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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 $183.00. 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 no deductible for prescription drugs. During the initial coverage phase, after the deductible is met, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you will pay an $8 copay at standard and mail order pharmacies. Standard generic drugs have 23% coinsurance, preferred brands have 50% coinsurance, and non-preferred drugs have 33% coinsurance. Specialty tier drugs have no copay at standard pharmacies.
Additional Benefits
The Tufts Medicare Preferred HMO Prime Rx (HMO) plan offers a range of benefits, including inpatient hospital stays with a $300 copay per admission and outpatient services with varying copays. Emergency, urgent, and worldwide emergency services are covered with copays between $30 and $125. Primary care visits have a $10 copay, and specialist visits are $15. Preventive services include annual exams, health education, and some additional benefits like wigs and weight management programs. The plan also covers hearing and vision services, with copays for exams and coverage for eyewear. Dental services have limited coverage, and home health services are available with no copay.
Inpatient Hospital See details
Inpatient Hospital services, including Acute and Psychiatric care, are covered. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, there is a $300 copay per admission or stay, with a service-specific out-of-pocket maximum of $900. Additional days for Inpatient Hospital-Acute are covered with no limit, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered, with a copay of $0-$100. Observation Services have a $100 copay, and Ambulatory Surgical Center (ASC) Services have no copay. Outpatient Substance Abuse Services, including individual and group sessions, have a $10 copay. Outpatient Blood Services are covered, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by this plan. There is no copay or coinsurance for this benefit.
Ambulance and Transportation Services See details
The Tufts Medicare Preferred HMO Prime Rx (HMO) plan covers ambulance services with no coinsurance and a $125 copay for both ground and air ambulance services; transportation services to a plan-approved health-related location are also covered. 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 the Tufts Medicare Preferred HMO Prime Rx (HMO) plan. Emergency Services have a $110 copay, and there is no coinsurance. Urgently Needed Services have a $30 copay, and there is no coinsurance. Worldwide Emergency Coverage has a $110 copay, Worldwide Urgent Coverage has a $30 copay, and Worldwide Emergency Transportation has a $125 copay, and there is no coinsurance for any of these services.
Primary Care See details
The Tufts Medicare Preferred HMO Prime Rx (HMO) plan covers primary care physician services with a $10 copay, and chiropractic services with a $15 copay. Occupational therapy services, physical therapy, and speech-language pathology services have a $15 copay, while other services like physician specialist services have a $15 copay. Mental health services have a $0-$10 copay, and other health care professional services have a $10-$20 copay. Psychiatric services and opioid treatment program services have a $0-$10 copay, and additional telehealth benefits have a $0-$100 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams, health education, in-home safety assessments, wigs for hair loss related 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 services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. This plan does not cover Personal Emergency Response Systems (PERS), post-discharge in-home medication reconciliation, re-admission prevention, counseling services, home-based palliative care, in-home support services, support for caregivers, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, adult day health services, or home and bathroom safety devices and modifications. Home and bathroom safety devices and modifications have a 10% coinsurance.
Hearing Services See details
Hearing Services include routine hearing exams with a $15 copay, fitting/evaluation for hearing aids, and prescription hearing aids. Prescription hearing aids have a copay between $250 and $1150, but inner ear, outer ear, and over the ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with a $15 copay, and coverage for eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum benefit of $150 per year.
Dental Services See details
Dental services are partially covered by the Tufts Medicare Preferred HMO Prime Rx (HMO) plan. Medicare Dental Services require prior authorization and a doctor referral with a $15 copay, while services such as 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. 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 (HMO) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits are covered under the Tufts Medicare Preferred HMO Prime Rx (HMO) plan. Durable Medical Equipment (DME) has no copay and 10% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have no copay and a 10% coinsurance for Prosthetic Devices and 0-10% coinsurance for Medical Supplies, and Diabetic Equipment is covered, 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, while Therapeutic Radiological Services are not covered. 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, but additional hours of care and personal care services are not covered. A referral and authorization are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Tufts Medicare Preferred HMO Prime Rx (HMO) plan. This includes Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, the copay is $20, for days 21-44 the copay is $80, and for days 45-100 there is no copay. Additional days beyond Medicare-covered, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for acupuncture with no copay, a meal benefit, and other services with 10% coinsurance, but does not cover over-the-counter items, 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, or Self-Directed Personal Assistance Services.
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