coinsurance, featuring a $10 copay for primary care visits and a $15 copay for specialists, physical therapy, and occupational therapy. While many specialty and telehealth services are covered, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by Tufts Medicare Preferred HMO Prime Rx (HMO) with no copay and no coinsurance for most benefits, including annual physical exams, kidney disease education, and routine screenings. While home and bathroom safety devices require a 10% coinsurance, several sub-services are not covered, including personal emergency response systems, post-discharge medication reconciliation, readmission prevention, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
Tufts Medicare Preferred HMO Prime Rx (HMO) partially covers hearing services, offering an annual routine hearing exam and fitting for a $15 copay and no coinsurance. Prescription hearing aids are covered with a copay ranging from $250 to $1,150 and no coinsurance for up to two aids per year, though OTC hearing aids and inner ear, outer ear, or over the ear prescription models are not covered.
Vision Services See details
Tufts Medicare Preferred HMO Prime Rx (HMO) covers vision services with no deductibles, offering one annual routine eye exam for a $15 copay and no coinsurance, though other eye exam services are not covered. Eyewear, including contacts and eyeglasses, is covered with no copay and no coinsurance up to a $150 combined annual maximum.
Dental Services See details
Dental services are partially covered under the Tufts Medicare Preferred HMO Prime Rx (HMO), which only covers Medicare-covered dental services for a $15 copay and no coinsurance, requiring prior authorization and referrals. Routine, preventive, and comprehensive dental services—including oral exams, cleanings, x-rays, restorative care, and orthodontics—are not covered.
Home Infusion bundled Services See details
Tufts Medicare Preferred HMO Prime Rx (HMO) partially covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. While insulin is covered with no copay or coinsurance, Medicare Part B chemotherapy, radiation, and other Part B drugs are not covered under this benefit.
Dialysis Services See details
Dialysis Services are covered by Tufts Medicare Preferred HMO Prime Rx (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is partially covered by Tufts Medicare Preferred HMO Prime Rx (HMO), featuring no copays for covered services but requiring prior authorization. Durable medical equipment and prosthetics carry a 10% coinsurance, medical supplies have no coinsurance to 10% coinsurance, and diabetic equipment has 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 (HMO) partially covers diagnostic and radiological services, with therapeutic radiological services not covered. Diagnostic procedures and tests have a $0 to $30 copay and no coinsurance, lab and outpatient X-ray services have no copays, and diagnostic radiological services require a copay and a minimum 20% coinsurance.
Home Health Services See details
Tufts Medicare Preferred HMO Prime Rx (HMO) covers Home Health Services with no copay and no coinsurance, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Tufts Medicare Preferred HMO Prime Rx (HMO) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD services are all not covered.
Skilled Nursing Facility (SNF) See details
Tufts Medicare Preferred HMO Prime Rx (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 daily copay for days 1 through 20, an $80 daily copay for days 21 through 44, and no copay for days 45 through 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not required, additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Tufts Medicare Preferred HMO Prime Rx (HMO) partially covers Other Services, which includes unlimited acupuncture treatments with no copay and no coinsurance. Over-the-counter (OTC) items and meal benefits are not covered.
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